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PubMed1992

Colonoscopic screening examination of relatives of patients with colorectal cancer. II. Relations between tumour characteristics and the presence of polyps.

Colonoscopy was offered to 206 first-degree relatives of 181 patients operated on for colorectal cancer (CRC). Findings of polyps in relatives correlated with Dukes staging, extent of dedifferentiation and localization of tumour in the operated patient, and type of family relationship. Adenomas in relatives and Dukes staging of carcinoma in the patients were inversely related. Relatives of patients with Dukes stage A tumour had more than twice as many adenomas as and a higher prevalence of multiple adenomas than relatives of patients with advanced cancer at the time of operation. If the patient had polyp(s) in addition to tumour, the number of adenomas per relative was almost doubled. Hyperplastic polyps in relatives were associated with poorly differentiated carcinoma in their related patients. These results support the theory that not all CRC are derived from polyps and that adenoma-derived CRC may have a better prognosis than 'de novo' CRC. An adenoma prevalence risk table is also presented.

Adenoma↗
PubMed1995

Processing relative clauses varying on syntactic and semantic dimensions: an analysis with event-related potentials.

Event-related potentials were used to study how parsing of German relative clauses is influenced by semantic information. Subjects read well-formed sentences containing either a subject or an object relative clause and answered questions concerning the thematic roles expressed in those sentences. Half of the sentences contained past participles that on grounds of semantic plausibility biased either a subject or an object relative reading; the other half contained past participles that provided no semantic information favoring either reading. The past participle elicited an N400 component, larger in amplitude for neutral than for semantically biased verbs, but this occurred only in the case of subject relative clauses. More specific effects were obtained only for a subgroup of subjects, when these were grouped into fast and slow comprehenders on the basis of their question-answering reaction times. Fast comprehenders showed larger N400 amplitudes for neutral than for semantically biased past participles in general and larger N400s for the latter when there was a bias for an object relative reading as opposed to a subject relative reading. Syntactic ambiguity resolution, indicated by an auxiliary in sentence final position, was associated in this subgroup with a positive component (P345), larger in amplitude for auxiliaries indicating an object relative reading than for those indicating a subject relative reading. The latter component was independent of semantically biasing information given by a preceding past participle. Implications of these findings for models of language comprehension are considered.

Adult↗
PubMed1997

ABH and related histo-blood group antigens in normal & malignant human endometrium in relation to genetic and hormonal factors.

