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Breast (Edinburgh, Scotland) Dec 2022Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVES
Mammographic density is a well-defined risk factor for breast cancer and having extremely dense breast tissue is associated with a one-to six-fold increased risk of breast cancer. However, it is questioned whether this increased risk estimate is applicable to current breast density classification methods. Therefore, the aim of this study was to further investigate and clarify the association between mammographic density and breast cancer risk based on current literature.
METHODS
Medline, Embase and Web of Science were systematically searched for articles published since 2013, that used BI-RADS lexicon 5th edition and incorporated data on digital mammography. Crude and maximally confounder-adjusted data were pooled in odds ratios (ORs) using random-effects models. Heterogeneity regarding breast cancer risks were investigated using I statistic, stratified and sensitivity analyses.
RESULTS
Nine observational studies were included. Having extremely dense breast tissue (BI-RADS density D) resulted in a 2.11-fold (95% CI 1.84-2.42) increased breast cancer risk compared to having scattered dense breast tissue (BI-RADS density B). Sensitivity analysis showed that when only using data that had adjusted for age and BMI, the breast cancer risk was 1.83-fold (95% CI 1.52-2.21) increased. Both results were statistically significant and homogenous.
CONCLUSIONS
Mammographic breast density BI-RADS D is associated with an approximately two-fold increased risk of breast cancer compared to having BI-RADS density B in general population women. This is a novel and lower risk estimate compared to previously reported and might be explained due to the use of digital mammography and BI-RADS lexicon 5th edition.
Topics: Female; Humans; Breast Density; Breast Neoplasms; Mammography; Breast; Risk Factors
PubMed: 36183671
DOI: 10.1016/j.breast.2022.09.007 -
Annals of Internal Medicine Jul 2011Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes. (Review)
Review
BACKGROUND
Approximately 80 million Americans have limited health literacy, which puts them at greater risk for poorer access to care and poorer health outcomes.
PURPOSE
To update a 2004 systematic review and determine whether low health literacy is related to poorer use of health care, outcomes, costs, and disparities in health outcomes among persons of all ages.
DATA SOURCES
English-language articles identified through MEDLINE, CINAHL, PsycINFO, ERIC, and Cochrane Library databases and hand-searching (search dates for articles on health literacy, 2003 to 22 February 2011; for articles on numeracy, 1966 to 22 February 2011).
STUDY SELECTION
Two reviewers independently selected studies that compared outcomes by differences in directly measured health literacy or numeracy levels.
DATA EXTRACTION
One reviewer abstracted article information into evidence tables; a second reviewer checked information for accuracy. Two reviewers independently rated study quality by using predefined criteria, and the investigative team jointly graded the overall strength of evidence.
DATA SYNTHESIS
96 relevant good- or fair-quality studies in 111 articles were identified: 98 articles on health literacy, 22 on numeracy, and 9 on both. Low health literacy was consistently associated with more hospitalizations; greater use of emergency care; lower receipt of mammography screening and influenza vaccine; poorer ability to demonstrate taking medications appropriately; poorer ability to interpret labels and health messages; and, among elderly persons, poorer overall health status and higher mortality rates. Poor health literacy partially explains racial disparities in some outcomes. Reviewers could not reach firm conclusions about the relationship between numeracy and health outcomes because of few studies or inconsistent results among studies.
LIMITATIONS
Searches were limited to articles published in English. No Medical Subject Heading terms exist for identifying relevant studies. No evidence concerning oral health literacy (speaking and listening skills) and outcomes was found.
CONCLUSION
Low health literacy is associated with poorer health outcomes and poorer use of health care services.
PRIMARY FUNDING SOURCE
Agency for Healthcare Research and Quality.
Topics: Educational Status; Health Care Costs; Health Knowledge, Attitudes, Practice; Health Literacy; Health Services; Health Services Accessibility; Healthcare Disparities; Hospitalization; Humans; Outcome Assessment, Health Care; United States
PubMed: 21768583
DOI: 10.7326/0003-4819-155-2-201107190-00005 -
Evidence Report/technology Assessment Mar 2011To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve... (Review)
Review
OBJECTIVES
To update a 2004 systematic review of health care service use and health outcomes related to differences in health literacy level and interventions designed to improve these outcomes for individuals with low health literacy. Disparities in health outcomes and effectiveness of interventions among different sociodemographic groups were also examined.
