ABSTRACT
PURPOSE: Screening is a significant method for cancer control, nevertheless the implementation of non cost-effective screening tests at national level may constitute a major burden to health economics. The purpose of this study was to determine the cancer screening activities of a large sample of the Hellenic population, in a country with opportunistic screening practice. METHODS: A large survey on cancer screening in Greece was organized and conducted by the Panhellenic Association for Continual Medical Research (PACMeR). Screening performance of evidence-based (EB), non-evidence-based (non EB) and of undefined benefit tests was analysed. RESULTS: 7001 individuals were analysed. Eighty-eight percent of males and 93% of females stated that they were interested in cancer screening practices. Gynecological cancer screening was performed in the range of 23-38%. Colorectal cancer screening was rarely performed in both genders (1- 2%), while non-evidence-based tests were regularly performed (urinalysis 50% and chest radiography 15-18%). Full blood count and PSA measurement were widely accepted (over 45% in both genders and 19.5% in males, respectively). Sociodemographic characteristics did not influence the performance of EB tests in males while females' activities were highly influenced by such parameters. CONCLUSION: Opportunistic cancer screening in a primary health care system where national guidelines are missing may cause ambiguous results. Reconsideration of health policy in such cases is mandatory.
Subject(s)
Government Regulation , Health Policy , Health Priorities , Mass Screening/methods , Neoplasms/diagnosis , Practice Patterns, Physicians' , Primary Health Care , Unnecessary Procedures , Aged , Chi-Square Distribution , Cost-Benefit Analysis , Cross-Sectional Studies , Female , Greece , Health Care Costs , Health Policy/economics , Health Priorities/economics , Health Priorities/legislation & jurisprudence , Health Services Research , Humans , Male , Mass Screening/economics , Mass Screening/legislation & jurisprudence , Middle Aged , Practice Guidelines as Topic , Practice Patterns, Physicians'/economics , Practice Patterns, Physicians'/legislation & jurisprudence , Predictive Value of Tests , Primary Health Care/economics , Primary Health Care/legislation & jurisprudence , Surveys and Questionnaires , Unnecessary Procedures/economicsABSTRACT
PURPOSE: To estimate cancer screening coverage among a large sample of Greek individuals. METHODS: 7012 adults from 30 Hellenic areas were surveyed. Tests included: faecal occult blood test, sigmoidoscopy,chest X-ray, urine test, testicular examination,trans-rectal ultrasound, full blood count, skin examination,digital rectal examination, PSA, Pap test, mammography,clinical breast examination (CBE), self breast examination and breast ultrasound. RESULTS: Eighty-eight percent of males and 93% of females declared being interested in cancer screening; 37.8% of men and 37.9% of women had had a medical consultation for screening purpose in the previous 2 years. Less than 2%reported having received screening for colorectal cancer or skin malignancies. Screening for cervical cancer, mammography and CBE was reported by 39.6%, 22.8% and 27.9% of females respectively. Twenty percent of males reported screening for prostate cancer. CONCLUSION: The actual opportunistic screening approach presents important deficiencies with displaced priorities in test performance and a low proportion of individuals undergoing recommended tests (AU)
Subject(s)
Humans , Male , Female , Middle Aged , Aged , Multicenter Studies as Topic/methods , Health Priorities , Neoplasms/prevention & control , Uterine Neoplasms/diagnosis , Mass Screening/methods , Mass Screening , Attitude to Health , Breast Neoplasms/diagnosis , Greece/epidemiology , Mammography/statistics & numerical data , Mammography , Patient Participation/methods , Patient Participation , Physical Examination/statistics & numerical data , Prostatic Neoplasms/diagnosisABSTRACT
Although data from literature suggest that diabetic women are frequently under screened for gynaecological cancers little is known about screening implementation for other cancers for both genders. This study investigates comprehensive cancer screening practices of diabetics as compared with non-diabetics; analyses screening patterns both by gender and level of evidence and reveals target subgroups that should be paid more attention for screening implementation. 675 diabetics vs. 5772 non-diabetic Greek individuals entered the PACMeR 02 cancer screening study. Diabetic women reported significantly lower performance for the sex-specific evidence-based cancer screening tests and digital rectal examination (DRE) as compared with non-diabetics (P < 0.05). Diabetic women older than 60 years old, of elementary education, housewives and farmers showed the lowest performance rates (P < 0.01). Prostate cancer screening was higher among diabetic men with ultrasound and DRE reaching statistical significance (P < 0.05). Subgroups analysis did not reveal a hidden relationship. Both genders of diabetics reported never performing skin examination at higher rates (P < 0.001), although screening intent is extremely low in both diabetics and non-diabetics (<1%). Evidence-based screening coverage was inconsistent in both genders independently by the diabetic status. Primary care efforts should be provided to implement presymptomatic cancer control.
Subject(s)
Diabetes Complications/diagnosis , Early Detection of Cancer , Mass Screening , Neoplasms/diagnosis , Adult , Age Factors , Aged , Aged, 80 and over , Case-Control Studies , Female , Greece , Health Services Accessibility , Humans , Male , Mass Screening/statistics & numerical data , Middle Aged , Risk Factors , Sex Factors , Socioeconomic Factors , Young AdultABSTRACT
BACKGROUND: Colorectal cancer is the second leading cause of cancer death in European countries. Differences in screening implementation may explain USA vs. European survival differences. The proportion of European primary care physicians advising colorectal screening has been reported to be inconsistent. We therefore hypothesised the presence of a belief-related bias among European physicians regarding who is responsible for cancer screening delivery. OBJECTIVES: To index beliefs in cancer screening implementation among a wide sample of Greek physicians. Study design Cross-sectional survey. METHODS: Three hundred and sixty-six physicians involved in primary care activities in 15 provinces answered a questionnaire about responsibility in cancer screening delivery. Results 22.4% and 7.6% of physicians declared that the health system and the patients, respectively, have the main responsibility for cancer screening implementation, while 70 % advocated patient-health system co-responsibility. Beliefs were statistically correlated to age (p=0.039) and specialisation category (p=0.002). Patients' will was mainly indicated by internists, trainee internists and physicians older than 30, while GPs, trainee GPs and house officers were mainly health system-oriented. Worryingly, when physicians were asked about which specialty should inform the population, 81% indicated family doctor (for-fee-service) while the involvement of free-from-fee specialities was inconsistent. CONCLUSION: A considerable disorientation about responsibilities in cancer screening delivery was observed in our study sample. Continual medical education and clear redefinition of primary care physicians' activities are required (AU)
No disponible
Subject(s)
Humans , Male , Female , Colorectal Neoplasms/epidemiology , Colorectal Neoplasms/prevention & control , Physicians/statistics & numerical data , Mass Screening , Practice Patterns, Physicians'/standards , Practice Patterns, Physicians' , Health Knowledge, Attitudes, Practice , Greece/epidemiology , Data Collection/methods , Data CollectionSubject(s)
Mass Screening/methods , Neoplasms/diagnosis , Neoplasms/mortality , Early Diagnosis , HumansABSTRACT
Hypocalcemia, hyperparathyroidism, hypovitaminosis D, hypocalcitoninemia and decreased bone mass are side effects of several anticonvulsant drugs. Since calcitonin inhibits the mineral mobilization of bone and augments minerals bone content, combined therapy with calcitonin, calcium, vitamin-C and vitamin-D was administrated to a patient with severe anticonvulsant disturbances of bone metabolism. Calcitonin hypersensitivity was evident. The symptomatology, characterized by the rare hypocalcemic hyperpyrexia, regressed after calcium infusion.