Recent immunohistochemical studies have shown that endometrial carcinomas are characterized by changes in glycosylation involving histo-blood group antigens. These carbohydrate determinants are present not only on erythrocytes but are also expressed by epithelial cells. Their expression herein has been shown to be related to the genetic status of the individual in terms of the ABO, Lewis and ABH-secretor type. Moreover, they show changes in expression relating to development, tissue-type, differentiation, cell-motility and malignancy. Meanwhile, most studies performed on endometrial tissue have not considered duly that histo-blood group antigen expression herein may be influenced by genetic and hormonal factors. Using immunohistochemistry and MABs with specificity to ABH- and related histo-blood group antigens with different peripheral core structures we have studied the expression of these carbohydrates in the human endometrium in relation to genetic and hormonal factors. The present paper presents a summary and a discussion of present knowledge on expression of histo-blood group antigens in the normal and malignant human endometrium. In addition, the possible regulatory mechanisms that control their expression in the endometrium are discussed. The histo-blood group phenotype of normal endometrial epithelial cells show great complexity. Variations in expression are related to the genetic status, i.e., the ABO, Lewis and ABH-secretor status. However, our findings suggest that the regulation of Lewis antigen expression in the endometrium differs from that in erythrocytes. Moreover, expression of histo-blood group and related carbohydrates varies with layer, mucosal histology, cell-type and hormone levels in serum. In glands in the functionalis and basalis, the histo-blood group phenotype is characterized by a predominant expression of sialylated types 2 and 3 chains. Expression of ABH determinants is, in general, low. However, the expression of fucosylated and terminal ABH determinants vary with the menstrual cycle, degree of proliferation and hormone levels in serum. The secretory phenotype is characterized by an increased expression of type-1 chain antigens, and by expression of sialylated chains as S-Tn, MS-Le(a), DS-Lac. A/B transferase protein expression was found to correlate with E2 levels in serum. These findings in conjunction with studies of glycosyltransferase activity in murine endometrial cell strongly suggest that the endometrial epithelial cell histo-blood group phenotype is also modulated by the ovarian hormones. The histo-blood group phenotype of endometrial carcinomas and precursor lesions is also influenced by the ABO, Lewis and secretor-status. Except for loss of A/B transferases and A/B antigens, which appear to be a late event, the changes are demonstrable also in preneoplastic endometrial cells. The malignant phenotype is characterized by an increased expression of type-1 chain carbohydrates. ABH-secretors express H and Le(b) antigens in addition to Le(a) and S-Le(a) antigens, whereas ABH-non-secretors express Le(a), and S-Le(a) determinants mainly. Moreover, endometrial carcinomas express Tn antigen, and sialylated carbohydrates, which are expressed in luteal phases of the normal endometrium, i.e., S-Tn, DS-Lac, and MS-Le(a) antigens. Thus the histo-blood group phenotype of endometrial carcinoma cells in many ways shows a resemblance to that of secretory endometria. The relation between expression of T, S-T and A/B transferase protein and E2 levels in serum was maintained in endometrial carcinomas. Expression of H, Le(b), LeX, S-LeX, and LeY was related to the tumour grade, whereas only expression of H determinants was related to the FIGO stage. In accord, recent studies have suggested that expression of H and Le(b) antigens in endometrial carcinomas may be correlated with prognosis. An increased activity of alpha 1-2 and alpha 1-3/4 fucosyltransferases has recently been demonstrated in endometrial carci

ABO Blood-Group System↗
PubMed2000

Differential effects of calcitonin gene-related peptide and calcitonin gene-related peptide 8-37 upon responses to N-methyl-D-aspartate or (R, S)-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate in spinal nociceptive neurons with knee joint input in the rat.

Calcitonin gene-related peptide is involved in the spinal processing of nociceptive input from the knee joint and in the generation and maintenance of joint inflammation-evoked hyperexcitability of spinal cord neurons. The present study examined whether this peptide influences the excitation of nociceptive spinal cord neurons by agonists at the N-methyl-D-aspartate and the non-N-methyl-D-aspartate [(R, S)-alpha-amino-3-hydroxy-5-methylisoxazole-4-propionate (AMPA)/kainate] receptors, both of which are essential for the excitation and hyperexcitability of spinal cord neurons. In anaesthetized rats extracellular recordings were made from dorsal horn neurons with knee input, and compounds were administered ionophoretically close to the neurons recorded. When calcitonin gene-related peptide was administered the responses of the neurons to the application of both N-methyl-D-aspartate and AMPA were increased. The coadministration of the antagonist calcitonin gene-related peptide 8-37 had no effect on the responses to N-methyl-D-aspartate, but it prevented the enhancement of the responses to N-methyl-D-aspartate by calcitonin gene-related peptide. By contrast, the administration of calcitonin gene-related peptide 8-37 enhanced the responses of the neurons to AMPA, and it did not antagonize but rather increased the effects of calcitonin gene-related peptide on these responses. The data suggest that the facilitatory role of calcitonin gene-related peptide on the development and maintenance of inflammation-evoked hyperexcitability is caused at least in part by the modulation of the activation of the dorsal horn neurons through their N-methyl-D-aspartate and non-N-methyl-D-aspartate receptors. The different effects of calcitonin gene-related peptide 8-37 on the respones to N-methyl-D-aspartate and AMPA suggest that different intracellular pathways may facilitate the activation of N-methyl-D-aspartate and ionotropic non-N-methyl-D-aspartate receptors.

