Epidemiología y diagnóstico precoz. Papel del médico de atención primaria en las campañas de cribado

El cáncer de mama es el más frecuente en las mujeres y una de las patologías que más trastornos causa en las mujeres de los países desarrollados, debido a su incidencia creciente, a su elevada mortalidad y a la repercusión social que comporta (AU)

[Factors influencing coverage, response and participation in breast cancer screening program]. / Factores condicionantes de la cobertura, la respuesta y la participación en un programa de cribado del cáncer de mama.

BACKGROUND: The objective was to analyze sociodemographic, organizational and health care-related factors associated to level of enrollment in a breast cancer screening program developed in one area of Barcelona (Spain). MATERIAL AND METHODS: Three types of indicators were used: coverage, response and participation. The influence of age, educational level, previous clinical contacts, the person who received the citation and the reason for not attending after the first citation were studied. The odds ratio (OR) was used to estimate the magnitude of the association between variables. The OR were adjusted by age and education through unconditional logistic regression. RESULTS: The rates were: coverage 79.2%, response 74.6%, and participation 61%. The response after the first citation was influenced by the recipient of the letter (p < 0.001); when it was the target-woman, the response was 75%. The response after the successive citations was 50.5% if the reason for not attending previously was circumstantial, and 11.5% when it was lack of interest. Having had previous clinical contacts in the primary care centre or in the reference hospital multiplied by 4 to 7 times the response. Coverage decreased with age, and it presented a curvilinear pattern with respect to educational level. Multivariate analyses emphasized the importance of previous clinical contacts (ORs between 3.5 and 8.1; p < 0.001). CONCLUSIONS: Previous contacts with the health system, the method of citation and the reason for not attending after the initial phase were factors clearly associated with participation in a breast cancer screening program. Research on factors influencing participation would contribute to improve the results of screening programs currently underway in Spain.

[Epidemiologic data of uro-oncologic pathology in a urology service of a university general hospital. Comments regarding cancer of the prostate]. / Análisis de datos epidemiológicos de patología uro-oncológica en un servicio de urología de un Hospital General Universitario. Comentarios respecto al cáncer de próstata.

Data from 92, 93 and 94 tumoral records is analyzed based on the first visit system, staging at time of diagnosis, intervals between visits and management. After finding data unsatisfactory, a program for health care improvement is developed in order to secure diagnosis at earlier stages which may allow for curative radical treatment. The program was implemented in 1995. Results are communicated, and compared with those from previous years; the effectiveness of the program is verified.