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
AIM: To describe potential beneficial effects of tyrosine kinase inhibitor in the treatment of unresectable/metastatic fibrous histiocytoma. METHODS: We report a case of advanced stage fibrous histiocytoma with locally recurrent disease plus lung and bone metastatic deposits. Patient was treated with the tyrosine kinase inhibitor sunitinib. RESULTS: Treatment with Sunitinib resulted in disease stabilization in the regional lesion and in good partial response for metastatic foci (reduction in number and size). After 13 months of treatment the patient is doing well with no tumor progression. CONCLUSIONS: This case appears to be one of the first documentations of beneficial effect and potential long-term benefit of TKIs in the treatment of fibrous histiocytoma.
Subject(s)
Antineoplastic Agents/therapeutic use , Bone Neoplasms/secondary , Histiocytoma, Malignant Fibrous/secondary , Indoles/therapeutic use , Kidney Neoplasms/pathology , Lung Neoplasms/secondary , Protein Kinase Inhibitors/therapeutic use , Pyrroles/therapeutic use , Bone Neoplasms/drug therapy , Histiocytoma, Malignant Fibrous/drug therapy , Histiocytoma, Malignant Fibrous/pathology , Humans , Kidney Neoplasms/drug therapy , Lung/drug effects , Lung/pathology , Lung Neoplasms/drug therapy , Male , Middle Aged , Neoplasm Recurrence, Local , Protein-Tyrosine Kinases/antagonists & inhibitors , SunitinibABSTRACT
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)
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