Animals↗
PubMed2001

Weight-related and shape-related self-evaluation in eating-disordered and non-eating-disordered women.

OBJECTIVE: Weight- and shape-related self-evaluation refers to the process whereby an individual determines her self-worth based on an evaluation of her body weight and shape. This is a hallmark feature of both anorexia and bulimia nervosa, as specified in the 4th ed. of the Diagnostic and Statistical Manual of Mental Disorders. The purpose of this study was to further our understanding of weight-related self-evaluation in eating-disordered women. METHOD: Eating-disordered patients, restrained eaters, and unrestrained eaters completed an experimenter-designed questionnaire that examines different dimensions of weight-related self-evaluation (i.e., the Multidimensional Weight-Related Self-Evaluation Inventory). RESULTS: Results revealed that weight-related self-evaluation is a feature shared, to some extent, by both eating-disordered patients and restrained eaters. However, eating-disordered patients extend weight-related self-evaluation to include more domains of self-esteem than did restrained eaters. DISCUSSION: These findings support a multidimensional approach to weight-related self-evaluation and further our understanding of the process of weight-related self-evaluation in eating-disordered patients.

Adult↗
PubMed2004

Burden of relatives and predictors of burden. Baseline results from the Munich 5-year-follow-up study on relatives of first hospitalized patients with schizophrenia or depression.

In the present study, part of the Munich 5-year follow-up study on key relatives of first-hospitalized schizophrenic and depressive patients, baseline results with respect to relatives' burden and predictors of burden are presented. Basing on a transactional stress model the following hypothesis was tested: the impact of the patients' illness on their relatives' stress outcome is moderated by the psychosocial resources of the relatives. Stress outcome was measured in terms of objective and subjective burden, well-being, self-rated symptoms and global satisfaction with life. Potential moderating variables included age and gender, generalized stress response and illness-related coping strategies, beliefs of control,perceived social support,personality factors, expressed emotion and life stressors. A total of 83 relatives, whose ill family members had been hospitalized in the Department of Psychiatry of the Ludwig-Maximilians-University of Munich for the first time, participated in the study. Findings did not entirely support the hypothesis. On the one hand, relatives' stress outcome was independent of the objective stressors (severity of the illness, kind of symptoms, level of psychosocial functioning at admission). On the other hand, burden was significantly associated with several psychosocial resources and dispositions of the relatives. Multivariate linear regression analyses indicated that expressed emotion, emotion-focused coping strategies and generalized negative stress response are the most relevant predictors of burden. It is argued that a multidimensional approach in burden assessment is necessary and has relevant implications for improving family intervention strategies.

Adaptation, Psychological↗
PubMed2005

The role of relatives in discharge planning from psychiatric hospitals: the perspective of patients and their relatives.

This study prospectively assessed the preferences and satisfaction of 98 psychiatric inpatients and 40 of their relatives with family involvement in discharge planning. Preferences questionnaires were administered during hospitalization. Satisfaction questionnaires were completed 3 months later. Preferences noted by most participants included information concerning patient health status, ways to prevent further hospitalizations, services for relatives, and signs of patient decompensation. More relatives than patients felt that post-discharge residence and activities were important areas to be involved in. Most participants were satisfied if relatives were involved in discharge planning. However, up to 89% of patients, and 84% of relatives, reported no communication between clinical staff and relatives regarding discharge. When this was the case, satisfaction rates dropped sharply, especially for relatives. The need for increased communication between clinicians and relatives regarding discharge planning remains a problem.

Adult↗
PubMed1995

The impact of cancer on key relatives: a comparison of relative and patient concerns.

