Estadísticas

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      "titulo" => "Sesión temática : Software de distribución libre para epidemiología y Salud Pública: cómo coordinar el desarrollo internacional"
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    "titulo" => "Sesión temática : Información sobre el impacto de los programas de cribado de cáncer de mama"
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    "textoCompleto" => "<p class="elsevierStylePara"> Viernes 3 de Octubre &#47; Friday 3&#44; October<br></br> 15&#58;00&#58;00 a&#47;to 16&#58;30&#58;00</p><p class="elsevierStylePara"><span class="elsevierStyleBold">325 INFORMACI&#211;N SOBRE EL IMPACTO DE LOS PROGRAMAS DE CRIBADO DE C&#193;NCER DE MAMA&#46; INFORMATION ABOUT THE IMPACT OF BREAST CANCER SCREENING PROGRAMMES</span></p><p class="elsevierStylePara"> Lola Salas Trejo&#42;&#44; Teresa Cerd&#225; Mota&#42;&#42;</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">&#42;Unidad Prevenci&#243;n de C&#225;ncer&#46; D&#46;G&#46; Salud P&#250;blica&#44; Conselleria Sanitat&#44; Valencia&#44; Spain&#46; &#42;&#42;Direcci&#243;n Xeral de Sa&#250;de P&#250;blica&#44; Conselleria de Sanidade&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"> Over the last few years Breast Cancer Screening Programmes have undergone tremendous growth both in Spain and in the rest of Europe&#46; Fortunately&#44; networks which coordinate these programmes have also been developed&#44; these being the &#34;European Breast Cancer Network &#40;EBCN&#41;&#34; in Europe&#44; and the &#34;Annual Conference on Breast Cancer Screening Programmes&#34; in Spain&#46; Both these networks play a vital role through allowing professionals to exchange their experience and as regards the quality control of the processes involved&#44; aspects which have determined the great impact that Breast Cancer Screening Programmes have had up to now and continue to have on the population&#44; specifically among women&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">326 COMPARACI&#211;N DE INDICADORES DE LOS PROGRAMAS INCLUIDOS</span></p><p class="elsevierStylePara"> Nieves Ascunce Elizaga</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Instituto de Salud P&#250;blica de Navarra&#44; Departamento de salud Gobierno de Navarra&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"> In 1989 the European network of Breast Cancer Screening Programmes &#40;EBCN&#41; was got under way with the first pilot programmes that were being implemented in Europe at the time&#46; Seventeen centres are involved in the network at the present time&#44; and ten of these&#44; from six different countries&#44; have participated in an assessment project in order to jointly present their main results using impact-predicting indicators&#46;</p><p class="elsevierStylePara"> These indicators have been calculated as defined in &#34;European guidelines for quality assurance in mammography screening&#34; and their reference values have been used for comparative purposes&#46; It was similarly examined if different organisational systems have an influence on the results in respect of these same indicators&#46;</p><p class="elsevierStylePara"> Data on the following aspects is given&#58;</p><p class="elsevierStylePara"> Participation<br></br> Detection rate<br></br> Characteristics of the tumours detected</p><p class="elsevierStylePara"><span class="elsevierStyleBold">327 INFORMACI&#211;N A LAS MUJERES SOBRE CRIBADO DE C&#193;NCER</span></p><p class="elsevierStylePara"> Livia Giordano</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Unit of epidemiology&#44; CPO Piemonte Torino&#44; Italia&#46;</span></p><p class="elsevierStylePara"> The past approach to screening information has mainly stressed benefits of screening for the population with the purpose of encouraging every eligible woman to participate&#44; often glossing over detrimental side effects such as anxiety&#44; false reassurance&#44; false alarms&#44; unnecessary biopsies&#44; overdiagnosis and overtreatment&#46;</p><p class="elsevierStylePara"> There is now a general agreement that women cannot express informed participation in a population-based cancer screening programme unless they are given honest and balanced information&#44; including explanations about advantages and disadvantages&#46;</p><p class="elsevierStylePara"> Although scientific literature stresses the importance of providing complete and truthful information to facilitate informed choice and participation in screening programmes&#44; the question of how much information can or should be given to support &#40;and not confuse or hinder&#41; decisions is complex&#46;</p><p class="elsevierStylePara"> Some of the issues related to screening have to do with tensions between population and individual interests&#46; While experts argue that more information on the disadvantages of screening would reduce uptake and thus reduce the benefits available at population level&#44; very limited work has been done to test this hypothesis&#46;</p><p class="elsevierStylePara"> There is agreement that the information given about screening is inadequate and the recent revision of the written