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Holman LL, Lu KH, Bast RC, Hernandez MA, Bodurka DC, Skates S, Sun CC. Risk perception, worry, and test acceptance in average-risk women who undergo ovarian cancer screening. Am J Obstet Gynecol 2014; 210:257.e1-6. [PMID: 24246524 PMCID: PMC4001707 DOI: 10.1016/j.ajog.2013.11.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Revised: 10/15/2013] [Accepted: 11/13/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE We evaluated baseline knowledge of ovarian cancer risk and perceptions toward ovarian cancer screening (OCS) by initiating the normal risk ovarian screening study. STUDY DESIGN Average-risk, postmenopausal women were enrolled between 2001 and 2011 as they entered the normal risk ovarian screening study. Participants completed baseline surveys of risk perception, cancer worry (Cancer Worry Scale), anxiety (State-Trait Anxiety Inventory), health and well-being survey (SF-36 HEALTH SURVEY), and acceptability of OCS. RESULTS Of the 1242 women who were enrolled, 925 women (74.5%) completed surveys. The respondents estimated a mean lifetime risk of ovarian cancer of 29.9%, which is much higher than the actual risk of 1.4% for women in the United States. Only 2.8% of participants correctly estimated their risk; 35.4% of the participants reported their lifetime risk to be ≥50%. Cancer worry was low, with a median Cancer Worry Scale score of 7 of 24. Anxiety was comparable with published norms for women in this age group, with median STAI-State and STAI-Trait scores of 30 and 29 of 80, respectively. Overall, women reported good physical and mental well-being. In terms of OCS acceptability, 97.2% of respondents agreed or strongly agreed that "the benefits of screening outweigh the difficulties." Very few women were reluctant to undergo OCS because of time constraints (1.1%), pain (2.0%), or embarrassment (1.9%). CONCLUSION Average-risk women who underwent OCS highly overestimated their risk of ovarian cancer. Despite this, participants reported low cancer worry and anxiety. The discrepancy between knowledge of and attitudes toward ovarian cancer risk highlights the need for educational efforts in this area.
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Affiliation(s)
- Laura L Holman
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Karen H Lu
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Robert C Bast
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Mary A Hernandez
- Department of Experimental Therapeutics, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Diane C Bodurka
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven Skates
- Biostatistics Center, Massachusetts General Hospital, Boston, MA
| | - Charlotte C Sun
- Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
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Tan ASL, Gibson L, Zafar HM, Gray SW, Hornik RC, Armstrong K. Associations between cancer-related information seeking and receiving PET imaging for routine cancer surveillance--an analysis of longitudinal survey data. Cancer Epidemiol Biomarkers Prev 2014; 23:481-9. [PMID: 24550351 PMCID: PMC3951580 DOI: 10.1158/1055-9965.epi-13-0999] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Routine cancer surveillance with positron emission tomography (PET) is not recommended for most patients who have completed curative treatment for cancer. Yet, recent trends suggest that PET is increasingly used for follow-up among patients with cancer. This study investigates whether information-seeking behaviors predicted self-reported utilization of PET for routine surveillance in patients with colorectal, breast, and prostate cancer. METHODS We conducted annual surveys for 3 years in a cohort of Pennsylvania cancer survivors diagnosed with colorectal, breast, or prostate cancer in 2005. The outcome was self-reported PET receipt for routine surveillance among 944 patients diagnosed with nonmetastatic disease (stages 0-III). Predictors included cancer-related information seeking from nonmedical sources and providers. Weighted multiple logistic regression analyses were performed. RESULTS In this population, 11% of patients reported receiving at least one PET scan for routine follow-up in a 12-month period several years after diagnosis. Seeking cancer-related information from nonmedical sources was associated with higher odds of subsequent reported PET use [OR, 3.7; 95% confidence interval (CI), 1.1-12.1; P = 0.032], after adjusting for potential confounders. Patient engagement with physicians about cancer-related information was not a significant predictor. CONCLUSIONS Overall reported PET utilization for routine surveillance of colorectal, breast, and prostate cancer is low. However, we found a significant association with information seeking from nonmedical sources but not from providers. IMPACT Exposure to cancer-related information through mass media and lay interpersonal sources may be driving inappropriate utilization of high-cost advanced imaging procedures. These findings have important implications for cancer survivors, healthcare providers, and health policy.
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Affiliation(s)
- Andy SL Tan
- Center of Excellence in Cancer Communication Research, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104
| | - Laura Gibson
- Center of Excellence in Cancer Communication Research, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104
| | - Hanna M. Zafar
- Department of Radiology, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104
| | - Stacy W. Gray
- Population Sciences, Center for Community Based Research, Lowe Center for Thoracic Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02115
| | - Robert C Hornik
- Center of Excellence in Cancer Communication Research, Annenberg School for Communication, University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104
| | - Katrina Armstrong
- Department of Medicine, Massachusetts General Hospital, 55 Fruit Street, GRB 740, Boston, MA 02114
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Royak-Schaler R, Cheuvront B, Wilson KR, Williams CM. Addressing women's breast cancer risk and perceptions of control in medical settings. J Clin Psychol Med Settings 2013; 3:185-99. [PMID: 24226756 DOI: 10.1007/bf01993905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many women with family histories of breast cancer deal with two distinct but related issues: their objective physical risk and the emotions this risk engenders. Studies indicate that approximately 70% of African American and white women are concerned about their chances of developing breast cancer someday and perceive themselves to be at risk. Health care providers, including psychologists, need to be aware of the special needs and psychosocial concerns of high-risk women with family histories of breast cancer, since perceptions of breast cancer risk influence screening practices. Providers need training in understanding the significance of specific family patterns of breast cancer, screening guidelines appropriate for women at risk, and the benefits and risks of available prevention options, including genetic screening. Delivering accurate information about both established risk factors known to elevate personal risk, such as age and family history, and factors which women associate with breast cancer, such as bumping and bruising a breast, smoking, and oral contraceptive use, is essential for promoting accurate risk perceptions and appropriate screening schedules.
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Affiliation(s)
- R Royak-Schaler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Henneman L, Oosterwijk JC, van Asperen CJ, Menko FH, Ockhuysen-Vermey CF, Kostense PJ, Claassen L, Timmermans DR. The effectiveness of a graphical presentation in addition to a frequency format in the context of familial breast cancer risk communication: a multicenter controlled trial. BMC Med Inform Decis Mak 2013; 13:55. [PMID: 23627498 PMCID: PMC3644257 DOI: 10.1186/1472-6947-13-55] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2012] [Accepted: 04/22/2013] [Indexed: 11/24/2022] Open
Abstract
Background Inadequate understanding of risk among counselees is a common problem in familial cancer clinics. It has been suggested that graphical displays can help counselees understand cancer risks and subsequent decision-making. We evaluated the effects of a graphical presentation in addition to a frequency format on counselees’ understanding, psychological well-being, and preventive intentions. Design: Multicenter controlled trial. Setting: Three familial cancer clinics in the Netherlands. Methods Participants: Unaffected women with a breast cancer family history (first-time attendees). Intervention: Immediately after standard genetic counseling, an additional consultation by a trained risk counselor took place where women were presented with their lifetime breast cancer risk in frequency format (X out of 100) (n = 63) or frequency format plus graphical display (10 × 10 human icons) (n = 91). Main outcome measures: understanding of risk (risk accuracy, risk perception), psychological well-being, and intentions regarding cancer prevention. Measurements were assessed using questionnaires at baseline, 2-week and 6-month follow-up. Results Baseline participant characteristics did not differ between the two groups. In both groups there was an increase in women’s risk accuracy from baseline to follow-up. No significant differences were found between women who received the frequency format and those who received an additional graphical display in terms of understanding, psychological well-being and intentions regarding cancer prevention. The groups did not differ in their evaluation of the process of counseling. Conclusion Women’s personal risk estimation accuracy was generally high at baseline and the results suggest that an additional graphical display does not lead to a significant benefit in terms of increasing understanding of risk, psychological well-being and preventive intentions. Trial registration Current Controlled Trials http://ISRCTN14566836
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Affiliation(s)
- Lidewij Henneman
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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O'Neill SC, DeFrank JT, Vegella P, Richman AR, Henry LR, Carey LA, Brewer NT. Engaging in health behaviors to lower risk for breast cancer recurrence. PLoS One 2013; 8:e53607. [PMID: 23326466 PMCID: PMC3543271 DOI: 10.1371/journal.pone.0053607] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Accepted: 11/30/2012] [Indexed: 11/18/2022] Open
Abstract
PURPOSE While post-treatment breast cancer survivors face up to twice the cancer risk of the general population, modifiable health behaviors may somewhat reduce this risk. We sought to better understand health behaviors that early stage breast cancer survivors engage in to reduce recurrence risk. METHODS Data came from a cross-sectional multi-site survey of 186 early-stage breast cancer survivors who received genomic testing for breast cancer recurrence risk (Oncotype DX) during their clinical care. Study outcomes were meeting health behavior recommendations (daily fruit and vegetable intake, regular physical activity, and having a healthy body mass index (BMI)). RESULTS Approximately three-quarters of survivors we surveyed believed the 3 behaviors might reduce their cancer risk but many did not engage in these behaviors for this purpose: 62% for BMI, 36% for fruit and vegetable consumption, and 37% for physical activity. Survivors with higher recurrence risk, as indicated by their genomic test results, were no more likely to meet any of the three health behavior recommendations. Adherence to health behavior recommendations was higher for women who were white, college-educated, and had higher incomes. CONCLUSIONS Many nonadherent breast cancer survivors wish to use these behavioral strategies to reduce their risk for recurrence, suggesting an important opportunity for intervention. Improving BMI, which has the largest association with cancer risk, is an especially promising target.