This study examines the impact of diagnosis on key relatives of 108 newly diagnosed cancer patients. Cancers of the breast, colon, female reproductive tract and testicle were included. Relatives completed a self-report checklist of concerns and the General Health Questionnaire (GHQ) (28 items). Patients were administered a corresponding concerns checklist as part of a semi-structured interview. More relatives than patients expressed each of the nine common concerns; the discrepancy was greatest for concern about the patient's emotional reaction, reported by 95% of relatives and only 18% of patients. The total relatives' concern score (median 16.0) was significantly greater than the patients' score (median 4.0) (P < 0.0001). Cancer type, age of patient and nature of relationship to patient had little impact on the frequency of relatives' concerns. 52 (48%) relatives scored above the usual cut-off on the GHQ, suggesting significant psychological morbidity. Relatives of newly diagnosed cancer patients report high levels of concerns and psychological distress, and deserve greater attention than they currently receive.

Adolescent↗
PubMedDate not supplied

Estimation of the cut-off value in cardiovascular autonomic nervous function tests: not-age-related criteria or the age-related 5th percentile.

The aim of the study was to estimate the cut-off value of cardiovascular tests using not-age-related criteria or the age-related 5th percentile in 165 diabetic patients. The cANP, pANP, and smNP were assessed using previously recommended standardized test procedures. Prevalence of overall definite (borderline) cANP was 35.2% (23.0%) when using the 5th percentile or 16.4% (27.9%) when using not age-related criteria (p for the difference < 0.0001) (p = 0.3205). Prevalence of pANP was 54.0% and of smNP 37.0%. Concerning cANP, the number of test results below the 5th percentile (N5) correlated significantly with the number of abnormal test results using not age-related criteria (Nnar) (p < 0.000001) but the slope of the regression line differed substantially from 1. Using the 5th percentile as the cut-off value for cANP testing, sensitivity and specificity were calculated for not age-related criteria for respiratory sinus arrhythmia (90.5%, 80.2%), Valsalva test (30.4%, 98.0%), lying-to-standing test (46.3%, 98.7%), orthostatic systolic blood pressure fall (69.0%, 78.3%), and overall definite cANP (44.8%, 92.8%). The statistical analysis revealed that the age-related 5th percentile is superior to the not-age-related cut-off values in diabetic patients. We therefore suggest that age-related normal values (percentiles) have to be applied when cANP is estimated.

Adolescent↗
PubMed2006

Analysis of speech-related variance in rapid event-related fMRI using a time-aware acquisition system.

Speech production introduces signal changes in fMRI data that can mimic or mask the task-induced BOLD response. Rapid event-related designs with variable ISIs address these concerns by minimizing the correlation of task and speech-related signal changes without sacrificing efficiency; however, the increase in residual variance due to speech still decreases statistical power and must be explicitly addressed primarily through post-processing techniques. We investigated the timing, magnitude, and location of speech-related variance in an overt picture naming fMRI study with a rapid event-related design, using a data acquisition system that time-stamped image acquisitions, speech, and a pneumatic belt signal on the same clock. Using a spectral subtraction algorithm to remove scanner gradient noise from recorded speech, we related the timing of speech, stimulus presentation, chest wall movement, and image acquisition. We explored the relationship of an extended speech event time course and respiration on signal variance by performing a series of voxelwise regression analyses. Our results demonstrate that these effects are spatially heterogeneous, but their anatomic locations converge across subjects. Affected locations included basal areas (orbitofrontal, mesial temporal, brainstem), areas adjacent to CSF spaces, and lateral frontal areas. If left unmodeled, speech-related variance can result in regional detection bias that affects some areas critically implicated in language function. The results establish the feasibility of detecting and mitigating speech-related variance in rapid event-related fMRI experiments with single word utterances. They further demonstrate the utility of precise timing information about speech and respiration for this purpose.

Adult↗
PubMed1997

The relation of cardiovascular disease and its risk factors to the 5-year incidence of age-related maculopathy: the Beaver Dam Eye Study.