DATA SOURCES
We searched MEDLINE®, the Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, PsychINFO, and the Educational Resources Information Center. For health literacy, we searched using a variety of terms, limited to English and studies published from 2003 to May 25, 2010. For numeracy, we searched from 1966 to May 25, 2010.
REVIEW METHODS
We used standard Evidence-based Practice Center methods of dual review of abstracts, full-text articles, abstractions, quality ratings, and strength of evidence grading. We resolved disagreements by consensus. We evaluated whether newer literature was available for answering key questions, so we broadened our definition of health literacy to include numeracy and oral (spoken) health literacy. We excluded intervention studies that did not measure health literacy directly and updated our approach to evaluate individual study risk of bias and to grade strength of evidence.
RESULTS
We included good- and fair-quality studies: 81 studies addressing health outcomes (reported in 95 articles including 86 measuring health literacy and 16 measuring numeracy, of which 7 measure both) and 42 studies (reported in 45 articles) addressing interventions. Differences in health literacy level were consistently associated with increased hospitalizations, greater emergency care use, lower use of mammography, lower receipt of influenza vaccine, poorer ability to demonstrate taking medications appropriately, poorer ability to interpret labels and health messages, and, among seniors, poorer overall health status and higher mortality. Health literacy level potentially mediates disparities between blacks and whites. The strength of evidence of numeracy studies was insufficient to low, limiting conclusions about the influence of numeracy on health care service use or health outcomes. Two studies suggested numeracy may mediate the effect of disparities on health outcomes. We found no evidence concerning oral health literacy and outcomes. Among intervention studies (27 randomized controlled trials [RCTs], 2 cluster RCTs, and 13 quasi-experimental designs), the strength of evidence for specific design features was low or insufficient. However, several specific features seemed to improve comprehension in one or a few studies. The strength of evidence was moderate for the effect of mixed interventions on health care service use; the effect of intensive self-management inventions on behavior; and the effect of disease-management interventions on disease prevalence/severity. The effects of other mixed interventions on other health outcomes, including knowledge, self-efficacy, adherence, and quality of life, and costs were mixed; thus, the strength of evidence was insufficient.
CONCLUSIONS
The field of health literacy has advanced since the 2004 report. Future research priorities include justifying appropriate cutoffs for health literacy levels prior to conducting studies; developing tools that measure additional related skills, particularly oral (spoken) health literacy; and examining mediators and moderators of the effect of health literacy. Priorities in advancing the design features of interventions include testing novel approaches to increase motivation, techniques for delivering information orally or numerically, "work around" interventions such as patient advocates; determining the effective components of already-tested interventions; determining the cost-effectiveness of programs; and determining the effect of policy and practice interventions.
Topics: Cause of Death; Emergency Medical Services; Health Literacy; Health Status; Hospitalization; Humans; Influenza Vaccines; Mammography; Outcome Assessment, Health Care; Patient Compliance; Randomized Controlled Trials as Topic
PubMed: 23126607
DOI: No ID Found -
Radiology Oct 2022Background Contrast-enhanced mammography (CEM) is a more accessible alternative to contrast-enhanced MRI (CE-MRI) in breast imaging, but a summary comparison of... (Meta-Analysis)
Meta-Analysis
Background Contrast-enhanced mammography (CEM) is a more accessible alternative to contrast-enhanced MRI (CE-MRI) in breast imaging, but a summary comparison of published studies is lacking. Purpose To directly compare the performance of CEM and CE-MRI regarding sensitivity, specificity, and negative predictive value in detecting breast cancer, involving all publicly available studies in the English language. Materials and Methods Two readers extracted characteristics of studies investigating the comparative diagnostic performance of CEM and CE-MRI in detecting breast cancer. Studies published until April 2021 were eligible. Sensitivity, specificity, negative predictive value, and positive and negative likelihood ratios were calculated using bivariate random effects models. A Fagan nomogram was used to identify the maximum pretest probability at which posttest probabilities of a negative CEM or CE-MRI examination were in line with the 2% malignancy rate benchmark for downgrading a Breast Imaging Reporting and Data System (BI-RADS) category 4 to a BI-RADS category 3 result. statistics, Deeks funnel plot asymmetry test for publication bias, and meta-regression were used. Results Seven studies investigating 1137 lesions (654 malignant, 483 benign) with an average cancer prevalence of 65.3% (range: 47.3%-82.2%) were included. No publication bias was found ( = .57). While the positive likelihood ratio was equal at a value of 3.1 for CE-MRI and 3.6 for CEM, the negative likelihood ratio of CE-MRI (0.04) was lower than that with CEM (0.12). CE-MRI had higher sensitivity for breast cancer than CEM (97% [95% CI: 86, 99] vs 91% [95% CI: 77, 97], respectively; < .001) but lower specificity (69% [95% CI: 46, 85] vs 74% [95% CI: 52, 89]; = .09). A Fagan nomogram demonstrated that the maximum pretest probability at which both tests could rule out breast cancer was 33% for CE-MRI and 14% for CEM. Furthermore, iodine concentration was positively associated with CEM sensitivity and negatively associated with its specificity ( = .04 and < .001, respectively). Conclusion Contrast-enhanced MRI had superior sensitivity and negative likelihood ratios with higher pretest probabilities to rule out malignancy compared with contrast-enhanced mammography. © RSNA, 2022 See also the editorial by Mann and Veldhuis in this issue.