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Affiliation(s)
- Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, United States of America.
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Kasparian NA, Bränström R, Chang YM, Affleck P, Aspinwall LG, Tibben A, Azizi E, Baron-Epel O, Battistuzzi L, Bruno W, Chan M, Cuellar F, Debniak T, Pjanova D, Ertmanski S, Figl A, Gonzalez M, Hayward NK, Hocevar M, Kanetsky PA, Leachman S, Bergman W, Heisele O, Palmer J, Peric B, Puig S, Schadendorf D, Gruis NA, Newton-Bishop J, Brandberg Y. Skin examination behavior: the role of melanoma history, skin type, psychosocial factors, and region of residence in determining clinical and self-conducted skin examination. ACTA ACUST UNITED AC 2013; 148:1142-51. [PMID: 22801744 DOI: 10.1001/archdermatol.2012.1817] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVE To examine the frequency and correlates of skin examination behaviors in an international sample of individuals at varying risk of developing melanoma. DESIGN A cross-sectional, web-based survey. SETTING Data were collected from the general population over a 20-month period on behalf of the Melanoma Genetics Consortium (GenoMEL). PARTICIPANTS A total of 8178 adults from Northern (32%), Central (33%), and Southern (14%) Europe, Australia (13%), and the United States (8%). MAIN OUTCOME MEASURES Self-reported frequency of skin self-examination (SSE) and clinical skin examination (CSE). RESULTS After adjustment for age and sex, frequency of skin examination was higher in both Australia (odds ratio [OR]SSE=1.80 [99% CI, 1.49-2.18]; ORCSE=2.68 [99% CI, 2.23-3.23]) and the United States (ORSSE=2.28 [99% CI, 1.76-2.94]; ORCSE=3.39 [99% CI, 2.60-4.18]) than in the 3 European regions combined. Within Europe, participants from Southern Europe reported higher rates of SSE than those in Northern Europe (ORSSE=1.61 [99% CI, 1.31-1.97]), and frequency of CSE was higher in both Central (ORCSE=1.47 [99% CI, 1.22-1.78]) and Southern Europe (ORCSE=3.46 [99% CI, 2.78, 4.31]) than in Northern Europe. Skin examination behavior also varied according to melanoma history: participants with no history of melanoma reported the lowest levels of skin examination, while participants with a previous melanoma diagnosis reported the highest levels. After adjustment for region, and taking into account the role of age, sex, skin type, and mole count, engagement in SSE and CSE was associated with a range of psychosocial factors, including perceived risk of developing melanoma; perceived benefits of, and barriers to, skin examination; perceived confidence in one's ability to engage in screening; and social norms. In addition, among those with no history of melanoma, higher cancer-related worry was associated with greater frequency of SSE. CONCLUSIONS Given the strong association between psychosocial factors and skin examination behaviors, particularly among people with no history of melanoma, we recommend that greater attempts be made to integrate psycho-education into the fabric of public health initiatives and clinical care, with clinicians, researchers, and advocacy groups playing a key role in guiding individuals to appropriate tools and resources.
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Affiliation(s)
- Nadine A Kasparian
- School of Women’s and Children’s Health, Faculty of Medicine, University of New South Wales, Kensington, NSW, Australia.
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Kuppermann M, Wang G, Wong S, Blanco A, Conrad P, Nakagawa S, Terdiman J, Ladabaum U. Preferences for outcomes associated with decisions to undergo or forgo genetic testing for Lynch syndrome. Cancer 2013; 119:215-25. [PMID: 22786716 PMCID: PMC4356667 DOI: 10.1002/cncr.27634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Revised: 02/24/2012] [Accepted: 04/11/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Current guidelines recommend offering genetic testing for Lynch syndrome to individuals whose tumors suggest this condition and to relatives of affected individuals. Little is known, however, regarding how patients view the prospect of such testing. In addition, data on preferences (utilities) for the potential outcomes of testing decisions for use in cost-effectiveness analyses are lacking. METHODS Time tradeoff utilities were elicited for 10 potential outcomes of Lynch syndrome testing decisions and 3 associated cancers from 70 participants, representing a range of knowledge about and experiences with Lynch syndrome. RESULTS Highest mean utilities were assigned to scenarios in which only the assessor's sibling had Lynch-associated colorectal cancer (ranging from 0.669 ± 0.231 to 0.760 ± 0.220). Utilities assigned to scenarios in which the assessor had Lynch-associated colorectal cancer ranged from 0.605 ± 0.252 to 0.682 ± 0.246, whereas the lowest mean utilities were assigned to 2 of the general cancer states (0.601 ± 0.238 and 0.593 ± 0.272 for colorectal and ovarian cancer respectively). Only 43% of the sample assigned higher values to undergoing Lynch testing and receiving negative results versus forgoing Lynch testing, whereas 50% assigned higher values to undergoing rather than forgoing surgery to prevent a subsequent cancer. CONCLUSIONS Genetic testing for Lynch syndrome, regardless of results, can have profound effects on quality of life; the utilities we collected can be used to incorporate these effects into cost-effectiveness analyses. Importantly, preferences for the potential outcomes of testing vary substantially, calling into question the extent to which patients would avail themselves of such testing if it were offered to them.
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Affiliation(s)
- Miriam Kuppermann
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, USA.
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Tan ASL, Moldovan-Johnson M, Gray SW, Hornik RC, Armstrong K. An analysis of the association between cancer-related information seeking and adherence to breast cancer surveillance procedures. Cancer Epidemiol Biomarkers Prev 2012; 22:167-74. [PMID: 23118144 DOI: 10.1158/1055-9965.epi-12-0781] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Breast cancer surveillance is important for women with a known history of breast cancer. However, relatively little is known about the prevalence and determinants of adherence to surveillance procedures, including associations with seeking of cancer-related information from medical and nonmedical sources. METHODS We conducted a longitudinal cohort study of breast cancer patients diagnosed in Pennsylvania in 2005. Our main analyses included 352 women who were eligible for surveillance and participated in both baseline (~1 year after cancer diagnosis) and follow-up surveys. Outcomes were self-reported doctor visits and physical examination, mammography, and breast self-examination (BSE) at 1-year follow-up. RESULTS Most women underwent two or more physical examinations according to recommended guidelines (85%). For mammography, 56% of women were adherent (one mammogram in a year) while 39% reported possible overuse (two or more mammograms). Approximately 60% of respondents reported regular BSE (≥ 5 times in a year). Controlling for potential confounders, higher levels of cancer-related information seeking from nonmedical sources at baseline was associated with regular BSE (OR, 1.52; 95% CI, 1.01-2.29; P, 0.046). There was no significant association between information-seeking behaviors from medical or nonmedical sources and surveillance with physical examination or mammography. CONCLUSIONS Seeking cancer-related information from nonmedical sources is associated with regular BSE, a surveillance behavior that is not consistently recommended by professional organizations. IMPACT Findings from this study will inform clinicians on the contribution of active information seeking toward breast cancer survivors' adherence to different surveillance behaviors.
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Affiliation(s)
- Andy S L Tan
- University of Pennsylvania, 3620 Walnut Street, Philadelphia, PA 19104, USA.
