Screening for breast cancer : medicalization, visualization and the embodied experience

Women’s perspectives on breast screening (mammography and breast awareness) were explored in interviews with midlife women sampled for diversity of background and health experience. Attending mammography screening was considered a social obligation despite women’s fears and experiences of discomfort. Women gave considerable legitimacy to mammography visualizations of the breast, and the expert interpretation of these. In comparison, women lacked confidence in breast awareness practices, directly comparing their sensory capabilities with those of the mammogram, although mammography screening did not substitute breast awareness in a straightforward way. The authors argue that reliance on visualizing technology may create a fragmented sense of the body, separating the at risk breast from embodied experience

The epidemiology and survival of extrapulmonary small cell carcinoma in South East England, 1970–2004

<p>Abstract</p> <p>Background</p> <p>Extrapulmonary small cell carcinoma (EPSCC) is a rare cancer and few studies describe its epidemiology. Our objectives were to compare the incidence and survival of EPSCC in South East England with small cell carcinoma of the lung (SCLC), to determine the most common anatomical presenting sites for EPSCC and to compare survival in EPSCC by disease stage and site of diagnosis.</p> <p>Methods</p> <p>We used data from the Thames Cancer Registry database for South East England between 1970 and 2004 to determine the incidence, most common anatomical sites, and survival by site, and stage of EPSCC. 1618 patients registered with EPSCC were identified. We calculated the age-standardised incidence rate for EPSCC using the European standard population and compared this to that for SCLC. We calculated survival using the Kaplan-Meier method for EPSCC and SCLC, and reported 3-year survival for different EPSCC anatomical sites and disease stages.</p> <p>Results</p> <p>The incidence of EPSCC was much lower than for SCLC, similar in males and females, and stable throughout the study period, with incidence rates of 0.45 per 100,000 in males and 0.37 in females during 2000–2004. In general, patients with EPSCC had a better 3-year survival (19%) than SCLC (5%). The most common anatomical sites for EPSCC were oesophagus (18%), other gastrointestinal (15%), genitourinary (20%), head and neck (11%), and breast (10%). Breast EPSCC had the best 3-year survival (60%) and gastrointestinal EPSCC the worst (7%).</p> <p>Conclusion</p> <p>This study suggests that EPSCC has a stable incidence and confirms that it presents widely, but most commonly in the oesophagus and breast. Site and extent of disease influence survival, with breast EPSCC having the best prognosis. Further studies using standardised diagnosis, prospective case registers for uncommon diseases and European cancer registries are needed to understand this disease.</p

Socioeconomic and ethnic inequalities in screen-detected breast cancer in London

Background We investigated socioeconomic and ethnic inequalities in screen-detected breast cancer in London—a city with relatively low breast cancer screening uptake and a diverse population.Methods Data on 11 957 breast cancers in London women aged 50–64 between 1998 and 2005 were extracted from the Thames Cancer Registry. We investigated the relationship between socioeconomic deprivation and the incidence and 5-year relative survival of screen-detected and non screen-detected cancers. Using logistic regression analysis we explored whether differences in screen-detected cancers between White, Asian and Black women were influenced by age and socioeconomic deprivation.Results The incidence of screen-detected breast cancer was lower in deprived women and their 5-year relative survival was worse than affluent women. However, survival differences were smaller for screen-detected disease. Among women with breast cancer the odds ratios (OR) for screen-detected disease differed between ethnic groups and these differences were not influenced by adjustment for age and deprivation. Compared with White women, Indian women had higher odds (OR 1.50, 95% confidence interval (1.23–1.84)], and Black Caribbean [0.68 (0.54–0.87)] and Black African women [0.53 (0.38–0.76)] significantly lower odds.Conclusion A sustained focus on increasing screening uptake among deprived women and in Black communities could decrease inequalities in early diagnosis