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Screening has been shown to prevent death from cancers of the breast, colon, and cervix Current cancer screening recommendations from the American Cancer Society, the Canadian Task Force on Preventive Health Care, and the United States Preventive Services Task Force are shown in Table 1 9 The appropriate form and frequency of screening for breast cancer is controversial A large randomized trial of breast self-examination conducted among factory workers in Shanghai found no benefit A systematic review performed for the United States Preventive Services Task Force found that mammography was moderately effective in reducing breast cancer mortality for women 40 74 years of age The absolute benefit was greater for older women, and the risk of false-positive results was high for all women All current recommendations call for cervical and colorectal cancer screening Prostate cancer screening, however, is controversial, as no completed studies have answered the question whether early detection and treatment after screen detection produce sufficient benefits to outweigh harms of treatment Providers and patients are advised to discuss how to proceed in light of this uncertainty Single serum prostate-specific antigen (PSA) measurements appear to offer relatively high sensitivity and specificity to detect prostate cancer The sensitivity is about 65%, the specificity about 80%, and the positive predictive value for prostate cancer is about 45% When both the digital rectal examination and serum PSA are abnormal, PSA specificity increases, but sensitivity falls (to 30%) and predictive value rises only slightly Whether early detection through screening and subsequent treatment alters the natural course of the disease remains to be seen There are still no data on the morbidity and mortality benefits of screening Unlike the American College of Physicians, the American Cancer Society recommends that providers offer annual PSA testing for men over age 50 Screening is not

Mortality rates of cancer have begun to decrease in the past 2 years; part of this decrease results from reductions in tobacco use, since cigarette smoking is the most important preventable cause of cancer Primary prevention of skin cancer consists of restricting exposure to ultraviolet light by wearing appropriate clothing and use of sunscreens In the past 2 decades, there has been a threefold increase in the incidence of squamous cell carcinoma and a fourfold increase in melanoma in the United States Persons who engage in regular physical exercise and avoid obesity have lower rates of breast and colon cancer Prevention of occupationally induced cancers involves minimizing exposure to carcinogenic substances such as asbestos, ionizing radiation, and benzene compounds Chemoprevention has

Table 1 9 Cancer screening recommendations for average-risk adults, 2003

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Some programming languages (such as C++) distinguish between the is-composed-of (composition) and the has-a (aggregation) relationships, but this distinction does not apply in C#, and they are treated as equivalent.

Test Breast Self-examination (BSE) Clinical breast examination Mammography ACS1 Monthly for women over age 20 CTF2 Fair evidence that BSE should not be used Every 1 2 years in women aged 40 59 USPSTF3 Insufficient evidence to recommend for or against Insufficient evidence to recommend for or against Recommended every 1 2 years for women aged 40 and over (B)

due to intertrigo, psoriasis, lichen simplex chronicus, or seborrheic or contact dermatitis (from soaps, colognes, douches, contraceptives, and perhaps scented toilet tissue), or it may be due to irritating secretions, as in diarrhea, leukorrhea, or trichomoniasis, or to local disease (candidiasis, dermatophytosis, erythrasma) Oxyuriasis (pinworm) is a rare cause in adults Lichen sclerosus may at times be the cause Erythrasma is easily diagnosed by demonstration of coral-red fluorescence with Wood s light; it is easily cured with erythromycin orally or topically Uncleanliness may be at fault In pruritus ani, hemorrhoids are often found, and leakage of mucus and bacteria from the distal rectum onto the perianal skin may be important in cases in which no other skin abnormality is found Many women experience pruritus vulvae In women, pruritus ani by itself is rare, and pruritus vulvae does not usually involve the anal area, though anal itching will usually spread to the vulva In men, pruritus of the scrotum is most commonly seen in the absence of pruritus ani Up to one-third of causes of anogenital pruritus may be due to nerve impingements of the lumbosacral spine

Lim ST et al Weekly docetaxel is safe and effective in the treatment of advanced-stage acquired immunodeficiency syndrome-related Kaposi sarcoma Cancer 2005 Jan 15;103(2): 417 21 [PMID: 15578686]

This process of aggregation (or composition) allows you to build very complex classes by assembling and combining relatively simple classes. The .NET Framework provides a String class to handle text strings. You might create your own Address class out of five text strings (address line 1, address line 2, city, state, and zip code). You might then create a second class, Employee, which has as one of its members an instance of Address.

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