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Pelletier M, Knäuper B, Loiselle CG, Perreault R, Mizrahi C, Dubé L. Moderators of psychological recovery from benign cancer screening results. ACTA ACUST UNITED AC 2012; 19:e191-200. [PMID: 22670109 DOI: 10.3747/co.19.935] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The sudden confrontation of a potential health threat such as cancer, even after the diagnosis turns out to be benign, can have enduring adverse psychological consequences, including persistent anxiety, cancer fears, and other manifestations of psychological distress. The present study examines factors that potentially moderate psychological recovery among women who face a breast cancer threat. DESIGN Participants were adult women had just received a benign outcome from a breast cancer diagnostic procedure that had been conducted because of suspicion of breast cancer (a non-conclusive mammography or ultrasonography result, a referral from their doctor because of pain or family history, detection of a lump, a 6-month follow-up appointment after a breast abnormality from a previous screening or diagnostic procedure, or a fluid leak from one or both breasts). We measured several psychological traits at Time 1 (right after receipt of the "no cancer" feedback) and then each month for the next 3 months. Analyses examined the factors that hindered or facilitated psychological recovery from the cancer threat. RESULTS Results showed that trait anxiety and family history of cancer hindered recovery and that older age and optimism facilitated recovery and lessened adverse psychological consequences. Self-regulatory strategies such as planful problem-solving, positive reappraisal, and mastery facilitated recovery. CONCLUSIONS Our findings shed light on the factors that are implicated in psychological recovery from a benign breast cancer outcome after a diagnostic procedure (ultrasonography, repeat or initial mammography, stereotactic biopsy, fine-needle aspiration, or ultrasound-guided biopsy). Those factors could be used to identify women who may experience prolonged psychological distress, so as to assist them when they face stressful diagnostic concerns.
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Affiliation(s)
- M Pelletier
- Department of Adult Education and Counselling Psychology, Ontario Institute for Studies in Education, University of Toronto, Toronto, ON
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Vyas A, Madhavan S, LeMasters T, Atkins E, Gainor S, Kennedy S, Kelly K, Vona-Davis L, Remick S. Factors influencing adherence to mammography screening guidelines in Appalachian women participating in a mobile mammography program. J Community Health 2012; 37:632-46. [PMID: 22033614 DOI: 10.1007/s10900-011-9494-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
The objectives of this study were to evaluate the characteristics (demographic, access to care, health-related behavioral, self and family medical history, psychosocial) of women age 40 years and above who participated in a mobile mammography screening program conducted throughout West Virginia (WV) to determine the factors influencing their self-reported adherence to mammography screening guidelines. Data were analyzed using the Andersen Behavioral Model of Healthcare Utilization framework to determine the factors associated with adherence to mammography screening guidelines in these women. Of the 686 women included in the analysis, 46.2% reported having had a mammogram in the past 2 years. Bivariate analyses showed predisposing factors such as older age and unemployed status, visit to a obstetrician/gynecologist (OB/GYN) in the past year (an enabling factor) and need-related factors such as having a family history of breast cancer (BC), having had breast problems in the past, having had breast biopsy in the past, having had a Pap test in past 2 years, and having had all the screenings for cholesterol, blood glucose, bone mineral density and high blood pressure in past 2 years to be significant predictors of self-reported adherence to mammography guidelines. In the final model, being above 50 years (OR=2.132), being morbidly obese (OR=2.358), having BC-related events and low knowledge about mammography were significant predictors of self-reported adherence. Breast cancer related events seem to be associated with mammography screening adherence in this rural Appalachian population. Increasing adherence to mammography screening may require targeted, community-based educational interventions that precede and complement visits by the mobile mammography unit.
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Affiliation(s)
- Ami Vyas
- Department of Pharmaceutical Systems and Policy, School of Pharmacy, Robert C. Byrd Health Sciences Center (North), West Virginia University, Morgantown, WV 26506-9510, USA.
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Psychosocial and Quality of Life in Women Receiving the 21-Gene Recurrence Score Assay: The Impact of Decision Style in Women with Intermediate RS. J Cancer Epidemiol 2012; 2012:728290. [PMID: 22899924 PMCID: PMC3413972 DOI: 10.1155/2012/728290] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Revised: 06/07/2012] [Accepted: 06/12/2012] [Indexed: 11/23/2022] Open
Abstract
Multigene assays such as the 21-gene recurrence score (RS) quantify risk for recurrence and potential benefit from chemotherapy in early-stage, ER+ breast cancers. Few studies have assessed the impact of testing on patient-reported outcomes such as cancer-related distress or quality of life. The few studies that have assessed these outcomes do not consider potential modifiers, such as the patients' level of involvement in the treatment decision-making process. In the current study, 81 breast cancer patients who received the RS assay completed cross-sectional surveys. We used linear multiple regression to assess whether test result, decision-making role (passive versus shared/active), and their interaction contributed to current levels of distress, quality of life, and decisional conflict. There were no associations between these variables and test result or decision-making role. However, women who received an intermediate RS and took a passive role in their care reported higher-cancer-related distress and cancer worry and lower quality of life than those who took a shared or active role. These data should be confirmed in prospective samples, as these poorer outcomes could be amenable to intervention.
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Worry is good for breast cancer screening: a study of female relatives from the ontario site of the breast cancer family registry. J Cancer Epidemiol 2012; 2012:545062. [PMID: 22792104 PMCID: PMC3391896 DOI: 10.1155/2012/545062] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2012] [Accepted: 04/27/2012] [Indexed: 11/17/2022] Open
Abstract
Background. Few prospective studies have examined associations between breast cancer worry and screening behaviours in women with elevated breast cancer risks based on family history. Methods. This study included 901 high familial risk women, aged 23-71 years, from the Ontario site of the Breast Cancer Family Registry. Self-reported breast screening behaviours at year-one followup were compared between women at low (N = 305), medium (N = 433), and high (N = 163) levels of baseline breast cancer worry using logistic regression. Nonlinear relationships were assessed using likelihood ratio tests. Results. A significant non-linear inverted "U" relationship was observed between breast cancer worry and mammography screening (P = 0.034) for all women, where women at either low or high worry levels were less likely than those at medium to have a screening mammogram. A similar significant non-linear inverted "U" relationship was also found among all women and women at low familial risk for worry and screening clinical breast examinations (CBEs). Conclusions. Medium levels of cancer worries predicted higher rates of screening mammography and CBE among high-risk women.
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Sie AS, Spruijt L, van Zelst-Stams WAG, Mensenkamp AR, Ligtenberg MJ, Brunner HG, Prins JB, Hoogerbrugge N. DNA-testing for BRCA1/2 prior to genetic counselling in patients with breast cancer: design of an intervention study, DNA-direct. BMC WOMENS HEALTH 2012; 12:12. [PMID: 22569005 PMCID: PMC3416735 DOI: 10.1186/1472-6874-12-12] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2011] [Accepted: 05/08/2012] [Indexed: 12/23/2022]
Abstract
Background Current practice for patients with breast cancer referred for genetic counseling, includes face-to-face consultations with a genetic counselor prior to and following DNA-testing. This is based on guidelines regarding Huntington’s disease in anticipation of high psychosocial impact of DNA-testing for mutations in BRCA1/2 genes. The initial consultation covers generic information regarding hereditary breast cancer and the (im)possibilities of DNA-testing, prior to such testing. Patients with breast cancer may see this information as irrelevant or unnecessary because individual genetic advice depends on DNA-test results. Also, verbal information is not always remembered well by patients. A different format for this information prior to DNA-testing is possible: replacing initial face-to-face genetic counseling (DNA-intake procedure) by telephone, written and digital information sent to patients’ homes (DNA-direct procedure). Methods/design In this intervention study, 150 patients with breast cancer referred to the department of Clinical Genetics of the Radboud University Nijmegen Medical Centre are given the choice between two procedures, DNA-direct (intervention group) or DNA-intake (usual care, control group). During a triage telephone call, patients are excluded if they have problems with Dutch text, family communication, or of psychological or psychiatric nature. Primary outcome measures are satisfaction and psychological distress. Secondary outcome measures are determinants for the participant’s choice of procedure, waiting and processing times, and family characteristics. Data are collected by self-report questionnaires at baseline and following completion of genetic counseling. A minority of participants will receive an invitation for a 30 min semi-structured telephone interview, e.g. confirmed carriers of a BRCA1/2 mutation, and those who report problems with the procedure. Discussion This study compares current practice of an intake consultation (DNA-intake) to a home informational package of telephone, written and digital information (DNA-direct) prior to DNA-testing in patients with breast cancer. The aim is to determine whether DNA-direct is an acceptable procedure for BRCA1/2 testing, in order to provide customized care to patients with breast cancer, cutting down on the period of uncertainty during this diagnostic process. Trial registration The study is registered at the Dutch Trial Registry http://www.trialregister.nl (NTR3018).
