Unnecessary ultrasonography as supplier‐induced demand in diagnosis of primary breast cancer in Iran: A cross‐sectional study

Author(s):  
Mohammad Akbari ◽  
Abbas Assari Arani ◽  
Mohammad Esmaeil Akbari ◽  
Bahram Sahabi ◽  
Alireza Olyaeemanesh ◽  
...  
Author(s):  
Mohammad Akbari ◽  
Abbas Assari Arani ◽  
Mohammad Esmaeil Akbari ◽  
Bahram Sahabi ◽  
Alireza Olyaeemanesh

Background: Supplier-induced demand (SID) refers to the concept that healthcare providers may deliver services to patients that are not medically necessary. An estimation of the extent to which this event has occurred can be insightful for policymaking and guiding health systems. This study aimed to investigate the extent to which SID presents itself during diagnostic MRI (magnetic resonance imaging) for primary breast cancer. Methods: In this cross-sectional study, data were obtained using questionnaires from a random sample of 310 cases. To identify patients who were candidates for undergoing a necessary diagnostic MRI, we employed the international clinical guidelines with the confirmation of our expert panelists. With their assistance, a comprehensive index was created to screen those who were affected by SID. Results: Of the respondents, 94.1% had undergone an unnecessary diagnostic MRI and, thus, were likely affected by SID, which indicated the lack of sovereignty of clinical guidelines in the prescription of MRI diagnosis imaging. Conclusion: This study supported the SID hypothesis and the unnecessary demand for diagnostic MRI in primary breast cancer. In addition, our evidence indicated that excessive costs were imposed; these can positively influence policymakers’ decisions regarding healthcare management. 


Breast Care ◽  
2020 ◽  
pp. 1-7
Author(s):  
Elna Kuehnle ◽  
Wulf Siggelkow ◽  
Kristina Luebbe ◽  
Iris Schrader ◽  
Karl-Heinz Noeding ◽  
...  

<b><i>Background:</i></b> Although immigrant health is an important issue in national health policy, there is a serious shortage of data in many countries. Most studies lack information on educational status, which is a major limitation. This prospective cross-sectional study analyzed a real-world breast cancer population on the influence of immigration background and educational status on participation in breast cancer early detection programs in the federal state of Lower Saxony, Germany. <b><i>Methods:</i></b> Data collection was conducted from 2012 to 2016 in six certified breast cancer centers using a standardized questionnaire for patients’ interview and tumor-specific data from the patients’ medical records. <b><i>Results:</i></b> 2,145/3,047 primary breast cancer cases were analyzed. 17.5% of our patients had a history of immigration, including <i>n</i> = 202 first-generation immigrants and <i>n</i> = 168 second-generation immigrants. Most of them were citizens of EU27 member states. No significant difference was seen in age, tumor stage, histology, grading, Ki-67, Her2/neu-status, and hormone receptor status compared to the native cohort. 100% participation rate in the breast cancer early detection programs were seen in patients with no school graduation. With regards to the national mammography screening program, participation decreased significantly with educational status (<i>p</i> = 0.0003). <b><i>Conclusions:</i></b> No tumor biological differences were seen between immigrants and German natives. In first-generation immigrants, early detection programs were well accepted despite sociocultural and language differences. Participation rate decreased significantly with higher education levels irrespective of country of origin. Immigration background does not have a negative effect on the participation in breast cancer screening. This mainly relates to immigrants from EU27 member states.


2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hlma Ismail ◽  
Mosa Shibani ◽  
Hanaa Wael Zahrawi ◽  
Ali Fouad Slitin ◽  
Mhd Amin Alzabibi ◽  
...  

Abstract Background Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students’ knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors. Methods This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother’s education, and source of information. Unpaired Student’s T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption. Results Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years). Conclusion This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.


2021 ◽  
Author(s):  
Nitikorn Phoosuwan ◽  
Pranee C. Lundberg

Abstract Background: Globally, breast cancer is commonly found among women, and Sweden has the largest number of new cases diagnosed. Treatment leads to increased survival of patients, but they are at risk to experience psychological distress, including anxiety and depressive symptoms, and decreased health-related quality of life (HRQoL). This study investigated relationship between psychological distress and HRQoL, and related factors among women with breast cancer in Sweden.Methods: This descriptive cross-sectional study was conducted in Sweden. A total of 481 women with breast cancer from a list of a regional cancer centre answered a questionnaire about sociodemographic factors, social support, psychological distress and HRQoL. Data were subjected to Pearson’s correlation and linear regression analyzes. Results: Psychological distress was related to HRQoL in terms of body image, future perspective, side effects of systemic therapy, breast symptoms, arm symptoms, and hair loss. Lower age was likely to increase symptoms of anxiety, and undergone breast reconstruction was likely to increase symptoms of depression. Breast reconstruction and chemotherapy worsened body image, low support from partner decreased sexual functioning and enjoyment, and low support from physicians and nurses worsened future perspective, side effects of systemic therapy, breast symptoms and indignation about hair loss.Conclusions: Psychological distress were correlated with the HRQoL. Increased support from physicians, nurses, and partner may increase the HRQoL among women with breast cancer. Treatments of women with breast cancer, such as breast reconstruction and chemotherapy were factors that decreased the psychological distress and increased the HRQoL.


2020 ◽  
Vol 26 (1) ◽  
pp. 6-9
Author(s):  
Soheila Sayad ◽  
Seyyed Ahmadi ◽  
Reza Nekouian ◽  
Mahshid Panahi ◽  
Khatereh Anbari

Background: Present study aimed to investigate immunohistochemical parameters in post-surgical cases of invasive breast cancer. Methods: In this single center cross-sectional study we investigated ethnicity, familial history, type of cancer, stage of cancer, lymph node positivity, bilateral involvement, metastasis and immunohistochemical parameters (estrogen and progesterone receptor, human epidermal growth factor receptor 2, as well as frequency of triple positive and triple negative patients merely based on immunohistochemical parameters). Results: Frequency of positive familial history was 27.42% (16.31-38.52%). Lymph node involvement was detected in 55.93% (43.26-68.60%) of the cases. Frequency of positive HER2 was 38.60% (25.96-51.23%). There were 17.54% (7.67-27.42%) of triple positive and 7.02% (0.39-13.65%) of triple negative cases. The most common stage at the time of diagnosis was stage 3 with 43.33% (30.79-55.87%) frequency. In Lur/Lak population higher frequency of positive HER2 cases was detected whereas in Mazani population frequency of positive HER2 cases was low (p=0.0291). Conclusions: These results could contribute to understanding of breast cancer patterns among different ethnicities. In order to draw clear conclusion future investigations have to be done in several health centers, for longer time periods and with larger number of patients.


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