Acetic-acid guided visual inspection vs. cytology-based screening for cervical cancer in the Philippines.

OBJECTIVES: To compare the validity and acceptability of acetic-acid visualization (VIA), magnified acetic-acid visualization (VIAM), spatula+cotton swab-Papanicolaou (Pap) smear (SS), and cervical brush-Pap smear (CB) in the detection of precursor/early cervical cancer lesions. METHODS: A total of 12992 women aged between 25 and 65 years from 14 Philippine centers were randomly allocated to the four tests. The gold standard was colposcopy with biopsy for positive/suspicious cases. RESULTS: Sensitivity rates [95% confidence intervals (CIs)] were 37 (CI, 26.8-48.5), 34.1 (CI, 24.8-44.8), 14.3 (CI, 6.4-27.8), and 19.1 (CI, 9.2-34.6) for VIA, VIAM, SS, and CB, respectively. Specificity rates were 90.7 (CI, 89.6-91.7), 90.7 (CI, 89-91.1), 97.5 (CI, 96.8-98), and 97.9 (CI, 97.3-98.4), respectively. Kappa for the Pap smear (PS) within centers ranged from -0.154 to 0.783, and between centers from -0.028 to 0.364. Screeners preferred CB; screened-women preferred VIA. CONCLUSIONS: The acetic-acid visualization and VIAM methods are recommended for initial cervical cancer screening in the Philippines.

Knowledge, attitudes and practices on breast cancer and breast examination of nurses and midwives in Metro Manila.

This cross-sectional panel study determined the baseline knowledge about breast cancer and the attitudes on breast examination of nurses and midwives assigned at the different health centers in Metro Manila, and determined their sensitivity in detecting breast lumps after teaching them the Mamma-Care technique of breast examination, before they began to implement breast examination in the field. 225 nurses and midwives from a randomly selected 101 health centers in Metro Manila participated in a training seminar regarding breast cancer screening. They were given questionnaires to determine their baseline knowledge (multiple choice objective questionnaires) and attitudes (Liker-scale questionnaire) regarding their implementation of breast exam in the field. During the seminar, they were taught the Mamma-Care technique of breast examination with the aid of a videotape and lecture demonstration. They were then asked to examine silicone breast models which contain lumps of varying sizes (2 cm), mobility and hardness. Their sensitivity (through positive lumps detected by examination/total number of lumps in the breast model) in detecting lumps was then evaluated. Correct pretest knowledge on breast cancer symptoms, risk factors, treatment and screening were 83%, 64%, 86%, and 82%, respectively, which improved after training for 93%, 75%, 93%, and 92%, respectively. Trends in attitudes regarding implementation of breast exam were favorable. Sensitivity rates were 100% (33 nurses/midwives), 80% (48 n/m), 60% (n/m), 20% (17 n/m), and 0% (2 n/m). Overall sensitivity rate was 62%. Training and practice of skills among health center workers would enhance the Department of Health program on early detection of breast cancer in the Philippines.

Hospital visitor-companions as a source of controls for case-control studies in the Philippines.

Hospital visitor-companions are being used as a source of controls in an ongoing case-control study on breast cancer in the Philippines. As a tool for rapid epidemiologic assessment in obtaining research data for case-control studies, visitor-companions may serve as an alternative source of controls. To determine their generalizability and consistency, this proposed group was compared to neighbourhood controls and to hospital-patient controls. Hospital visitor-companions were comparable to neighbourhood controls in terms of cooperation in the interviews, height, weight, marital status, longest residence, education, cigarette smoking, alcohol intake, annual income, proportion with salaried jobs, ownership of house, land, and business, number of people living in the house, number of siblings, medical history, parity, menopausal status, breast feeding practices, and use of oral contraceptives. Neighbourhood controls however had longer interview durations than visitor-companion controls (p less than 0.05). Hospital-patient controls were less likely to breast feed, had lower alcohol intake, and had more exposure to chronic diseases and diagnostic x-ray than visitor-companion or neighbourhood controls (p less than 0.05). It was concluded that visitor-companions may usefully serve as an alternative source of controls for case-control studies when their limitations are taken into consideration during analysis.

Oral plus intramuscular medroxyprogesterone acetate (high dose Farlutal) in advanced breast cancer.

The efficacy and tolerability of the combined scheme of administering high dose medroxyprogesterone acetate in advanced breast cancer is evaluated.