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Affiliation(s)
- Aisha S Sie
- Department of Human Genetics, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Phillips KM, McGinty HL, Gonzalez BD, Jim HSL, Small BJ, Minton S, Andrykowski MA, Jacobsen PB. Factors associated with breast cancer worry 3 years after completion of adjuvant treatment. Psychooncology 2012; 22:936-9. [PMID: 22419546 DOI: 10.1002/pon.3066] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 02/03/2012] [Accepted: 02/14/2012] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Although many survivors continue to worry about cancer years after completing treatment, little is known about factors associated with cancer worry. This study examined associations between breast cancer worry and demographic and clinical variables, as well as fatigue, symptom burden, and risk perception in a sample of breast cancer survivors 3 years post-adjuvant treatment. We hypothesized that after controlling for demographic and treatment factors, a significant proportion of variance in cancer worry would be explained by greater fatigue severity, more symptom burden, and greater perceived risk of recurrence. METHODS Stage 0-II breast cancer patients (N = 202) completed measures of risk perception, cancer worry (modified Lerman's Cancer Worry Scale), symptom burden (Memorial Symptom Assessment Scale), and fatigue severity (Fatigue Symptom Inventory) 3 years after completing adjuvant treatment. Multiple regression analyses were used to determine the proportion of variance in cancer worry accounted for by fatigue, symptom burden, and risk perception after controlling for demographic and clinical variables. RESULTS Age, fatigue, symptom burden, and risk perception each explained a significant proportion of variance in cancer worry (p < 0.05). Fatigue, symptom burden, and risk perception together accounted for 27% of the variance in cancer worry after controlling for demographic and clinical factors (p < 0.01). CONCLUSIONS The hypothesis was supported that fatigue, symptom burden, and risk perception are associated with cancer worry among breast cancer survivors. It is possible that lingering fatigue and other symptoms may remind breast cancer survivors of their disease.
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Affiliation(s)
- Kristin M Phillips
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL 33612, USA
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65
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Hilgart JS, Coles B, Iredale R. Cancer genetic risk assessment for individuals at risk of familial breast cancer. Cochrane Database Syst Rev 2012; 2012:CD003721. [PMID: 22336791 PMCID: PMC7154385 DOI: 10.1002/14651858.cd003721.pub3] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND The recognition of an inherited component to breast cancer has led to an increase in demand for information, reassurance, and genetic testing, which has resulted in the creation of genetic clinics for familial cancer. The first step for patients referred to a cancer genetic clinic is a risk assessment. OBJECTIVES To evaluate the impact of cancer genetic risk-assessment services on patients at risk of familial breast cancer. SEARCH METHODS The specialised register maintained by the Cochrane Breast Cancer Group was searched on 16th February 2005. We also searched MEDLINE, EMBASE, CINAHL, PsycLIT, CENTRAL, DARE, ASSIA, Web of Science, SIGLE and LILACS. The original searches covered the period 1985 to February 2005. We also handsearched relevant journals. For this review update the search was repeated through to April 2011. SELECTION CRITERIA We considered trials looking at interventions for cancer genetic risk-assessment services for familial breast cancer for inclusion. Trials assessed outcomes such as understanding of risk, satisfaction and psychological well-being. We excluded studies if they concerned cancers other than breast cancer or if participants were not at risk of inherited breast cancer. We also excluded trials concerning the provision of general cancer genetic information or education as this review was concerned with the delivery of genetic risk assessment. Participants could be individuals of any age or gender, with or without a known BRCA mutation, but without a previous history of breast cancer or any other serious illness. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. Additional information was sought from investigators as necessary. Due to the heterogeneity of both the interventions and outcomes, we reported data descriptively. MAIN RESULTS In this review update, we included five new trials, bringing the total number of included studies to eight. The included trials (pertaining to 10 papers), provided data on 1973 participants and assessed the impact of cancer genetic risk assessment on outcomes including perceived risk of inherited cancer, and psychological distress. This review suggests that cancer genetic risk-assessment services help to reduce distress, improve the accuracy of the perceived risk of breast cancer, and increase knowledge about breast cancer and genetics. The health professional delivering the risk assessment does not appear to have a significant impact on these outcomes. AUTHORS' CONCLUSIONS This review found favourable outcomes for patients after risk assessment for familial breast cancer. However, there were too few papers to make any significant conclusions about how best to deliver cancer genetic risk-assessment services. Further research is needed assessing the best means of delivering cancer risk assessment, by different health professionals, in different ways and in alternative locations.
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Affiliation(s)
- Jennifer S Hilgart
- Institute of Medical Genetics, Cardiff University, Heath Park, Cardiff, Wales, UK, CF14 4XN
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66
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Hartman SJ, Dunsiger SI, Marcus BH. A pilot study of a physical activity intervention targeted towards women at increased risk for breast cancer. Psychooncology 2011; 22:381-7. [PMID: 22135183 DOI: 10.1002/pon.2101] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2011] [Revised: 10/06/2011] [Accepted: 10/19/2011] [Indexed: 01/01/2023]
Abstract
OBJECTIVE The objective was to pilot test a physical activity intervention targeted towards women with a first-degree relative with breast cancer. METHODS Sedentary women (n = 27) with at least one first-degree relative with breast cancer but no personal breast cancer diagnosis received a print-based physical activity intervention. The intervention was a 12-week theory-based and individually tailored physical activity intervention targeted towards women with a family history of breast cancer. Participants' minutes of physical activity, worry about breast cancer, perceived risk of developing breast cancer, and perceived control over breast cancer risk were assessed at baseline and 12 weeks. RESULTS There was a significant increase in minutes of moderate to vigorous intensity physical activity from baseline to 12 weeks (t = 4.93, p < 0.001), with a mean increase in physical activity of 130.56 min/week (SD = 137.50). At 12 weeks, 41% met the American College of Sports Medicine criteria of engaging in 150 min or more of moderate intensity activity. Regression models indicate that change in perceived risk of breast cancer was significantly associated with change in physical activity (t = -2.36, p = 0.03, r = 0.34), with decreases in perceived risk associated with increases in physical activity over time. CONCLUSIONS Findings suggest that a targeted intervention can increase physical activity and decrease perceived risk of breast cancer.
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Affiliation(s)
- Sheri J Hartman
- Department of Family and Preventive Medicine, University of California, San Diego, CA 92093-0901, USA.
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67
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Roussi P, Sherman KA, Miller SM, Hurley K, Daly MB, Godwin A, Buzaglo JS, Wen KY. Identification of cognitive profiles among women considering BRCA1/2 testing through the utilisation of cluster analytic techniques. Psychol Health 2011; 26:1327-43. [PMID: 21756124 PMCID: PMC3197930 DOI: 10.1080/08870446.2010.521938] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Based on the cognitive-social health information processing model, we identified cognitive profiles of women at risk for breast and ovarian cancer. Prior to genetic counselling, participants (N = 171) completed a study questionnaire concerning their cognitive and affective responses to being at genetic risk. Using cluster analysis, four cognitive profiles were generated: (a) high perceived risk/low coping; (b) low value of screening/high expectancy of cancer; (c) moderate perceived risk/moderate efficacy of prevention/low informativeness of test result; and (d) high efficacy of prevention/high coping. The majority of women in Clusters One, Two and Three had no personal history of cancer, whereas Cluster Four consisted almost entirely of women affected with cancer. Women in Cluster One had the highest number of affected relatives and experienced higher levels of distress than women in the other three clusters. These results highlight the need to consider the psychological profile of women undergoing genetic testing when designing counselling interventions and messages.