Topics: Breast; Breast Neoplasms; Contrast Media; Female; Humans; Iodine; Magnetic Resonance Imaging; Mammography; Sensitivity and Specificity
PubMed: 36154284
DOI: 10.1148/radiol.212530 -
JAMA Internal Medicine Nov 2023Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests. (Meta-Analysis)
Meta-Analysis
IMPORTANCE
Cancer screening tests are promoted to save life by increasing longevity, but it is unknown whether people will live longer with commonly used cancer screening tests.
OBJECTIVE
To estimate lifetime gained with cancer screening.
DATA SOURCES
A systematic review and meta-analysis was conducted of randomized clinical trials with more than 9 years of follow-up reporting all-cause mortality and estimated lifetime gained for 6 commonly used cancer screening tests, comparing screening with no screening. The analysis included the general population. MEDLINE and the Cochrane library databases were searched, and the last search was performed October 12, 2022.
STUDY SELECTION
Mammography screening for breast cancer; colonoscopy, sigmoidoscopy, or fecal occult blood testing (FOBT) for colorectal cancer; computed tomography screening for lung cancer in smokers and former smokers; or prostate-specific antigen testing for prostate cancer.
DATA EXTRACTION AND SYNTHESIS
Searches and selection criteria followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were independently extracted by a single observer, and pooled analysis of clinical trials was used for analyses.
MAIN OUTCOMES AND MEASURES
Life-years gained by screening was calculated as the difference in observed lifetime in the screening vs the no screening groups and computed absolute lifetime gained in days with 95% CIs for each screening test from meta-analyses or single randomized clinical trials.
RESULTS
In total, 2 111 958 individuals enrolled in randomized clinical trials comparing screening with no screening using 6 different tests were eligible. Median follow-up was 10 years for computed tomography, prostate-specific antigen testing, and colonoscopy; 13 years for mammography; and 15 years for sigmoidoscopy and FOBT. The only screening test with a significant lifetime gain was sigmoidoscopy (110 days; 95% CI, 0-274 days). There was no significant difference following mammography (0 days: 95% CI, -190 to 237 days), prostate cancer screening (37 days; 95% CI, -37 to 73 days), colonoscopy (37 days; 95% CI, -146 to 146 days), FOBT screening every year or every other year (0 days; 95% CI, -70.7 to 70.7 days), and lung cancer screening (107 days; 95% CI, -286 days to 430 days).
CONCLUSIONS AND RELEVANCE
The findings of this meta-analysis suggest that current evidence does not substantiate the claim that common cancer screening tests save lives by extending lifetime, except possibly for colorectal cancer screening with sigmoidoscopy.