OBJECTIVE: The purpose of the study is to examine the association between cardiovascular disease and its risk factors and the incidence of age-related maculopathy. PARTICIPANTS: A population of 3583 adults (range, 43-86 years of age at baseline) living in Beaver Dam, Wisconsin, was studied at baseline and 5 years later. METHODS: Standardized protocols for physical examination, blood collection, administration of a questionnaire, and stereoscopic color fundus photography to determine age-related maculopathy were used. Standard univariate and multivariate analyses were performed. MAIN OUTCOME MEASURES: Incidence and progression of age-related maculopathy were measured. RESULTS: After controlling for age and gender, the authors found both higher systolic blood pressure (odds ratio [OR] per 10 mmHg, 1.16; 95% confidence interval [CI] 1.05, 1.27) and uncontrolled treated hypertension (OR 1.98, 95% CI 1.00, 3.94) were related to the incidence of retinal pigment epithelial depigmentation. After controlling for age and gender, the authors found that both blood pressure and uncontrolled treated hypertension were not significantly associated with an increased risk of having exudative macular degeneration develop (for systolic blood pressure, OR 1.18, 95% CI 0.95, 1.45; for uncontrolled treated hypertension, OR 2.10, 95% CI 0.54, 8.11). After controlling for age and gender, the authors found higher pulse pressure was significantly associated with increased incidence of retinal pigment epithelial depigmentation (OR per 10 mmHg 1.27, 95% CI 1.14, 1.42) and exudative macular degeneration (OR per 10 mmHg 1.29, 95% CI 1.02, 1.65). These relations remained significant after controlling for other risk factors in multivariable analyses. CONCLUSIONS: These findings indicate modest relations between higher pulse pressure (a presumed indicator of atherosclerotic vascular disease) and uncontrolled hypertension with increased 5-year incidence of retinal pigment epithelial depigmentation. Overall, however, data from this study show neither consistent nor strong relations between cardiovascular disease and most of its risk factors with the incidence of lesions associated with age-related maculopathy.

Adult↗
PubMed2002

Topographical analysis of stimulus-related and response-related electrical scalp activity and interhemispheric dynamics in normal humans.

It is believed that reaction time estimates of interhemispheric relay (IHR) time or accuracy cost reflect motor relay and that visual evoked response potential (ERP) estimates reflect visual relay. If this is so, then response-related ERP estimates of IHR might be expected to correlate more with reaction time (RT) estimates of IHR than visual ERPs do, and the former ought to interact with the latter. A simple reaction time experiment (Poffenberger paradigm) was carried out with an 18-electrode montage on 10 normal subjects to investigate visual and motor interhemispheric relay effects and their interrelation. Three components in stimulus-synchronized and three other components in response-synchronized averaged signals were analyzed. Latencies and amplitudes of these components were studied as a function of the visual field stimulated and the hand required to respond. Effects interpretable as interhemispheric relay effects were observed in stimulus-related as well as response-related components. Few interhemispheric relay effect estimates in stimulus-related and response-related electrical scalp potentials were related to behavioral estimates of interhemispheric relay effects (derived from reaction times and omission errors). The spatiotemporal distributions of the electrical interhemispheric relay effects differed in stimulus and response-related components and they were statistically unrelated. We conclude that sensory interhemispheric relay may be picked up with stimulus-synchronized ERPs whereas motor interhemispheric relay effects may be measurable with response-related ERPs in normal humans. However, this proposal ought to be tested with callosotomized subjects.

Adult↗
PubMed2004

Validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands.

