Towards a more comprehensive understanding of cancer burden in North Carolina: priorities for intervention.

OBJECTIVE: To apply 4 measures of population burden in examining cancer burden in North Carolina and to identify priorities for intervention. METHODS: Four measures were used: incidence, mortality, prevalence, and years of potential life lost (YPLL). The North Carolina Central Cancer Registry provided summary data on incidence and mortality and record-level data that were examined using SEER*Stat software to calculate prevalence. North Carolina vital statistics (mortality) data and life expectancy estimates stratified by age, race, and sex were used to calculate YPLL. Each cancer site was ranked according to burden for each of the 4 individual burden measures and summarized into an overall rank. Burden was examined overall and by sex and race. PRINCIPAL FINDINGS: Four cancers--lung/bronchus, female breast, prostate, and colon/rectum--accounted for approximately 57% of the total cancer incidence, prevalence, mortality, and YPLL in North Carolina. Patterns of burden in gender and race subgroups were similar, although non-whites often had higher mortality rates than did whites despite similar incidence rates. An estimated 207,583 people were living with cancer in 2004 Breast and prostate cancer accounted for 42% of these survivors. Lung/bronchus cancer was the most severe cancer, accounting for more deaths and years of life lost than any other 5 cancers combined. CONCLUSIONS: Each of the 4 measures provides unique insight and guidance for cancer coordination and control efforts. Lung/bronchus, female breast, prostate, and colon/rectum cancers accounted for the majority of North Carolina's cancer burden and should be priorities for intervention.

Research for North Carolina: The University Cancer Research Fund.

In 2008 an estimated 40,000 North Carolinians will be diagnosed with cancer. This disease is the number one cause of death in our state and will claim more than 17,000 lives this year. North Carolina is swimming against a demographic tide of growth and aging that will bring 80,000 new cancer cases by 2050, despite continued improvements in cancer prevention, early detection, and treatment. By establishing the University Cancer Research Fund, North Carolina has taken a bold, nation-leading step forward toward improving the future health and well-being of its citizens. Research that creates new knowledge, turns that knowledge into advances in treatment, screening, and prevention, and then ensures delivery of those advances across the state-that research is the key that unlocks the doors to a new and better future. The Fund will make that research possible. As has often been the case, North Carolina was ahead of the national curve by creating the UCRF in July 2007. In November 2007, Texas passed a $3 billion bond referendum to provide $300 million annually to support cancer research over the next decade. In 2005, California passed a $3 billion bond referendum to support stem cell research. Perhaps noting the downturn in federal funding for biomedical research, other states are watching these states' investments to see if they improve their citizens' health and make researchers nationally competitive. We will rigorously evaluate the UCRF to show the nation that North Carolina has taken a bold and wise step. The North Carolina General Assembly and the people of North Carolina have presented the University of North Carolina at Chapel Hill, the UNC Lineberger Comprehensive Cancer Center, the North Carolina Cancer Hospital, and UNC Health Care with an astounding opportunity and responsibility. We embrace that opportunity and that responsibility and pledge ourselves to our shared vision of a better future for the citizens of North Carolina.

Increasing use of mammography among older, rural African American women: results from a community trial.

OBJECTIVES: A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older. METHODS: A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys. The primary outcome was self-reported mammography use in the previous 2 years. RESULTS: The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = -1, 14) in community-wide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by low-income women in comparison counties. Adjustment for potentially confounding characteristics did not change the results. CONCLUSIONS: A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.

How consistently do women report lifetime mammograms at successive interviews?

BACKGROUND: Little data exist on the reliability of self-reported regular mammography use measures. We used data from two successive interviews of 892 women aged 50 to 74 years without a history of abnormal mammograms to investigate how consistently women report their lifetime number of mammograms. METHODS: We added an estimated number of mammograms obtained between interviews to the baseline report to create a revised baseline report for comparison with the follow-up report. We then examined the correlation in paired reports, the level of agreement between paired reports, and factors associated with consistent reporting. RESULTS: Spearman rank correlation between paired reports was 0.73. Agreement between paired reports dropped with increasing lifetime number of mammograms. After adjustment for mammography use, women's characteristics did not appear to be strongly associated with consistent reporting. CONCLUSIONS: Self-reported lifetime number of mammograms is a reasonably consistent measure for younger women or women with less mammography experience, but it is less reliable for women with long mammography histories. In these women, it may be useful to distinguish those who obtain regular screening from those who do not. Assessing reliability as well as validity for other measures of regular mammography use will allow additional measures to be identified.

Pesquisaje para el cáncer de mama con autoexamen de la mama / m

Se revisa la evidencia relacionada con el autoexamen de mama (AEM) y el pesquisaje para el cancer de mama. A nuestro entender, no existe ningún ensayo perspectivo controlado que relacione el AEM con las vidas salvadas del cancer del mama, en comparación con el examen de mama clínico y la mamografía, la sensibilidad estimada el AEM es baja (20 al 3o por ciento) y es inferior entre las mujeres de edad avanzada. La sensibilidad potencial del AEM debe ser mayor debido a que las mujeres pueden detectar pequeñas protuberancias (0,3 CM) en modelos de silicona, la instrucción aumenta la frecuencia del AEM a corto plazo. La sensibilidad también aumenta, pero la especificidad disminuye. Aún no estan claros los efectos psicológicos del AEM docente. Se desconoce el costo del pesquisaje por AEM, pero depende de la exactitud de la prueba, así como el método de entrenamiento utilizado. El autoexamen de mama tiene un potencial como prueba de pesquisaje para detectar el cancer de mama, pero muchas cuestiones requieren un examen cientifico antes de que se pueda abogar por este procedimiento como prueba de pesquisaje para el cancer de mama