Christina M. Bancej

Influence of delay to diagnosis on prognostic indicators of screen‐detected breast carcinoma

Although delay to diagnosis after a breast screening abnormality causes anxiety, its effect on prognosis is unknown.

2,4-Dichlorophenoxyacetic acid residues in semen of Ontario farmers

Although paternal exposures to environmental toxicants probably play a role in adverse pregnancy outcomes, few data are available on the extent of this exposure. One semen and two 24-h urine samples were collected from 97 Ontario farmers who had recently used the phenoxy herbicides 2,4-D (2.4-dichlorophenoxyacetic acid) and/or MCPA ([4-chloro-2-methylphenoxyl acetic acid). Both samples were analyzed for 2,4-D using an immunoassay-based technique. Approximately 50% of the semen samples had detectable levels of 2, 4-D (> or =5.0 pph (ng/mL)). Semen levels of 2.4-D were correlated more closely with the second of the two urine samples. Although several studies have measured 2.4-D in the urine of applicators, this study is the first to attempt to measure 2,4-D levels in semen. As these pesticides can be excreted in the semen, they could be toxic to sperm cells and be transported to the woman and developing embryo/fetus. Further research is needed to understand how pesticide handling practices can affect semen pesticide residues and the relationship between the levels observed and reproductive health.

Inconsistent self-reported mammography history: Findings from the National Population Health Survey longitudinal cohort

BackgroundSelf-reported information has commonly been used to monitor mammography utilization across populations and time periods. However, longitudinal investigations regarding the prevalence and determinants of inconsistent responses over time and the impact of such responses on population screening estimates are lacking.MethodsBased on longitudinal panel data for a representative cohort of Canadian women aged 40+ years (n = 3,537) assessed in the 1994–95 (baseline) and 1996–97 (follow-up) National Population Health Survey (NPHS), we examined the prevalence of inconsistent self-reports of mammography utilization. Logistic regression models were used to estimate the associations between womens baseline sociodemographic and health characteristics and 2 types of inconsistent responses: (i) baseline reports of ever use which were subsequently contradicted by follow-up reports of never use; and (ii) baseline reports of never use which were contradicted by follow-up reports of use prior to 1994–95.ResultsAmong women who reported having a mammogram at baseline, 5.9% (95% confidence interval (CI): 4.6–7.3%) reported at follow-up that they had never had one. Multivariate logistic regression analyses showed that women with such inconsistent responses were more often outside target age groups, from low income households and less likely to report hormone replacement therapy and Pap smear use. Among women reporting never use at baseline and ever use at follow-up, 17.4% (95%CI: 11.7–23.1%) reported their most recent mammogram as occurring prior to 1994–95 (baseline) and such responses were more common among women aged 70+ years and those in poorer health.ConclusionsWomen with inconsistent responses of type (i), i.e., ever users at baseline but never users at follow-up, appeared to exhibit characteristics typical of never users of mammography screening. Although limited by sample size, our preliminary analyses suggest that type (ii) responses are more likely to be the result of recall bias due to competing morbidity and age. Inconsistent responses, if removed from the analyses, may be a greater source of loss to follow-up than deaths/institutionalization or item non-response.

The Influence of Breast Self-Examination on Subsequent Mammography Participation

OBJECTIVES We evaluated whether breast self-examination (BSE) influences subsequent mammography participation. METHODS We evaluated associations between BSE and subsequent mammography participation, adjusting for baseline screening behaviors and sociodemographic, health, and lifestyle characteristics, among women aged 40 years and older using data from the longitudinal Canadian National Population Health Survey. RESULTS Regular performance of BSE at baseline was not associated with receipt of a recent mammogram at follow-up among all women (adjusted odds ratio [OR]=1.01; 95% confidence interval [CI]= 0.75, 1.35) or with mammography uptake among the subgroup of women reporting never use at baseline (adjusted OR=0.78; 95% CI=0.50, 1.22). CONCLUSIONS The lack of association between performance of BSE and subsequent mammography participation suggests that not recommending BSE is unlikely to influence mammography participation.

Report of the 2003 Pan-Canadian Forum on Cervical Cancer Prevention and Control: The recommendations reported herein reflect the decisions of the pan-Canadian forum participants as individual experts and do not necessarily reflect official policies of their respective organizations.

OBJECTIVE To develop evidence-based consensus recommendations on the delivery of cervical cancer screening, human papillomavirus (HPV) education, HPV testing, and the optimal tool for cervical cytology within the Canadian health system. PARTICIPANTS Leading up to a forum held in Ottawa on November 21 and 22, 2003, 254 registrants reviewed position papers through a Web-based discussion group. Experts in program management, clinical practice, epidemiology, public health, economics, and womens health, representing 48 organizations, then participated in the 2-day forum to develop consensus recommendations. EVIDENCE Writing groups prepared position papers on optimal methods for cervical cytology; education concerning HPV; HPV testing in primary screening; HPV testing as a triage tool in cytopathology; and delivery mechanisms for cervical screening. Systematic reviews were the primary source of evidence supplemented by literature searches. CONSENSUS PROCESS Feedback from Web-based discussions was incorporated into consecutive drafts of position papers. At the forum, recommendations and supporting evidence were presented, further debated in small-group sessions, and discussed in a plenary session. Despite divergent professional mandates and opinions, consensus was achieved on 15 recommendations across all areas. Final recommendations were posted to the Web for further input and circulated for written consensus by participants. CONCLUSIONS The recommendations cover the use of new evidence and technologies in cervical cancer prevention in Canada and provide a framework for provision of HPV education, planning the implementation of new cervical screening technologies in Canada, the development of evaluation plans, and new research areas.