This study examined the validity of the family history method for diagnosing schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders in first-degree relatives of schizophrenia probands. This is the first large-scale study that examined the validity of the family history method for diagnosing DSM-III-R personality disorders. The best estimate DSM-III-R diagnoses of 264 first-degree relatives of 117 adult-onset schizophrenia probands based on direct structured diagnostic interviews, family history interview, and medical records were compared to Family History Research Diagnostic Criteria (FH-RDC) diagnoses based on the NIMH Relative Psychiatric History Interview and to family history Structured Clinical Interview for DSM-III-R: Personality Disorders (SCID-II) diagnoses based on the SCID-II adapted to a third person format. Diagnoses of relatives were made blind to proband diagnostic status. The median sensitivity for schizophrenia and the related psychoses was 29% (range 0-50%), the median specificity 99% (range 98-100%), and the median positive predictive value (PPV) 67% (range 20-80%). The median sensitivity for the personality diagnoses was 25% (range 14-71%), the median specificity 100% (range 99-100%), and the median PPV 100% (range 67-100%). The family history method has low sensitivity but has excellent specificity and PPV for schizophrenia, schizophrenia-related psychoses, and schizophrenia-spectrum personality disorders. The kappa coefficient for the family history method was moderately good for the psychoses (0.598) and for paranoid and schizotypal personality disorder (0.576). Using the family history method, the validity of making schizophrenia-related personality disorder diagnoses was comparable to that of making psychotic disorder diagnoses.

Adolescent↗
PubMed1999

Activation of alcohol-related associative networks by recent alcohol consumption and alcohol-related cues.

AIMS: To investigate the influence of recent alcohol consumption and alcohol-related cues on performance in a sentence generation task. DESIGN: Two experiments were carried out. In the first, the performances of light, moderate and heavy drinkers were compared. In the second, subjects were randomly assigned to one of three experimental treatments (alcohol-priming, non-alcohol priming, and control) and classified as light, moderate or heavy drinkers. The effect of experimental treatment, drinking status, gender and the interaction between these factors was studied. SETTING: The experiments were carried out in quiet research rooms in psychology departments. PARTICIPANTS: Volunteers recruited from university campuses. MEASUREMENTS: Questionnaires were used to ascertain recent drinking histories. Subjects generated sentences incorporating ambiguous alcohol-related words which were provided by the experimenter. The sentences were then classified as alcohol-related or not, the dependent measure was the number of alcohol-related sentences produced. FINDINGS: In both experiments heavier drinkers produced more alcohol-related sentences and males produced more alcohol-related sentences than females. In the second experiment more alcohol-related sentences were produced after subjects were exposed the alcohol priming condition. CONCLUSIONS: The alcohol-related meaning of ambiguous words is more likely to be accessed by males and by heavier drinkers and after exposure to other alcohol cues.

Adult↗
PubMed1999

Task-related and item-related brain processes of memory retrieval.

In all cognitive tasks, general task-related processes operate throughout a given task on all items, whereas specific item-related processes operate differentially on individual items. In typical functional neuroimaging experiments, these two sets of processes have usually been confounded. Herein we report a combined positron emission tomography and event-related potential (ERP) experiment that was designed to distinguish between neural correlates of task-related and item-related processes of memory retrieval. Two retrieval tasks, episodic and semantic, were crossed with episodic (old/new) and semantic (living/nonliving) properties of individual items to yield evidence of regional brain activity associated with task-related processes, item-related processes, and their interaction. The results showed that episodic retrieval task was associated with increased blood flow in right prefrontal and posterior cingulate cortex, as well as with a sustained right-frontopolar-positive ERP, but that the semantic retrieval task was associated with left frontal and temporal lobe activity. Retrieval of old items was associated with increased blood flow in the left medial temporal lobe and with a brief late positive ERP component. The results provide converging hemodynamic and electrophysiological evidence for the distinction of task- and item-related processes, show that they map onto spatially and temporally distinct patterns of brain activity, and clarify the hemispheric encoding/retrieval asymmetry (HERA) model of prefrontal encoding and retrieval asymmetry.

Adult↗
PubMed1994

The use of the relation between relative force and endurance time.