Topics: Male; Humans; Early Detection of Cancer; Prostate-Specific Antigen; Mass Screening; Prostatic Neoplasms; Lung Neoplasms; Randomized Controlled Trials as Topic; Colorectal Neoplasms; Colonoscopy; Occult Blood
PubMed: 37639247
DOI: 10.1001/jamainternmed.2023.3798 -
Radiology Mar 2023Background The best supplemental breast cancer screening modality in women at average risk or intermediate risk for breast cancer with dense breast and negative... (Meta-Analysis)
Meta-Analysis
Background The best supplemental breast cancer screening modality in women at average risk or intermediate risk for breast cancer with dense breast and negative mammogram remains to be determined. Purpose To conduct systematic review and meta-analysis comparing clinical outcomes of the most common available supplemental screening modalities in women at average risk or intermediate risk for breast cancer in patients with dense breasts and mammography with negative findings. Materials and Methods A comprehensive search was conducted until March 12, 2020, in Medline, Epub Ahead of Print and In-Process and Other Non-Indexed Citations; Embase Classic and Embase; Cochrane Central Register of Controlled Trials; and Cochrane Database of Systematic Reviews, for Randomized Controlled Trials and Prospective Observational Studies. Incremental cancer detection rate (CDR); positive predictive value of recall (PPV1); positive predictive value of biopsies performed (PPV3); and interval CDRs of supplemental imaging modalities, digital breast tomosynthesis, handheld US, automated breast US, and MRI in non-high-risk patients with dense breasts and mammography negative for cancer were reviewed. Data metrics and risk of bias were assessed. Random-effects meta-analysis and two-sided metaregression analyses comparing each imaging modality metrics were performed (PROSPERO; CRD42018080402). Results Twenty-two studies reporting 261 233 screened patients were included. Of 132 166 screened patients with dense breast and mammography negative for cancer who met inclusion criteria, a total of 541 cancers missed at mammography were detected with these supplemental modalities. Metaregression models showed that MRI was superior to other supplemental modalities in CDR (incremental CDR, 1.52 per 1000 screenings; 95% CI: 0.74, 2.33; < .001), including invasive CDR (invasive CDR, 1.31 per 1000 screenings; 95% CI: 0.57, 2.06; < .001), and in situ disease (rate of ductal carcinoma in situ, 1.91 per 1000 screenings; 95% CI: 0.10, 3.72; < .04). No differences in PPV1 and PPV3 were identified. The limited number of studies prevented assessment of interval cancer metrics. Excluding MRI, no statistically significant difference in any metrics were identified among the remaining imaging modalities. Conclusion The pooled data showed that MRI was the best supplemental imaging modality in women at average risk or intermediate risk for breast cancer with dense breasts and mammography negative for cancer. © RSNA, 2023 See also the editorial by Hooley and Butler in this issue.
Topics: Female; Humans; Breast Neoplasms; Mammography; Breast Density; Early Detection of Cancer; Breast; Mass Screening; Observational Studies as Topic
PubMed: 36719288
DOI: 10.1148/radiol.221785 -
JAMA Oct 2015Patients need to consider both benefits and harms of breast cancer screening. (Review)
Review
IMPORTANCE
Patients need to consider both benefits and harms of breast cancer screening.
OBJECTIVE
To systematically synthesize available evidence on the association of mammographic screening and clinical breast examination (CBE) at different ages and intervals with breast cancer mortality, overdiagnosis, false-positive biopsy findings, life expectancy, and quality-adjusted life expectancy.
EVIDENCE REVIEW
We searched PubMed (to March 6, 2014), CINAHL (to September 10, 2013), and PsycINFO (to September 10, 2013) for systematic reviews, randomized clinical trials (RCTs) (with no limit to publication date), and observational and modeling studies published after January 1, 2000, as well as systematic reviews of all study designs. Included studies (7 reviews, 10 RCTs, 72 observational, 1 modeling) provided evidence on the association between screening with mammography, CBE, or both and prespecified critical outcomes among women at average risk of breast cancer (no known genetic susceptibility, family history, previous breast neoplasia, or chest irradiation). We used summary estimates from existing reviews, supplemented by qualitative synthesis of studies not included in those reviews.
FINDINGS
Across all ages of women at average risk, pooled estimates of association between mammography screening and mortality reduction after 13 years of follow-up were similar for 3 meta-analyses of clinical trials (UK Independent Panel: relative risk [RR], 0.80 [95% CI, 0.73-0.89]; Canadian Task Force: RR, 0.82 [95% CI, 0.74-0.94]; Cochrane: RR, 0.81 [95% CI, 0.74-0.87]); were greater in a meta-analysis of cohort studies (RR, 0.75 [95% CI, 0.69 to 0.81]); and were comparable in a modeling study (CISNET; median RR equivalent among 7 models, 0.85 [range, 0.77-0.93]). Uncertainty remains about the magnitude of associated mortality reduction in the entire US population, among women 40 to 49 years, and with annual screening compared with biennial screening. There is uncertainty about the magnitude of overdiagnosis associated with different screening strategies, attributable in part to lack of consensus on methods of estimation and the importance of ductal carcinoma in situ in overdiagnosis. For women with a first mammography screening at age 40 years, estimated 10-year cumulative risk of a false-positive biopsy result was higher (7.0% [95% CI, 6.1%-7.8%]) for annual compared with biennial (4.8% [95% CI, 4.4%-5.2%]) screening. Although 10-year probabilities of false-positive biopsy results were similar for women beginning screening at age 50 years, indirect estimates of lifetime probability of false-positive results were lower. Evidence for the relationship between screening and life expectancy and quality-adjusted life expectancy was low in quality. There was no direct evidence for any additional mortality benefit associated with the addition of CBE to mammography, but observational evidence from the United States and Canada suggested an increase in false-positive findings compared with mammography alone, with both studies finding an estimated 55 additional false-positive findings per extra breast cancer detected with the addition of CBE.