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Affiliation(s)
- Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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68
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Hartman SJ, Dunsiger SI, Jacobsen PB. The relationship of psychosocial factors to mammograms, physical activity, and fruit and vegetable consumption among sisters of breast cancer patients. Int J Womens Health 2011; 3:257-63. [PMID: 21892336 PMCID: PMC3163655 DOI: 10.2147/ijwh.s23246] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Indexed: 01/22/2023] Open
Abstract
This study examined the relationship of psychosocial factors to health-promoting behaviors in sisters of breast cancer patients. One hundred and twenty sisters of breast cancer patients completed questionnaires assessing response efficacy of mammography screenings, physical activity, and fruit and vegetable consumption on decreasing breast cancer risk, breast cancer worry, involvement in their sister’s cancer care, mammography screenings, physical activity, and fruit and vegetable consumption. Results indicate that greater perceived effectiveness for mammograms was associated with a 67% increase in odds of yearly mammograms. Greater involvement in the patient’s care was associated with a 7% decrease in odds of yearly mammograms. Greater perceived effectiveness for physical activity was significantly related to greater physical activity. There was a trend for greater perceived effectiveness for fruits and vegetables to be associated with consuming more fruits and vegetables. Breast cancer worry was not significantly associated with the outcomes. While perceived effectiveness for a specific health behavior in reducing breast cancer risk was consistently related to engaging in that health behavior, women reported significantly lower perceived effectiveness for physical activity and fruits and vegetables than for mammograms. Making women aware of the health benefits of these behaviors may be important in promoting changes.
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Affiliation(s)
- Sheri J Hartman
- Centers for Behavioral and Preventive Medicine, The Miriam Hospital and W Alpert Medical School of Brown University, Providence, RI
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69
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van Lier MGF, Korsse SE, Mathus-Vliegen EMH, Kuipers EJ, van den Ouweland AMW, Vanheusden K, van Leerdam ME, Wagner A. Peutz-Jeghers syndrome and family planning: the attitude towards prenatal diagnosis and pre-implantation genetic diagnosis. Eur J Hum Genet 2011; 20:236-9. [PMID: 21829227 DOI: 10.1038/ejhg.2011.152] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Peutz-Jeghers syndrome (PJS) is a hereditary disorder caused by LKB1 gene mutations, and is associated with considerable morbidity and decreased life expectancy. This study was conducted to assess the attitude of PJS patients towards family planning, prenatal diagnosis (PND) and pregnancy termination, and pre-implantation genetic diagnosis (PGD). In a cross-sectional study, 61 adult PJS patients were asked to complete a questionnaire concerning genetic testing, family planning, PND and PGD. The questionnaire was completed by 52 patients (85% response rate, 44% males) with a median age of 44 (range 18-74) years. A total of 37 (71%) respondents had undergone genetic testing. In all, 24 respondents (46%, 75% males) had children. A total of 15 (29%) respondents reported that their diagnosis of PJS had influenced their decisions regarding family planning, including 10 patients (19%, 9/10 females) who did not want to have children because of their disease. Termination of pregnancy after PND in case of a foetus with PJS was considered 'acceptable' for 15% of the respondents, whereas 52% considered PGD acceptable. In conclusion, the diagnosis of PJS influences the decisions regarding family planning in one third of PJS patients, especially in women. Most patients have a negative attitude towards pregnancy termination after PND, while PGD in case of PJS is judged more acceptable. These results emphasise the importance of discussing aspects regarding family planning with PJS patients, including PND and PGD.
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Affiliation(s)
- Margot G F van Lier
- Departments of Gastroenterology and Hepatology, Erasmus University Medical Centre, Rotterdam, The Netherlands
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70
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Jensen JD, Bernat JK, Davis LA, Yale R. Dispositional cancer worry: convergent, divergent, and predictive validity of existing scales. J Psychosoc Oncol 2011; 28:470-89. [PMID: 20730660 DOI: 10.1080/07347332.2010.498459] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Past research has suggested that dispositional cancer worry may be a key predictor of health behavior. The current study examined seven measures of dispositional cancer worry to see if they were significantly related (convergent validity), significantly different from similar but distinct traits (divergent validity), and capable of predicting cancer-relevant outcomes (predictive validity). Four hundred and eighty nine undergraduate students completed a survey measuring dispositional worry, dispositional cancer worry, and perceived cancer risk. Factor analysis identified four underlying dimensions that explained 67.3% of the variance in dispositional cancer worry: severity (42.8%), frequency (12.3%), psychological reactance (6.9%), and worry impact (5.3%). Four existing measures of dispositional cancer worry were found to represent each of these dimensions. In general, dispositional cancer worry measures were highly correlated with one another and only moderately correlated with measures of dispositional worry, supporting strong convergent and divergent validity. Hierarchical regression analyses revealed that dispositional cancer worry measures predicted significant variance in cancer-relevant outcomes above and beyond dispositional worry. The results of the current study support the notion that dispositional cancer worry and dispositional worry are distinct constructs. Furthermore, two dimensions of dispositional cancer worry (severity and frequency) seemed to have the strongest convergent, divergent, and predictive validity.
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Affiliation(s)
- Jakob D Jensen
- Department of Communication & Oncological Sciences Center, Discovery Park, Purdue University, West Lafayette, IN 47907, USA.
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71
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Kelly KM, Shedlosky-Shoemaker R, Porter K, Desimone P, Andrykowski M. Cancer recurrence worry, risk perception, and informational-coping styles among Appalachian cancer survivors. J Psychosoc Oncol 2011; 29:1-18. [PMID: 21240722 DOI: 10.1080/07347332.2011.534014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite a growing literature on the psychosocial impact of the threat of cancer recurrence, underserved populations, such as those from the Appalachian region, have been understudied. To examine worry and perceived risk in cancer survivors, Appalachian and non-Appalachian cancer patients at an ambulatory oncology clinic in a university hospital were surveyed. Appalachians had significantly higher worry than non-Appalachians. Cancer type and lower need for cognition were associated with greater worry. Those with missing perceived risk data were generally older, less educated, and lower in monitoring, blunting, and health literacy. Additional resources are needed to assist Appalachians and those with cancers with poor prognoses (e.g., liver cancer, pancreatic cancer) to cope with worry associated with developing cancer again. More attention for cancer prevention is critical to improve quality of life in underserved populations where risk of cancer is greater.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506, USA.
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72
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Quillin JM, Bodurtha JN, McClish D, Wilson DB. Genetic risk, perceived risk, and cancer worry in daughters of breast cancer patients. J Genet Couns 2011; 20:157-64. [PMID: 21132457 PMCID: PMC4870590 DOI: 10.1007/s10897-010-9336-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Accepted: 11/08/2010] [Indexed: 10/18/2022]
Abstract
This study explored relationships between worry, perceived risk for breast cancer, consulting a genetic counselor, having genetic testing, and genetic risk for women whose mothers had breast cancer. Analyses involved data from a community-based phone survey of women whose mothers had breast cancer. Participants were categorized as having low, intermediate, or high genetic risk based on their reported family history, in accordance with an accepted classification scheme. The Lerman Breast Cancer Worry Scale measured worry, and participants reported their perceived lifetime likelihood of breast cancer, risk compared to others, and chance from 1 to 100. ANOVA, chi-square, and multiple regression analyses were conducted as appropriate. One hundred-fifty women participated. Mean age was 38 years, and 81% were Caucasian. Fifty-two women had low, 74 had intermediate, and 24 had high genetic risk for breast cancer. There were no significant differences in worry or perceived risk by hereditary risk category. Most high-risk women (91%) had not spoken with a genetic counselor, and no one had previous genetic testing. These findings suggest perceived risk, worry about breast cancer, and use of expert consultation do not match the genetic contribution to risk. There is a need for effectively stratifying and communicating risk in the community and providing tailored reassurance or referral for high-risk assessment.
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Affiliation(s)
- John M Quillin
- Department of Human & Molecular Genetics and Massey Cancer Center, Virginia Commonwealth University, 1101 E. Marshall St, Richmond, VA 23298-0033, USA.
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73
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Bowen DJ, Robbins R, Bush N, Meischke H, Ludwig A, Wooldridge J. Effects of a Web-based intervention on women's breast health behaviors. Transl Behav Med 2011; 1:155-164. [PMID: 21643515 PMCID: PMC3104848 DOI: 10.1007/s13142-011-0028-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Helping women make choices to reduce cancer risk and to improve breast health behaviors is important, but the best ways to reach more people with intervention assistance is not known. To test the efficacy of a Web-based intervention designed to help women make better breast health choices, we adapted our previously tested, successful breast health intervention package to be delivered on the Internet, and then we tested it in a randomized trial. We recruited women from the general public to be randomized to either an active intervention group or a delayed intervention control group. The intervention consisted of a specialized Web site providing tailored and personalized risk information to all participants, followed by offers of additional support if needed. Follow-up at 1-year post-randomization revealed significant improvements in mammography screening in intervention women compared with control women (improvement of 13 percentage points). The intervention effects were more powerful in women who increased breast health knowledge and decreased cancer worry during intervention. These data indicate that increases in mammography can be accomplished in population-based mostly insured samples by implementing this simple, low resource intensive intervention.