information material &#40;first invitation letters and leaflets&#41; on mammography provided to women by some European breast cancer screening programmes confirm this belief&#46;</p><p class="elsevierStylePara"> Even if satisfactory to disclose information about the examination modality and the screening aims&#44; written information tools remain still inadequate in managing side effects and risks&#46;</p><p class="elsevierStylePara"> What possible suggestions to promote a real informed participation&#63;</p><p class="elsevierStylePara"> An important aspect of informed choice is that individuals must have access to relevant and appropriate information&#46; Relevant not just from the health professional&#39;s point of view but also from the individual&#39;s point of view&#46;</p><p class="elsevierStylePara"> The starting point for good quality information to enable informed choice is to provide information about the issues of importance to those who are receiving it&#46;</p><p class="elsevierStylePara"> For this reason&#44; researches on what women believe about the disease&#44; what they understood and what they want to know should become a priority&#46;</p><p class="elsevierStylePara"> As far as the communication approach&#44; a multifaceted and multi-level communication strategy should be adopted where differential information&#44; different levels of deepening and the synergy with different communication tools can be tested&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">328 EVALUACI&#211;N DEL IMPACTO EN LA MORTALIDAD MEDIANTE MODELOS EDAD-PERIODO-COHORTE</span></p><p class="elsevierStylePara"> Marina Poll&#225;n Santamar&#237;a</p><p class="elsevierStylePara"><span class="elsevierStyleItalic">Centro Nacional de Epidemiolog&#237;a&#44; Instituto de Salud Carlos III&#44; Espa&#241;a&#46;</span></p><p class="elsevierStylePara"><span class="elsevierStyleBold">Introduction&#58;</span> Decreasing of breast cancer mortality is the final indicator of effectiveness of any given population screening programme&#46; The goal of this presentation is to estimate the reduction in breast cancer mortality in the Autonomous using age-cohort-period &#40;APC&#41; models&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Material and methods&#58;</span> Log-Poisson regression APC models estimate the variability in specific mortality rates associated with the age of death&#44; the period of death and the birth-cohort&#46; The variable period reflects changes produced in a specific moment affecting all age groups &#40;such as changes in diagnosis&#44; treatment and codification&#41;&#44; while the cohort component mirrors variations mainly related with the generation &#40;such as differences in the prevalence of risk factors&#41;&#46; These models have been employed to forecast mortality not too far away from the last period available&#46; Here&#44; the reduction on mortality associated with the screening implantation is evaluated via APC models&#46; Annual age-specific rates of breast cancer mortality during the period&#58; 1980-1999 for age groups 30-34 until 85 and over were computed for every municipality &#40;312&#41;&#46; Numerators came from the Galician Mortality Registry and denominators were interpolated from censuses and municipal population registries&#46; The impact of the screening program was evaluated in two ways&#58; First&#44; fitting an APC model including&#58; age&#44; quinquenium&#44; birth-cohort&#44; a socio-economic index&#44; a variable reflecting rurality &#40;population lower than 3000&#44; 3000-10000 and towns greater than 10000&#41; and the percentage of population covered by the programme as explanatory variables&#46; The &#34;screening&#34; variable was 0 for those years and age-groups that were outside of the programme influence&#46; Secondly&#44; taking into account that the implantation of the screening programme has been progressively made between the years 1993 and 1998&#44; the number of deaths expected in the age groups and towns already screened were computed from an APC model using only those strata outside the influence of the programme&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Results&#58;</span> The strata under the screening programme presented a lower though still not statistically significant mortality for breast cancer &#40;RR per 10&#37; of population covered &#61; 0&#46;98&#59; p&#61;0&#46;074&#41;&#46; In the second approach&#44; the model used to estimate the number of breast cancer cases proved to be very consistent in the strata outside the influence of the program&#46; There was a reduction of 13&#37; in the observed mortality compared with the predicted&#46;</p><p class="elsevierStylePara"><span class="elsevierStyleBold">Comments&#58;</span> Owing to the lack of enough data after the full implantation of the screening programme&#44; it was not possible to consider a latency period in this analysis&#46; We plan to extend it to the following years&#46; For the next period&#44; all Galician municipalities will be under the programme and a real extrapolation should be necessary to extend the APC model&#46;</p>"
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