CONCLUSIONS AND RELEVANCE
For women of all ages at average risk, screening was associated with a reduction in breast cancer mortality of approximately 20%, although there was uncertainty about quantitative estimates of outcomes for different breast cancer screening strategies in the United States. These findings and the related uncertainty should be considered when making recommendations based on judgments about the balance of benefits and harms of breast cancer screening.
Topics: Adult; Biopsy; Breast Neoplasms; Early Detection of Cancer; False Positive Reactions; Female; Humans; Life Expectancy; Mammography; Middle Aged; Physical Examination; Risk; Ultrasonography
PubMed: 26501537
DOI: 10.1001/jama.2015.13183 -
Breast (Edinburgh, Scotland) Aug 2022Breast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little... (Review)
Review
OBJECTIVES
Breast cancer screening guidelines could provide valuable tools for clinical decision making by reviewing the available evidence and providing recommendations. Little information is known about how many countries have issued breast cancer screening guidelines and the differences among existing guidelines. We systematically reviewed current guidelines and summarized corresponding recommendations, to provide references for good clinical practice in different countries.
METHODS
Systematic searches of MEDLINE, EMBASE, Web of Science, and Scopus from inception to March 27th, 2021 were conducted and supplemented by reviewing the guideline development organizations. The quality of screening guidelines was assessed from six domains of the Appraisal of Guidelines for Research and Evaluation Ⅱ (AGREE Ⅱ) instrument by two appraisers. The basic information and recommendations of the issued guidelines were extracted and summarized.
RESULTS
A total of 23 guidelines issued between 2010 and 2021 in 11 countries or regions were identified for further review. The content and quality varied across the guidelines. The average AGREE Ⅱ scores of the guidelines ranged from 33.3% to 87.5%. The highest domain score was "clarity of presentation" while the domain with the lowest score was "applicability". For average-risk women, most of the guidelines recommended mammographic screening for those aged 40-74 years, specifically, those aged 50-69 years were regarded as the optimal age group for screening. Nine of 23 guidelines recommended against an upper age limit for breast cancer screening. Mammography (MAM) was recommended as the primary screening modality for average-risk women by all included guidelines. Most guidelines suggested annual or biennial mammographic screening. Risk factors of breast cancer identified in the guidelines mainly fell within five categories which could be broadly summarized as the personal history of pre-cancerous lesions and/or breast cancer; the family history of breast cancer; the known genetic predisposition of breast cancer; the history of mantle or chest radiation therapy; and dense breasts. For women at higher risk, there was a consensus among most guidelines that annual MAM or annual magnetic resonance imaging (MRI) should be given, and the screening should begin earlier than the average-risk group.
CONCLUSIONS
The majority of 23 included international guidelines were issued by developed countries which contained roughly the same but not identical recommendations on breast cancer screening age, methods, and intervals. Most guidelines recommended annual or biennial mammographic screening between 40 and 74 years for average-risk populations and annual MAM or annual MRI starting from a younger age for high-risk populations. Current guidelines varied in quality and increased efforts are needed to improve the methodological quality of guidance documents. Due to lacking clinical practice guidelines tailored to different economic levels, low- and middle-income countries (LMICs) should apply and implement the evidence-based guidelines with higher AGREE Ⅱ scores considering local adaption.
