scholarly journals The Impact of Mammography Screening Guideline Changes Among Women Serving in the U.S. Military

2020 ◽  
Vol 185 (11-12) ◽  
pp. e2088-e2096
Author(s):  
Julie A Bytnar ◽  
Celia Byrne ◽  
Cara Olsen ◽  
Catherine T Witkop ◽  
Mary Beth Martin ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Mammography Screening ◽  
Women In The Military ◽  
Screening Guidelines ◽  
Screening Guideline ◽  
The Military ◽  
The Impact ◽  
Universal Health ◽  
The U.S

Abstract Introduction The U.S. Preventive Services Task Force (USPSTF) modified their screening guidelines for breast cancer in November 2009. Previous studies evaluated the impact of these guideline changes among privately and Medicare insured populations. Women in the military form a unique population exposed to many social, environmental, and occupational hazards that may increase breast cancer incidence. By evaluating mammography screening rates among women in the military before and after the USPSTF guideline changes, this study evaluated the impact of the USPSTF breast cancer guideline change on screening mammography use within the military population and determined whether current guidelines were followed for this high-risk population with universal health care access. Materials and methods This study evaluated the impact of the 2009 guideline changes among the population of universally insured military servicewomen, comparing the proportion of active duty women aged 40 to 64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis. Stratified analyses evaluated differences by age (aged 40–49, 50–64), race, military branch, and rank. This research is considered exempt by the Uniformed Services University Institutional Review Board. Results The proportion of insured military servicewomen receiving mammograms increased from October 2005 through September 2009. A significant decrease occurred in the first quarter of 2010 following the publication of the screening guideline update. From this new baseline, the proportion of women screened increased again through September 2015. Comparative analyses showed more pronounced effects both immediately and over time among the women aged 50 to 64 compared to those aged 40 to 49 years and among older enlisted women compared with their officer counterparts. The patterns were near identical in all subgroups; however, no changes in rate were evident among Air Force and black servicewomen aged 50 to 64 and Army and Navy/Marine Corps servicewomen aged 40 to 49 years. No racial disparities in screening or impact were noted. Conclusions The USPSTF guidelines had differential impacts among some subpopulations. While older women, aged 50 to 64 years, had a greater temporary reduction immediately after the guideline change, younger women aged 40 to 49 years had a longer-term reduction in screening following the guideline changes. No racial disparities in the proportion screened or in the impact of the guideline change were noted in this population with universal health coverage. The lack of Department of Defense standard breast cancer screening guidelines was evident from the different patterns of mammography utilization observed among military branches. To completely understand the impact of the updated screening guidelines, future studies must incorporate research focusing on changes in breast cancer morbidity and mortality as well as updated cost-benefit analyses.

scholarly journals Improving physician compliance with mammography screening by implementing a breast cancer screening guideline at a hospital in Bahrain

2021 ◽  
Vol 10 (3) ◽  
pp. e001351
Author(s):  
Rabih Mustapha Abou leila ◽  
Michael Shannon ◽  
Sarah El-Nassir El-Nigoumi
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Mammography Screening ◽  
Eligible Patient ◽  
Improvement Project ◽  
Screening Guidelines ◽  
Physician Knowledge ◽  
Physician Compliance ◽  
Screening Guideline

BackgroundFrom a health and safety perspective, it is critical to use adequate, evidence-based breast screening guidelines. The aim of this quality improvement project was to improve physicians’ compliance with breast cancer screening guidelines to enhance the mammography screening rate among eligible women; this was achieved through the implementation of multifaceted changes to the hospital’s processes and the improvement of physicians’ attitudes towards the guidelines.MethodsThe project used the Plan-Do-Study-Act method to implement the changes. This was a pre-post evaluation study. The data were collected from patients’ charts. The primary outcome of interest was the rate of physician compliance with mammography screening guidelines before and after the implementation of the process changes. A literature review was conducted to determine which women should be identified as eligible for mammography screening.InterventionThe interventions targeted physician knowledge and hospital processes. Improving doctors’ expertise was achieved by implementing the US Preventive Service Task Force recommendation for mammography screening every 2 years for women aged 50–74 years. The process modifications included the establishment of a system that would be effective in identifying at-risk patients and reminding physicians at the point of care.ResultsOver the course of this study, 825 patients met the criteria for breast cancer screening. The rate of physician compliance with the breast cancer screening guideline increased from 2% to 69% after 23 weeks, and the control charts demonstrated a reliable process.ConclusionThis project examined the relationship between different interventions (identification of the eligible patient, reminder alerts and physician knowledge) and physician compliance with mammography screening guidelines. The results suggest a positive link between the study variables and physicians’ compliance with mammography screening guidelines.