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Affiliation(s)
- Deborah J Bowen
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
- />Department of Community Sciences, Boston University School of Public Health, 801 Massachusetts Avenue, Boston, MA 02118 USA
| | - Robert Robbins
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Nigel Bush
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Hendrika Meischke
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Abi Ludwig
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
| | - Jean Wooldridge
- />Fred Hutchinson Cancer Research Center, 1100 Fairview Ave. N., MP-900, Seattle, WA 98109-1024 USA
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74
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Salz T, DeFrank JT, Brewer NT. False positive mammograms in Europe: do they affect reattendance? Breast Cancer Res Treat 2010; 127:229-31. [PMID: 21052828 DOI: 10.1007/s10549-010-1245-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2010] [Accepted: 10/22/2010] [Indexed: 11/25/2022]
Affiliation(s)
- Talya Salz
- Department of Epidemiology and Biostatistics, Health Outcomes Research Group, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA.
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75
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Doughty Rice C, Ruschman JG, Martin LJ, Manders JB, Miller E. Retrospective comparison of patient outcomes after in-person and telephone results disclosure counseling for BRCA1/2 genetic testing. Fam Cancer 2010; 9:203-12. [PMID: 20473602 DOI: 10.1007/s10689-009-9303-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Telephone disclosure of BRCA1/2 molecular genetic test results has been proposed as a feasible alternative to traditional in-person results disclosure. The purpose of this study was to investigate the relationship between method of result disclosure with the patient outcome variables of knowledge, cancer worry, cancer risk perception, satisfaction, and cancer screening and prophylactic surgery behaviors. Study participants included 228 women who completed retrospective, self-administered, mailed surveys regarding their pre-test genetic counseling and results disclosure. No significant relationships were found between result disclosure method and the outcome variables investigated. A majority (90%) of individuals who received positive results by telephone returned for follow up visits. Factors which genetic counselors believed influenced their clinical decision to offer telephone disclosure, such as history of breast cancer, a priori risk of genetic mutation and family history of known mutation were not shown to significantly impact the actual disclosure method. This study suggests that telephone results disclosure is clinically appropriate when counselors utilize their clinical judgment to determine which patients are appropriate candidates.
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Affiliation(s)
- Courtney Doughty Rice
- Genetic Counseling Graduate Program, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, USA
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76
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Roussi P, Sherman KA, Miller S, Buzaglo J, Daly M, Taylor A, Ross E, Godwin A. Enhanced counselling for women undergoing BRCA1/2 testing: Impact on knowledge and psychological distress-results from a randomised clinical trial. Psychol Health 2010; 25:401-15. [PMID: 20204945 DOI: 10.1080/08870440802660884] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This randomised controlled trial evaluated the impact of an enhanced counselling (EC) intervention on knowledge about the heritability of breast and ovarian cancer and distress, as a function of BRCA test result, among high-risk women. Before deciding about whether or not to undergo genetic testing, participants were randomly assigned to the EC intervention (N = 69), designed to promote cognitive and affective processing of cancer risk information (following the standard individualised counselling session), or to the control condition (N = 65), which involved standard individualised counselling followed by a general health information session to control for time and attention. Women in the EC group exhibited greater knowledge than women in the control group, 1 week after the intervention. Further, at the affective level, the intervention was found to be the most beneficial for women testing positive: specifically 1 week after test result disclosure, women in the intervention group who tested positive experienced lower levels of distress than women in the control group who tested positive. The findings suggest that the design of counselling aids should include a component that explicitly activates the individual's cognitive-affective processing system.
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Affiliation(s)
- Pagona Roussi
- Department of Psychology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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77
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Preferences for surveillance strategies for women treated for high-grade precancerous cervical lesions. Gynecol Oncol 2010; 118:108-15. [PMID: 20553960 DOI: 10.1016/j.ygyno.2010.05.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2010] [Revised: 04/29/2010] [Accepted: 05/01/2010] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Data are lacking on how women view alternative approaches to surveillance for cervical cancer after treatment of high-grade cervical intraepithelial neoplasia. We measured and compared patient preferences (utilities) for scenarios with varying surveillance strategies and outcomes to inform guidelines and cost-effectiveness analyses of post-treatment surveillance options. METHODS English- or Spanish-speaking women who had received an abnormal Pap test result within the past 2 years were recruited from general gynecology and colposcopy clinics and newspaper and online advertisements in 2007 and 2008. Participation consisted of one face-to-face interview, during which utilities for 11 different surveillance scenarios and their associated outcomes were elicited using the time tradeoff metric. A sociodemographic questionnaire also was administered. RESULTS 65 women agreed to participate and successfully completed the preference elicitation exercises. Mean utilities ranged from 0.989 (undergoing only a Pap test, receiving normal results) to 0.666 (invasive cervical cancer treated with radical hysterectomy or radiation and chemotherapy). Undergoing both Pap and HPV tests and receiving normal/negative results had a lower mean utility (0.953) then undergoing only a Pap test and receiving normal results (0.989). Having both tests and receiving normal Pap but positive HPV results was assigned an even lower mean utility (0.909). 15.9% of the respondents gave higher utility scores to the Pap plus HPV testing scenario (with normal/negative results) than to the "Pap test alone" scenario (with normal results), while 17.5% gave the Pap test alone scenario a higher utility score. CONCLUSIONS Preferences for outcomes ending with normal results but involving alternative surveillance processes differ substantially. The observed differences in utilities have important implications for clinical guidelines and cost-effectiveness analyses.
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Halbert CH, Kessler L, Troxel AB, Stopfer JE, Domchek S. Effect of genetic counseling and testing for BRCA1 and BRCA2 mutations in African American women: a randomized trial. Public Health Genomics 2010; 13:440-8. [PMID: 20234119 DOI: 10.1159/000293990] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2009] [Accepted: 08/31/2009] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Limited empirical data are available on the effects of genetic counseling and testing among African American women. OBJECTIVE To evaluate the effects of genetic counseling and testing in African American women based on different levels of exposure: (a) women who were randomized to culturally tailored (CTGC) and standard genetic counseling (SGC) to women who declined randomization (non-randomized group), (b) participants and non-participants in genetic counseling, and (c) BRCA1 and BRCA2 (BRCA1/2) test result acceptors and decliners. DESIGN Randomized trial of genetic counseling conducted from February 2003 to November 2006. MEASURES We evaluated changes in perceived risk of developing breast cancer and cancer worry. RESULTS Women randomized to CTGC and SGC did not differ in terms of changes in risk perception and cancer worry compared to decliners. However, counseling participants had a significantly greater likelihood of reporting reductions in perceived risk compared to non-participants (p = 0.03). Test result acceptors also had a significantly greater likelihood of reporting decreases in cancer worry (p = 0.03). However, having a cancer history (p = 0.03) and a BRCA1/2 prior probability (p = 0.04) were associated with increases in cancer worry. CONCLUSIONS Although CTGC did not lead to significant improvements in perceived risk or psychological functioning, African American women may benefit from genetic counseling and testing. Continued efforts should be made to increase access to genetic counseling and testing among African American women at increased risk for hereditary disease. But, follow-up support may be needed for women who have a personal history of cancer and those with a greater prior probability of having a BRCA1/2 mutation.
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Affiliation(s)
- C H Halbert
- Center for Community-Based Research and Health Disparities, University of Pennsylvania, Philadelphia, PA 19104, USA.
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79
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DeFrank JT, Brewer N. A model of the influence of false-positive mammography screening results on subsequent screening. Health Psychol Rev 2010; 4:112-127. [PMID: 21874132 PMCID: PMC3160720 DOI: 10.1080/17437199.2010.500482] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.
