Monitoring surgical treatment of screen-detected breast lesions in Italy

Distante, V.; Mp, Mano; Ponti, Antonio; Cataliotti, Luigi; Filippini, L; Giorgi, Daniela; Lazzaretti, Maria Grazia; Marchesi, C.; Perfetti, Elisa; Segnan, Nereo

doi:10.1016/j.ejca.2004.01.015

Cited by 9 publications

(8 citation statements)

References 14 publications

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“…travel distance and increased crowding on the other (Distante et al, 2004;Bouche et al, 2008;Stitzenberg et al, 2009;Yun et al 2012). Unfortunately, our data do not include information on comorbidity, which is, however, highly correlated with socioeconomic position and therefore partially adjusted for in the analyses.…”

Section: Timeliness Indicatorsmentioning

confidence: 91%

Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy)

Zengarini

Ponti

Tomatis

et al. 2016

European Journal of Cancer Prevention

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Several studies suggest that population-based breast cancer screening programmes might help reduce social inequalities in breast cancer survival both by increasing early diagnosis and by improving access to effective treatments. To start disentangling the two effects, we evaluated social inequalities in quality of treatment of screen-detected breast cancer in the city of Turin (Italy). Combining data from the Audit System on Quality of Breast Cancer Treatment and the Turin Longitudinal Study, we analysed 2700 cases in the screening target age class 50-69 diagnosed in the period 1995-2008. We selected 10 indicators of the pathway of care, relative to timeliness and appropriateness of diagnosis and treatment, and three indicators of socioeconomic position: education, occupational status and housing characteristics. For each indicator of care, relative risks of failure were estimated by robust Poisson regression models, controlling for calendar period of diagnosis, size of tumour and activity volume of the surgery units. The principal predictor of failure of the good care indicators was the calendar period of diagnosis, with a general improvement with time in the quality of diagnosis and treatment, followed by size of the tumour and volume of activity. Socioeconomic indicators show only a marginal independent effect on timeliness indicators. The observed associations of quality indicators with socioeconomic characteristics are lower than expected, suggesting a possible role of the screening programme in reducing disparities in the access to good-quality treatments thanks to its capability to enter screen-detected women into a protected pathway of care.

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Section: Timeliness Indicatorsmentioning

confidence: 91%

Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy)

Zengarini

Ponti

Tomatis

et al. 2016

European Journal of Cancer Prevention

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“…This survey is one of the few published studies that analyzes the real diagnostic practice for breast cancer 4,8,[20][21][22][23][24] . Our study design permitted us to identify the main differences between cases diagnosed within a screening program and cases diagnosed outside a screening program in the same hospitals.…”

Section: Discussionmentioning

confidence: 99%

“…Most of the surveys reporting on routine practice have found important deviations from "best practice": a high percentage of women are treated without a preoperative cytological or histological diagnosis [4][5][6] , and many women receive unnecessary treatment such as surgical removal of benign neoplasms [7][8][9] and mastectomy for localized cancer 3 .…”

Section: Introductionmentioning

confidence: 99%

Breast Cancer Diagnostic Methods: Screen-Detected and Clinical Cases. An Italian Survey of Women's Experiences

Rossi

Camilloni

Mantellini

et al. 2007

Tumori

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Aims and Background The real practice of breast cancer diagnosis and treatment is often very different from guideline recommendations. Screening programs should minimize deviations from “best practice”. The aim of the study was to compare cases detected by screening programs with cases that were not part of the public screening program, analyzing the diagnostic pathways from the first suspected breast problem to therapeutic intervention for breast cancer. Methods We interviewed a random sample of 268 women aged 49–70 years in three Italian regions (Lazio, Tuscany, Basilicata) who were treated for breast cancer, stratified by screening participation. Results In the nonscreened group, 48% of women were symptomatic and 50% were diagnosed by preventive tests. The proportion of women treated within 30 days of diagnosis was significantly lower in the screened group, 21.3% vs 35.8% (P = 0.0003). The mean number of tests (mammography, ultrasonography, cytology and histology) performed in the screened group was significantly higher than in the nonscreened group, 3.7 vs 2.8 (P = 0.001). The percentage of women treated without a preoperative histological or cytological diagnosis was lower in the screened group than in the nonscreened group, 14% vs 25% (P = 0.024). Conclusion Participation in screening programs seems to lead to more appropriate disease management even for breast cancer cases treated at the same hospital.

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“…A significant difference exists between what is known to represent best practice and the actual practice of medicine [ 1 ]. Such gaps have been repeatedly documented in surgical practice [ 2 - 9 ]. Unfortunately, traditional continuing professional development (CPD) has not been able to bridge the gap between research and evidence-based guidelines and clinical practice [ 10 - 13 ] and consequently, many have advocated for an improved approach [ 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]

Wright

Law

Klar

et al. 2006

BMC Health Serv Res

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Abstract

Background

A significant gap has been documented between best practice and the actual practice of surgery. Our group identified that colorectal cancer staging in Ontario was suboptimal and subsequently developed a knowledge translation strategy using the principles of social marketing and the influence of expert and local opinion leaders for colorectal cancer.

Methods/Design

Opinion leaders were identified using the Hiss methodology. Hospitals in Ontario were cluster-randomized to one of two intervention arms. Both groups were exposed to a formal continuing medical education session given by the expert opinion leader for colorectal cancer. In the treatment group the local Opinion Leader for colorectal cancer was detailed by the expert opinion leader for colorectal cancer and received a toolkit. Forty-two centres agreed to have the expert opinion leader for colorectal cancer come and give a formal continuing medical education session that lasted between 50 minutes and 4 hours. No centres refused the intervention. These sessions were generally well attended by most surgeons, pathologists and other health care professionals at each centre. In addition all but one of the local opinion leaders for colorectal cancer met with the expert opinion leader for colorectal cancer for the academic detailing session that lasted between 15 and 30 minutes.

Discussion

We have enacted a unique study that has attempted to induce practice change among surgeons and pathologists using an adapted social marketing model that utilized the influence of both expert and local opinion leaders for colorectal cancer in a large geographic area with diverse practice settings.

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Monitoring surgical treatment of screen-detected breast lesions in Italy

Cited by 9 publications

References 14 publications

Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy)

Absence of socioeconomic inequalities in access to good-quality breast cancer treatment within a population-wide screening programme in Turin (Italy)

Breast Cancer Diagnostic Methods: Screen-Detected and Clinical Cases. An Italian Survey of Women's Experiences

A blended knowledge translation initiative to improve colorectal cancer staging [ISRCTN56824239]

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