scholarly journals The Afghan marathon: why no one is in a rush at the Doha talks

2021 ◽  
pp. 99-119
Author(s):  
M. Nessar
Keyword(s):  
Armed Conflict ◽  
Political Process ◽  
Peace Process ◽  
National Program ◽  
Political Situation ◽  
The Military ◽  
The Impact ◽  
National Reconciliation ◽  
The U.S

The article analyzes the Afghan peace process, including the roles of internal and external players. It examines the impact of the national reconciliation policy on the domestic political process in Afghanistan and on the military and political situation in the country. The national program aimed at settling the armed conflict is interpreted as a response to changes in the U.S. policy for Afghanistan, including preparations for the withdrawal of the U.S. troops. The author also pays attention to the geopolitical dimension of the problem and to possible scenarios for the evolution of the peace process.

The impact of mammography screening on the surgical treatment of breast cancer

2018 ◽  
Vol 24 (6) ◽  
pp. 1138-1138 ◽  
Author(s):  
Leonardo Ribeiro Soares ◽  
Ruffo Freitas-Junior
Keyword(s):  
Breast Cancer ◽  
Surgical Treatment ◽  
Mammography Screening ◽  
The Impact

scholarly journals Linking Reminders and Physician Breast Cancer Screening Recommendations: Results From a National Survey

2017 ◽  
pp. 1-10 ◽  
Author(s):  
Elizabeth J. Siembida ◽  
Archana Radhakrishnan ◽  
Sarah A. Nowak ◽  
Andrew M. Parker ◽  
Craig Evan Pollack
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Mammography Screening ◽  
Primary Care Physicians ◽  
Age Groups ◽  
National Sample ◽  
Average Risk ◽  
Screening Guidelines ◽  
Practice Characteristics

Purpose Physician reminders have successfully increased rates of mammography. However, considering recent changes to breast cancer screening guidelines that disagree on the optimal age to start and stop mammography screening, we sought to examine the extent to which reminders have been deployed for breast cancer screening targeting younger and older patients. Methods A mailed survey was sent to a national sample of 2,000 primary care physicians between May and September 2016. Physicians were asked whether they received reminders to screen women in various age groups (40 to 44, 45 to 49, and ≥ 75 years), the organizational screening guidelines they trusted most, and whether they recommended routine breast cancer screening to average-risk women in the different age groups. Using regression models, we assessed the association between reminders and physician screening recommendations, controlling for physician and practice characteristics, and evaluated whether the association varied by the guidelines they trusted. Results A total of 871 physicians responded (adjusted response rate, 52.3%). Overall, 28.9% of physicians reported receiving reminders for patient ages 40 to 44 years, 32.5% for patient ages 45 to 49 years, and 16.5% for patient ages ≥ 75 years. Receiving reminders significantly increased the likelihood of physicians recommending mammography screening. In adjusted analyses, 84% (95% CI, 77% to 90%) of physicians who received reminders recommended screening for women ages ≥ 75 versus 65% (95% CI, 62% to 69%) of those who did not receive reminders. The associations between reminders and screening recommendations remained consistent regardless of which guidelines physicians reported trusting. Conclusion Reminders were significantly associated with increases in physician screening recommendations for mammography, underscoring the need for careful implementation in scenarios where guidelines are discordant.

scholarly journals The impact of mammography screening programmes on incidence of advanced breast cancer in Europe: a literature review

BMC Cancer ◽  
2018 ◽  
Vol 18 (1) ◽  
Author(s):  
M. J. M. Broeders ◽  
P. Allgood ◽  
S. W. Duffy ◽  
S. Hofvind ◽  
I. D. Nagtegaal ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Literature Review ◽  
Advanced Breast Cancer ◽  
Mammography Screening ◽  
Advanced Breast ◽  
The Impact

Mammographic Screening at Age 40 or 45? What Difference Does it Make? the Potential Impact of American Cancer Society Mammography Screening Guidelines

2017 ◽  
Vol 83 (8) ◽  
pp. 847-849
Author(s):  
Crystal E. Fancher ◽  
Anthony Scott ◽  
Ahkeel Allen ◽  
Paul Dale
Keyword(s):  
Breast Cancer ◽  
Mammography Screening ◽  
Disease Free Survival ◽  
Mammographic Screening ◽  
Screening Mammography ◽  
Cancer Society ◽  
Free Survival ◽  
Screening Guidelines ◽  
Potential Impact ◽  
Disease Free