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Affiliation(s)
- Jessica T. DeFrank
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Noel Brewer
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
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Caruso A, Vigna C, Marozzo B, Sega FM, Sperduti I, Cognetti F, Savarese A. Subjective versus objective risk in genetic counseling for hereditary breast and/or ovarian cancers. JOURNAL OF EXPERIMENTAL & CLINICAL CANCER RESEARCH : CR 2009; 28:157. [PMID: 20025726 PMCID: PMC2806303 DOI: 10.1186/1756-9966-28-157] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/11/2009] [Accepted: 12/21/2009] [Indexed: 12/03/2022]
Abstract
Background Despite the fact that genetic counseling in oncology provides information regarding objective risks, it can be found a contrast between the subjective and objective risk. The aims of this study were to evaluate the accuracy of the perceived risk compared to the objective risk estimated by the BRCApro computer model and to evaluate any associations between medical, demographic and psychological variables and the accuracy of risk perception. Methods 130 subjects were given medical-demographic file, Cancer and Genetic Risk Perception, Hospital Anxiety-Depression Scale. It was also computed an objective evaluation of the risk by the BRCApro model. Results The subjective risk was significantly higher than objective risk. The risk of tumour was overestimated by 56%, and the genetic risk by 67%. The subjects with less cancer affected relatives significantly overestimated their risk of being mutation carriers and made a more innacurate estimation than high risk subjects. Conclusion The description of this sample shows: general overestimation of the risk, inaccurate perception compared to BRCApro calculation and a more accurate estimation in those subjects with more cancer affected relatives (high risk subjects). No correlation was found between the levels of perception of risk and anxiety and depression. Based on our findings, it is worth pursuing improved communication strategies about the actual cancer and genetic risk, especially for subjects at "intermediate and slightly increased risk" of developing an hereditary breast and/or ovarian cancer or of being mutation carrier.
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Affiliation(s)
- Anita Caruso
- Prevention and Training Activities in Psycho-Oncology, National Cancer Institute Regina Elena, Rome, Italy.
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81
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Stewart SL, Rakowski W, Pasick RJ. Behavioral constructs and mammography in five ethnic groups. HEALTH EDUCATION & BEHAVIOR 2009; 36:36S-54S. [PMID: 19805790 PMCID: PMC2921882 DOI: 10.1177/1090198109338918] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intention, self-efficacy, perceived susceptibility, perceived benefits, and subjective norms are key constructs of health behavior theories; their predictive validity for cancer screening has not been ascertained in multiethnic populations. Participants were 1,463 African American, Chinese, Filipina, Latina, and White women aged 40 to 74 interviewed by telephone in their preferred languages. The relationship between baseline constructs and mammography 2 years later was assessed using multivariable logistic regression. Intention predicted mammography overall and among Whites (odds ratio [OR] = 5.0, 95% confidence interval [CI] = 2.4, 10), with racial/ethnic differences in association (p = .020). Self-efficacy predicted mammography overall and among Whites (OR = 3.5, 95% CI = 1.1, 11), with no racial/ethnic interaction. Perceived benefits and subjective norms were associated with screening overall and in some racial/ethnic groups. These results generally support cross-cultural applicability of four of the five constructs to screening with mixed predictive value of measures across racial/ethnic groups. Additional in-depth inquiry is required to refine assessment of constructs.
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Affiliation(s)
- Susan L Stewart
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA 94143-0981, USA.
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82
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Park ER, Ostroff JS, Rakowski W, Gareen IF, Diefenbach MA, Feibelmann S, Rigotti NA. Risk perceptions among participants undergoing lung cancer screening: baseline results from the National Lung Screening Trial. Ann Behav Med 2009; 37:268-79. [PMID: 19711141 DOI: 10.1007/s12160-009-9112-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2008] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Lung cancer screening could present a "teachable moment" for promoting smoking cessation and relapse prevention. Understanding the risk perceptions of older individuals who undergo screening will guide these efforts. PURPOSE This paper examines National Lung Screening Trial (NLST) participants' perceptions of risk for lung cancer and other smoking-related diseases. We investigated (1) whether risk perceptions of lung cancer screening participants differed between current and former smokers and (2) which factors (sociodemographic, smoking and medical history, cognitive, emotional, and knowledge) were associated with these risk perceptions. METHODS We analyzed baseline data collected from 630 NLST participants prior to their initial screen. Participants were older (55-74 years), heavy (minimum 30 pack years) current or former smokers. A ten-item risk perception measure was developed to assess perceived lifetime risk of lung cancer and other smoking-related diseases. RESULTS The risk perception measure had excellent internal consistency (alpha = 0.93). Former smokers had lower risk perceptions compared to current smokers. Factors independently associated with high risk perceptions among current smokers included having a personal history of a smoking-related disease, higher lifetime maximum number of cigarettes smoked daily, having lived with a smoker, high worry, high perceived severity of lung cancer and smoking-related diseases, and accurate knowledge of tenfold increased risk of lung cancer for a one pack per day smoker. Factors independently associated with high risk perceptions among former smokers included being White, past history of smoking within 30 min of waking, high worry, and accurate knowledge of tenfold increased risk of lung cancer for a one pack per day smoker. CONCLUSIONS Using a comprehensive risk perception measurement, we found that current and former smokers held different risk perceptions. Former and current smokers' smoking and medical history, race, emotional concerns, behavior change cognitions, and knowledge should be considered during a prescreening risk communication session. We highlight the theoretical and risk communication implications for former and current smokers undergoing lung cancer screening.
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Affiliation(s)
- Elyse R Park
- Massachusetts General Hospital/Harvard Medical School, 50 Staniford Street, 9th Floor, Boston, MA 02114, USA.
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83
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Interest in genetic testing among affected men from hereditary prostate cancer families and their unaffected male relatives. Genet Med 2009; 11:344-55. [PMID: 19346959 DOI: 10.1097/gim.0b013e31819b2425] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE The objective of this study was to evaluate potential sociodemographic, medical, psychosocial, and behavioral correlates of interest in genetic testing in men from hereditary prostate cancer families. METHODS Family members affected with prostate cancer (n = 559) and their unaffected male relatives (n = 370) completed a mailed survey. Multivariable logistic regression models were used to examine the association between potential correlates and interest in genetic testing for prostate cancer. RESULTS Forty-five percent of affected and 56% of unaffected men reported that they definitely would take a genetic test for prostate cancer. More affected men reported high levels of familiarity with genetic testing than unaffected men (46 vs. 25%). There were several variables that were significantly correlated with interest in either affected or unaffected men, but only age and familiarity with genetics were significant in both groups. After controlling for confounding variables, only familiarity remained a significant correlate in both groups. CONCLUSIONS The contrast between low levels of familiarity with genetics and high test interest among unaffected men highlights the need for increased educational efforts targeting hereditary prostate cancer families. Overall, results illuminated several novel characteristics of men from hereditary prostate cancer families that should be considered when developing future informed consent procedures or educational materials for prostate cancer genetic testing.
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84
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Gierisch JM, O'Neill SC, Rimer BK, DeFrank JT, Bowling JM, Skinner CS. Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol 2009; 33:72-8. [PMID: 19481879 DOI: 10.1016/j.cdp.2009.03.001] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2009] [Revised: 02/24/2009] [Accepted: 03/08/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Evidence is mounting that annual mammography for women in their 40s may be the optimal schedule to reduce morbidity and mortality from breast cancer. Few studies have assessed predictors of repeat mammography on an annual interval among these women. METHODS We assessed mammography screening status among 596 insured Black and Non-Hispanic white women ages 43-49. Adherence was defined as having a second mammogram 10-14 months after a previous mammogram. We examined socio-demographic, medical and healthcare-related variables on receipt of annual-interval repeat mammograms. We also assessed barriers associated with screening. RESULTS 44.8% of the sample were adherent to annual-interval mammography. A history of self-reported abnormal mammograms, family history of breast cancer and never having smoked were associated with adherence. Saying they had not received mammography reminders and reporting barriers to mammography were associated with non-adherence. Four barrier categories were associated with women's non-adherence: lack of knowledge/not thinking mammograms are needed, cost, being too busy, and forgetting to make/keep appointments. CONCLUSIONS Barriers we identified are similar to those found in other studies. Health professionals may need to take extra care in discussing mammography screening risk and benefits due to ambiguity about screening guidelines for women in their 40s, especially for women without family histories of breast cancer or histories of abnormal mammograms. Reminders are important in promoting mammography and should be coupled with other strategies to help women maintain adherence to regular mammography.
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Affiliation(s)
- Jennifer M Gierisch
- Department of General Internal Medicine, Duke University Medical Center, Durham, NC 27707, USA.