Topics: Breast; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Mass Screening
PubMed: 35636342
DOI: 10.1016/j.breast.2022.04.003 -
Radiology Jun 2023Background There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically... (Meta-Analysis)
Meta-Analysis
Background There is considerable interest in the potential use of artificial intelligence (AI) systems in mammographic screening. However, it is essential to critically evaluate the performance of AI before it can become a modality used for independent mammographic interpretation. Purpose To evaluate the reported standalone performances of AI for interpretation of digital mammography and digital breast tomosynthesis (DBT). Materials and Methods A systematic search was conducted in PubMed, Google Scholar, Embase (Ovid), and Web of Science databases for studies published from January 2017 to June 2022. Sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) values were reviewed. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Comparative (QUADAS-2 and QUADAS-C, respectively). A random effects meta-analysis and meta-regression analysis were performed for overall studies and for different study types (reader studies vs historic cohort studies) and imaging techniques (digital mammography vs DBT). Results In total, 16 studies that include 1 108 328 examinations in 497 091 women were analyzed (six reader studies, seven historic cohort studies on digital mammography, and four studies on DBT). Pooled AUCs were significantly higher for standalone AI than radiologists in the six reader studies on digital mammography (0.87 vs 0.81, = .002), but not for historic cohort studies (0.89 vs 0.96, = .152). Four studies on DBT showed significantly higher AUCs in AI compared with radiologists (0.90 vs 0.79, < .001). Higher sensitivity and lower specificity were seen for standalone AI compared with radiologists. Conclusion Standalone AI for screening digital mammography performed as well as or better than radiologists. Compared with digital mammography, there is an insufficient number of studies to assess the performance of AI systems in the interpretation of DBT screening examinations. © RSNA, 2023 See also the editorial by Scaranelo in this issue.
Topics: Female; Humans; Artificial Intelligence; Breast Neoplasms; Early Detection of Cancer; Mammography; Breast; Retrospective Studies
PubMed: 37219445
DOI: 10.1148/radiol.222639 -
International Journal of Nursing Studies Oct 2020Early detection of cancer serves an important strategy for cancer control, but its uptake rate remains relatively limited. Nurse-led interventions may have potential... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Early detection of cancer serves an important strategy for cancer control, but its uptake rate remains relatively limited. Nurse-led interventions may have potential benefits for the early detection of cancer, but the evidence remains unclear.
OBJECTIVES
Synthesise the evidence on the impact of nurse-led interventions on early cancer detection. The primary outcome was early cancer detection uptake rate. Secondary outcomes were cancer knowledge, early detection beliefs, diagnosed precancerous lesions and early-stage cancers.
DESIGN
A systematic review and meta-analysis of randomised controlled trails.
DATA SOURCES
Eight English language databases (British Nursing Index, Cochrane Central Register of Controlled Trials, CINAHL Complete, EMBASE, Ovid Emcare, Medline, Scopus, Web of Science Core Collection) and three Chinese language databases (Chinese Biomedical Literature Databases, China Journal Net, and Wanfang Data) were searched from inception date to September 2019. Grey literature and reference lists of included studies were also examined.
REVIEW METHODS
Two reviewers independently assessed eligibility, extracted data and evaluated methodological quality using the Cochrane risk of bias (RoB 2.0) tool. Meta-analyses and descriptive analyses were used. Subgroup analyses were conducted for study settings and intervention types.
RESULTS
Ten studies examined the effects of nurse-led interventions, including education, patient reminders, counselling, and patient navigation, on early detection of breast or cervical cancer, colorectal cancer, and lung cancer. Nurse-led interventions improved the uptake rates of mammography [risk ratio (RR) = 1.97; 95% confidence interval (CI): 1.17-3.33; p = 0.01], clinical breast examination (RR = 2.16; 95% CI: 1.02-4.59; p = 0.05), regular breast self-examination (RR = 2.01; 95% CI: 1.54-2.63; p < 0.001), and colonoscopy (RR = 1.90; 95% CI: 1.57-2.30; p < 0.001), but not of faecal blood occult tests. Subgroup analyses showed significantly improved mammography and clinical breast examination uptake rates for interventions conducted at health centres, and that patient navigation had better effects on improving colonoscopy uptake rates than did counselling. The intervention also improved cancer knowledge, early detection beliefs, and cases of detected precancerous lesions.
CONCLUSIONS
Nurse-led interventions may improve early cancer detection uptake rates, cancer knowledge, early detection beliefs, and cases of detected precancerous lesions. The effects of nurse-led interventions conducted in home settings on improving mammography and clinical breast examination uptake rates may need further exploration. Patient navigation may be superior to counselling in improving colonoscopy uptake rates. Social media may be an option for delivering early cancer detection guidance, but needs to be further explored. Tweetable abstract: Nurse-led interventions have potential effects on promoting early detection of cancer.
Topics: China; Early Detection of Cancer; Humans; Neoplasms; Nurse's Role; Patient Navigation
PubMed: 32702568
DOI: 10.1016/j.ijnurstu.2020.103684