The relation between relative force (i.e., the actual force relative to the maximal voluntary force) and endurance time (i.e., the time the force can be maintained) is employed in a number of methods for ergonomics research. The aim is to assess the development of localized muscular fatigue as a consequence of isometric contractions and to compare activities regarding both the intensity and the duration of the isometric contractions exerted. The main assumption underlying this approach is that the relation is identical for different muscles and in different situations. Several anatomical and physiological factors contributing to variation in the relation are discussed and the consequences of this variation for the validity of the methods employing the relation are quantified. From this analysis, it appears, that the use of the relation between relative force and endurance time with the assumption mentioned leads to unreliable results. Therefore assessment of isometric contractions in labour situations will have to be based on fundamentally different methods.

Ergometry↗
PubMed2005

Diagnostic discrimination between graft-related and non-graft-related perioperative myocardial infarction with cardiac troponin I after coronary artery bypass surgery.

AIMS: The rise of markers for myocardial injury indicates early graft-related or non-graft-related perioperative myocardial infarction (PMI) after coronary artery bypass grafting (CABG). A diagnostic discrimination between these two situations may enable adequate therapeutic measures, limiting myocardial damage, and improving outcome. METHODS AND RESULTS: In a prospective study, 94 among 3308 consecutive CABG patients underwent acute reangiography because of evidence of PMI. Of these 94 patients, 56 had graft-related PMI (group 1), 38 patients had non-graft-related PMI (group 2), and 95 patients without evidence of PMI and angiographically patent grafts served as control (group 3). Cardiac troponin I (cTnI), creatine kinase (CK), and its MB fraction were determined. CTnI, but not CK/CK-MB levels were significantly higher in group 1 than in groups 2 and 3 at 12 and 24 h after aortic unclamping (P<0.0001). Receiver operating characteristic and multivariable logistic regression analyses indicated cTnI as the best discriminator between PMI 'in general' and 'inherent' release of cTnI after CABG with a cut-off value of 10.5 ng/mL and between graft-related and non-graft-related PMI with a cut-off value of 35.5 ng/mL. CONCLUSION: Perioperative cTnI elevation after CABG separates among patients with graft-related, non-graft-related, and without PMI, however, not earlier than 12 h after surgery.

Aged↗
PubMed1997

Mammographic surveillance of asymptomatic breast cancer relatives in general practice: rate of re-attendance and GP- and patient-related barriers.

BACKGROUND: Several guidelines have been formulated for mammographic screening of breast cancer relatives. No studies have examined the adherence of GPs and their patients to these recommendations. OBJECTIVES: We aimed to determine the rate of re-attendance of breast cancer relatives for mammographic screening requested by GPs and specify the barriers for non-attending follow-up mammography. METHODS: The study included all asymptomatic women aged 35 years or older with a first-degree family history of breast cancer, referred for mammography to our department of radiology by their GP between 1 January 1992 and 1 September 1994. Reasons for not re-attending mammography within 2 years were obtained by sending a questionnaire to GPs and, if necessary, telephone calls to GPs or their patients. The questionnaire was accompanied by a reminder, in which we advised re-attendance. The number of women who still underwent repeated mammographic screening within the 2 months following the reminder was determined. RESULTS: In 123 out of 234 patients (52.6%) follow-up mammography had been performed within 2 years. Barriers to undergoing follow-up mammography were GP-related in 70.3% of cases and patient-related in 29.7%. Of the 111 non-re-attenders, 52 (47.7%) still underwent follow-up mammography within 2 months after the reminder. This examination was performed more often if the barriers to re-attendance were GP-related rather than patient-related (57.7% versus 24.2%, 95% confidence interval (CI) 13.0-53.9). Significantly more patients re-attended after the reminder if the GP-related barrier was an insufficient retrieval system rather than disagreement with mammography guidelines (81.3% versus 20.0%, 95% CI 40.4-82.0). CONCLUSIONS: Many breast cancer relatives did not undergo regular mammographic screening. Non-re-attendance resulted from a limited degree of acceptance and implementation of the screening recommendations by physicians as well as reluctance of the patient to adhere to such recommendations. A reminder, generated by a radiology department, may increase the performance of follow-up mammography.

Adult↗