Colorectal cancer screening in Uruguay: current assessment and roadmap for the future

Abstract Cancer is a leading cause of death worldwide and is expected to remain a public health concern for years to come. Within Latin America, Uruguay has the highest colorectal cancer rates. Heeding past calls to action, in this article we provide a critical assessment of colorectal cancer needs and opportunities in Uruguay with a focus on developing a roadmap for future action. First, we provide an overview of risk factors, screening procedures and guidelines, and screening rates. Next, we provide an overview of psychosocial factors that influence colorectal cancer screening, with the goal of providing guidance for future behavioral health promotion initiatives in Uruguay. In this effort, we present four conceptual models that may be used for interventions: the ecological systems theory, informed decision-making, the health beliefs model, and the health literacy model. Subsequently, we propose using an integrated model based on the ecological systems theory and health literacy model to develop national, local, and community-based interventions to increase screening rates and lower the colorectal cancer burden in Uruguay. We close the paper with a summary and implications section, including recommendations for future research programs focused on the assessment of factors that influence screening.

Querendo fazer o que deve ser feito, mas fazendo somente o possível: o profissional de saúde frente à detecção precoce do câncer de mama / Willing to do what should be done, but doing only the possible: the health professional facing breast cancer early detection

O câncer de mama é a principal causa de morte por câncer nas mulheres em todo o mundo. No Brasil, a maioria dos tumores de mama é descoberta em estágios avançados, em grande parte dos casos pela própria mulher. As políticas públicas reforçam que a detecção seja feita em estágios iniciais, o que resulta em melhor resposta ao tratamento, menores custos e prognóstico mais favorável para a mulher. O estudo tem como objetivos: Identificar os significados atribuídos à detecção precoce do câncer de mama pelos profissionais de saúde, Descrever as ações de profissionais de saúde com relação à detecção precoce do câncer de mama em sua atuação profissional na Rede Básica de Saúde e Analisar o processo de interação dos profissionais de saúde com a detecção precoce do câncer de mama a partir de suas ações no âmbito da Rede Básica de Saúde. O estudo de natureza qualitativa, do tipo descritivo-exploratório, teve como referencial teórico-metodológico o Interacionismo Simbólico e a Grounded Theory, que subsidiaram uma interpretação da ação e das relações dos profissionais de saúde em busca da detecção precoce do câncer de mama, baseados na definição e interpretação de significados por eles atribuídos. Dos resultados emergiram quatro categorias: Querendo detectar o nódulo precocemente, Refletindo sobre o que é ideal no atendimento à Saúde da Mulher e as falhas dos profissionais de saúde, Percebendo e enfrentando as dificuldades da Atenção Primária para a detecção precoce do câncer de mama e Construindo a identidade profissional através de sua formação e interpretando a própria atuação profissional. Evidenciou-se que o profissional de saúde sabe que o ideal é detectar nódulos impalpáveis ou pequenos e entendem que fazem a sua parte ao solicitar exames de imagem, realizar Exame Clínico das Mamas, rastrear a partir dos grupos de maior risco e orientar a mulher quanto ao cuidado de si. Acreditam que há fatores que dificultam a realização de ações que consideram ideais, tornando-se obstáculos para a detecção precoce. A formação profissional influencia pois, a graduação e a pós-graduação não são suficientes para todo conhecimento que esperam obter, além de possuírem uma formação baseada no modelo tecnocrático, mais voltada ao tratamento do que preventiva, que não os prepara para uma perspectiva ampliada da saúde. O processo de interação do profissional com a detecção precoce indicou que há elementos que dependem dele e outros fora de seu controle, e embora queira fazer o ideal muitas vezes faz somente o que é possível. Apesar das adversidades da Atenção Primária à Saúde, o profissional precisa ter consciência do seu papel pelo funcionamento das políticas de saúde e não negligenciar o cuidado ou transferir a responsabilidade de suas ações. A detecção precoce do câncer de mama depende, também, do seu comprometimento em ser um bom rastreador e da vontade de dar algo a mais.

Breast cancer is the leading cause of cancer death in women around the world. In Brazil, most breast tumors are discovered in advanced stages, in most cases by the woman herself. Public policies reinforce detection in the early stages, which results in a better response to treatment, lower costs and a more favorable prognosis for women. The objectives of this study are: To identify the meanings attributed to breast cancer early detection by health professionals; To describe the health professionals' actions on breast cancer early detection in the context of their professional performance at the Basic Health Network; and to analyze their interaction process with the breast cancer early detection from their actions in the scope of the Basic Health Network. The qualitative study, a descriptive-exploratory type, had the Symbolic Interactionism and The Grounded Theory as theoretical-methodological reference, which subsidized an interpretation of the action and relationships of health professionals in pursuit for acting on breast cancer early detection, based on the definition and interpretation of meanings attributed by them. From results, four categories emerged: Willing to early detect the nodule, reflecting on what is ideal for Women's Healthcare of and the failures of health professionals, Realizing and facing the difficulties of Primary Care for breast cancer early detection and Building the professional identity through their training and interpreting their own professional performance. It was evidenced that the health professional knows that the ideal is to detect small or impalpable nodules and understand that they do their part when requesting imaging tests, perform Clinical Breast Examination, screening groups at highest risk and guiding woman about self care. They believe that there are factors that make it difficult to perform actions that they consider to be ideal, becoming obstacles to early detection. The professional training is influential since undergraduate and postgraduate courses are not enough for all the knowledge they hope to achieve, as well as having a training based on the technocratic model, more treatment than preventive oriented, which does not prepare them for an extended perspective of health. The process of professional interaction with early detection indicated that there are elements that depend on them and others outside of their control, and although they want to do the ideal often they do only what is possible. Despite the Primary Health Care adversities, professionals must be aware about their role for health policies performance and not neglect care or transfer responsibility for their actions. The breast cancer early detection also depends on their commitment of being a good screening professional and their will to give something more.