This is a 10-year retrospective chart review evaluating the potential impact of the most recent American Cancer Society mammography screening guidelines which excludes female patients aged 40 to 44 years from routine annual screening mammography. Instead they recommend screening mammography starting at age 45 with the option to begin screening earlier if the patient desires. The institutional cancer registry was systematically searched to identify all women aged 40 to 44 years treated for breast cancer over a 10-year period. These women were separated into two cohorts: screening mammography detected cancer (SMDC) and nonscreening mammography detected cancer (NSMDC). Statistical analysis of the cohorts was performed for lymph node status (SLN), five-year disease-free survival, and five-year overall survival. Women with SMDC had a significantly lower incidence of SLN positive cancer than the NSMDC group, 9 of 63 (14.3%) versus 36 of 81 (44 %; P < 0.001). The five-year disease-free survival for both groups was 84 per cent for SMDC and 80 per cent for NSMDC; this was not statistically significant. The five-year overall survival was statistically significant at 94 per cent for the SMDC group and 80 per cent for the NSMDC group (P < 0.05). This review demonstrates the significance of mammographic screening for early detection and treatment of breast cancer. Mammographic screening in women aged 40 to 44 detected tumors with fewer nodal metastases, resulting in improved survival and reaffirming the need for annual mammographic screening in this age group.

The Combat Exclusion and the Role of Women in the Military

Hypatia ◽  
1995 ◽  
Vol 10 (1) ◽  
pp. 56-73 ◽  
Author(s):  
Judith Wagner Decew
Keyword(s):  
Supreme Court ◽  
Women In The Military ◽  
History Of ◽  
Role Of Women ◽  
The Military ◽  
The U.S

I first discuss reasons for feminists to attend to the role of women in the military, despite past emphasis on antimilitarism. I then focus on the exclusion of women from combat duty, reviewing its sanction by the U.S. Supreme Court and the history of its adoption. I present arguments favoring the exclusion, defending strong replies to each, and demonstrate that reasoning from related cases and feminist analyses of equality explain why exclusion remains entrenched.

scholarly journals Household Net Worth, Racial Disparities, and Hormonal Therapy Adherence Among Women With Early-Stage Breast Cancer

2015 ◽  
Vol 33 (9) ◽  
pp. 1053-1059 ◽  
Author(s):  
Dawn L. Hershman ◽  
Jennifer Tsui ◽  
Jason D. Wright ◽  
Ellie J. Coromilas ◽  
Wei Yann Tsai ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Racial Disparities ◽  
Hormonal Therapy ◽  
Early Stage ◽  
Medication Possession Ratio ◽  
Household Wealth ◽  
Therapy Adherence ◽  
Net Worth ◽  
Black Race ◽  
The Impact

Purpose Nonadherence to adjuvant hormonal therapy is common and is associated with increased prescription copayment amount and black race. Studies suggest that household wealth may partly explain racial disparities. We investigated the impact of net worth on disparities in adherence and discontinuation. Patients and Methods We used the OptumInsight insurance claims database to identify women older than age 50 years diagnosed with early breast cancer, from January 1, 2007, to December 31, 2011, who were using hormonal therapy. Nonadherence was defined as a medication possession ratio of ≤ 80% of eligible days over a 2-year period. We evaluated the association of demographic and clinical characteristics, annual household income, household net worth (< $250,000, $250,000 to $750,000, or > $750,000), insurance type, and copayments (< $10, $10 to $20, or > $20) with adherence to hormonal therapy. Logistic regression analyses were conducted by sequentially adding sociodemographic and financial variables to race. Results We identified 10,302 patients; 2,473 (24%) were nonadherent. In the unadjusted analyses, adherence was negatively associated with black race (odds ratio [OR], 0.76; P < .001), advanced age, comorbidity, and Medicare insurance. Adherence was positively associated with medium (OR, 1.33; P < .001) and high (OR, 1.66; P < .001) compared with low net worth. The negative association of black race with adherence (OR, 0.76) was reduced by adding net worth to the model (OR, 0.84; P < .05). Correcting for other variables had a minimal impact on the association between race and adherence (OR, 0.87; P = .08). The interaction between net worth and race was significant (P < .01). Conclusion We found that net worth partially explains racial disparities in hormonal therapy adherence. These results suggest that economic factors may contribute to disparities in the quality of care.

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