Automated Detection Algorithm of Breast Masses in Three-Dimensional Ultrasound Images / 대한의료정보학회지

OBJECTIVES: We propose an automatic breast mass detection algorithm in three-dimensional (3D) ultrasound (US) images using the Hough transform technique. METHODS: One hundred twenty-five cropped images containing 68 benign and 60 malignant masses are acquired with clinical diagnosis by an experienced radiologist. The 3D US images are masked, subsampled, contrast-adjusted, and median-filtered as preprocessing steps before the Hough transform is used. Thereafter, we perform 3D Hough transform to detect spherical hyperplanes in 3D US breast image volumes, generate Hough spheres, and sort them in the order of votes. In order to reduce the number of the false positives in the breast mass detection algorithm, the Hough sphere with a mean or grey level value of the centroid higher than the mean of the 3D US image is excluded, and the remaining Hough sphere is converted into a circumscribing parallelepiped cube as breast mass lesion candidates. Finally, we examine whether or not the generated Hough cubes were overlapping each other geometrically, and the resulting Hough cubes are suggested as detected breast mass candidates. RESULTS: An automatic breast mass detection algorithm is applied with mass detection sensitivity of 96.1% at 0.84 false positives per case, quite comparable to the results in previous research, and we note that in the case of malignant breast mass detection, every malignant mass is detected with false positives per case at a rate of 0.62. CONCLUSIONS: The breast mass detection efficiency of our algorithm is assessed by performing a ROC analysis.

Self-reported early detection activities for breast cancer in Colombia in 2010: impact of socioeconomic and demographic characteristics / Actividades autorreportadas de detección temprana en cáncer de mama en Colombia en 2010: impacto de características socioeconómicas y demográficas

Objective. To explore which socioeconomic and demographic characteristics influence Colombian women to utilize screening mammography (SMMG). Materials and methods. Data of women aged 40-49 years (n=12 345) and 50-69 years (n=14 771) from the Colombian national survey of demography and health 2010 was analyzed. Risk estimates (odds ratios, OR) of self-reported SMMG use were obtained using logistic regression. Results. Among women aged 50-69 years, high wealth index (OR=4.7; CI95%, 3.9-5.8), affiliation to special or contributory health insurance regime (OR=3.4; CI95% 2.6-4.6 and OR=2.5; CI95% 2.1-3.0 respectively), health consultation in previous year (OR=2.7; CI95% 2.3-3.1), high education level (OR=2.3; CI95% 1.8-2.9) and very good self-reported health (OR=1.5; CI95% 1.1-2.0) positively influenced SMMG utilization. Among women aged 40-49 years, likelihood of having a SMMG was high after a health consultation in the previous year. Conclusions. Socioeconomic and demographic differences in use of SMMG need to be contemplated in screening recommendations before considering an organized population-based programme.

Objetivo. Explorar qué características socioeconómicas y demográficas influencian la utilización de mamografía de tamizaje (MT) en mujeres colombianas. Material y métodos. Se analizaron datos de mujeres entre 40 y 49 años (n=12 345) y 50-69 años (n=14 771) de la Encuesta Nacional de Demografía y Salud 2010 y estimaciones de riesgo (odds ratios, OR) del uso autorreportado de MT obtenidas usando regresión logística. Resultados. En mujeres de 50-69 años con alto índice de riqueza (OR=4.7; IC95% 3.9-5.8), la afiliación al seguro de salud especial o contributivo (OR=3.4; IC95% 2.6-4.6 y OR=2.5; 2.1-3.0 respectivamente), consulta de salud el año previo (OR=2.7; IC95% 2.3-3.1), alto nivel educativo (OR=2.3; IC95% 1.8-2.9) y muy buena salud autoreportada (OR=1.5; IC95% 1.1-2.0) influyeron positivamente en la utilización de MT. En mujeres de 40 y 49 años, hubo alta probabilidad de uso de MT si había consulta de salud el año previo. Conclusiones. Las diferencias socioeconómicas y demográficas en uso de MT deben contemplarse en recomendaciones de cribado antes de implementar tamización organizada.