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85
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Paskett E, Herndon J, Donohue K, Naughton M, Grubbs S, Pavy M, Hensley M, Stark N, Kornblith A, Bittoni M. Health-related quality of life in long-term breast cancer survivors: differences by adjuvant chemotherapy dose in Cancer and Leukemia Group B study 8541. Cancer 2009; 115:1109-20. [PMID: 19170232 DOI: 10.1002/cncr.24140] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Survivor's Health and Reaction (SHARE) study examined health-related quality of life (HRQL) in breast cancer patients who had participated in Cancer and Leukemia Group B Trial 8541 from 1985 to 1991. METHODS In total, 245 survivors (78% of eligible patients) who were 9.4 to 16.5 years postdiagnosis (mean, 12.5 years postdiagnosis) completed HRQL surveys relating to 5 domains. Analyses examined HRQL domains according to 3 different chemotherapy dose levels that were administered in the original treatment trial: low-dose cyclophosphamide, doxorubicin, and fluorouracil (CAF) at 300 mg/m(2), 30 mg/m(2), and 300 x 2 mg/m(2), respectively, over 4 cycles; standard-dose CAF at 400 mg/m(2), 40 mg/m(2), and 400 x 2 mg/m(2), respectively, over 6 cycles; and high-dose CAF at 600 mg/m(2), 60 mg/m(2) and 600 x 2 mg/m(2), respectively, over 4 cycles. RESULTS In univariate analyses, a statistically significant difference was observed on the Medical Outcomes Study 36-item short form Physical Role Functioning subscale by treatment group, with lower mean scores in the standard treatment arm (mean, 65.05) compared with mean scores in the low-dose arm (mean, 74.66) and the high-dose arm (mean, 84.94; P.0001). However, multivariate analysis revealed that treatment arm no longer was statistically significant, whereas the following factors were associated with decreased physical role functioning: age >or=60 years (odds ratio [OR], 3.55; P = .006), increased comorbidity interference total score (OR, 1.64; P = .005), lower vitality (OR, 1.05; P = .0002), and increased menopausal symptoms (OR, 1.04 P = .02). CONCLUSIONS At 9.4-16.5 years after their original diagnosis, differences in physical role functioning among breast cancer survivors who had received 3 different dose levels of chemotherapy were explained by clinical and demographic variables, such as age, fatigue, menopausal symptoms, and comorbidities. Prospective studies are needed to further assess the role of these factors in explaining HRQL and physical role functioning among long-term survivors.
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Affiliation(s)
- Electra Paskett
- College of Public Health and Comprehensive Cancer Center, The Ohio State University Comprehensive Cancer Center, 320 West 10th Avenue, Starling Loving Hall A356, Columbus, OH 43210-1240, USA.
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86
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Mellon S, Janisse J, Gold R, Cichon M, Berry-Bobovski L, Tainsky MA, Simon MS. Predictors of decision making in families at risk for inherited breast/ovarian cancer. Health Psychol 2009; 28:38-47. [PMID: 19210016 DOI: 10.1037/a0012714] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with decision making about inherited cancer risk information within families and determine the interdependence between survivors' and relatives' decision making. DESIGN A descriptive, cross-sectional design using a population-based sample of 146 dyads (N = 292) was used. Analyses included multilevel modeling using the Actor-Partner-Interdependence Model. MAIN OUTCOME MEASURES Decision making regarding inherited cancer risk information. RESULTS Several individual and family factors contributed toward survivors' and female relatives' decision making about inherited cancer risk information. Individual factors included the individual's perceptions of their family communication and cancer history. Family factors included survivors' and family members' age, communication and coping style that influenced the decision making of the other member of the dyad. Cancer worries and a monitoring coping style affected both seeking and avoiding decision making for survivors and relatives. CONCLUSIONS In view of the importance of genetic information upon family health outcomes, it is critical to address both individual and family factors that may influence decision making about cancer risk information and surveillance options for all members within the family.
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Affiliation(s)
- Suzanne Mellon
- College of Health Professions, University of Detroit Mercy, Detroit, MI 48221-3038, USA.
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87
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Mellon S, Gold R, Janisse J, Cichon M, Tainsky MA, Simon MS, Korczak J. Risk perception and cancer worries in families at increased risk of familial breast/ovarian cancer. Psychooncology 2009; 17:756-66. [PMID: 18613300 DOI: 10.1002/pon.1370] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
While families at increased risk for familial breast/ovarian cancer continue to overestimate their cancer risk with increased cancer worries about the future, few studies have examined factors that affect inherited cancer risk perception and cancer worries in both survivors and unaffected female relatives. The purpose of this study was to examine variables that may affect cancer worries and risk perceptions from a family-based perspective in a racially diverse, community-based, random sample of 146 dyads consisting of adult female breast and/or ovarian cancer survivors and their unaffected female relatives (N=292). Results indicated that coping style, self-efficacy, partner's income, family role relationship, and cancer risk perception were significant contributors to the survivors' and their unaffected relatives' cancer worries. Significant variables for perception of cancer risk for both survivors and relatives included income, race, family history of cancer, and cancer worries. Relatives had a higher perception of cancer risk, whereas survivors had more cancer worries. Additionally, the level of cancer worries reported by one member of the dyad was related to the amount of worries reported by the other. The results from this study underscore the importance of clinicians addressing concerns of both affected and unaffected members of families at increased risk of cancer to assist them in managing cancer worries and having realistic risk appraisals to make informed decisions about their own and their family's health surveillance options.
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Affiliation(s)
- Suzanne Mellon
- College of Health Professions, University of Detroit Mercy, Detroit, Michigan 48221-3038, USA.
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88
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Paskett ED, Herndon JE, Day JM, Stark NN, Winer EP, Grubbs SS, Pavy MD, Shapiro CL, List MA, Hensley ML, Naughton MA, Kornblith AB, Habin KR, Fleming GF, Bittoni MA. Applying a conceptual model for examining health-related quality of life in long-term breast cancer survivors: CALGB study 79804. Psychooncology 2009; 17:1108-20. [PMID: 18314912 DOI: 10.1002/pon.1329] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES The Survivor's Health and Reaction study used a quality-of-life model adapted for cancer survivors by Dow and colleagues to identify factors related to global health-related quality of life (HRQL) and to document the prevalence of problems and health-oriented behaviors in a follow-up study of breast cancer patients who participated in CALGB 8541. METHODS A total of 245 survivors (78% of those invited) who were 9.4-16.5 years post-diagnosis completed surveys that inquired about current HRQL, economic, spiritual, physical and psychosocial concerns, and health-oriented behaviors (e.g. smoking, exercise, and supplement use). A regression model was developed to examine factors related to global HRQL across all domains. RESULTS The regression model revealed that decreased energy levels (odds ratio (OR)=1.05, 95% confidence interval (CI): 1.03, 1.07), having heart disease (OR=5.01, 95% CI: 1.39, 18.1), having two or more co-morbidities (OR=2.39, 95% CI: 1.10, 5.19), and lower social support (OR=1.03, 95% CI: 1.02, 1.05) were associated with lower global HRQL. Factors related to psychological, spiritual, and economic domains were not predictive of global HRQL. Regarding lifestyle changes, some women reported engaging in health-oriented behaviors since their cancer diagnosis, such as improving eating habits (54%), increasing exercise (32%), and reducing/quitting smoking (20%). The most prevalent problems reported by women at follow-up were menopausal symptoms (64%), such as hot flashes and vaginal dryness, osteoporosis (25%), and lymphedema (23%). CONCLUSION Suggestions are provided to target interventions, such as provider-based strategies, in order to improve HRQL in long-term breast cancer survivors.
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Affiliation(s)
- Electra D Paskett
- The Ohio State University Comprehensive Cancer Center, Columbus, OH 43210-1240, USA.
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Ridge Y, Panabaker K, McCullum M, Portigal-Todd C, Scott J, McGillivray B. Evaluation of group genetic counseling for hereditary breast and ovarian cancer. J Genet Couns 2009; 18:87-100. [PMID: 19127417 DOI: 10.1007/s10897-008-9189-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2008] [Accepted: 08/15/2008] [Indexed: 11/28/2022]
Abstract
As demand for genetic counseling regarding hereditary cancer continues to grow, more efficient methods of providing this service must be explored. In this pilot study, group genetic counseling was offered to two different cohorts of women seeking genetic counseling for Hereditary Breast and Ovarian Cancer. Seven group sessions, designed to cover all aspects of an individual genetic counseling appointment, were conducted. Although patients were receptive to group genetic counseling, a significant proportion chose individual counseling when given the option. Advantages of group genetic counseling include shared experience and increased efficiency. Disadvantages include increased frustration at not being eligible for genetic testing, group influence on decision-making, privacy concerns, increased need for follow-up, and difficulty booking group appointments. Overall, the level of patient satisfaction with group genetic counseling was similar to that of individual counseling. The results of this pilot study suggest that further research is needed to determine whether group genetic counseling is an acceptable alternative to individual counseling.
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Affiliation(s)
- Yolanda Ridge
- Hereditary Cancer Program, BC Cancer Agency, Mail Box #614, 750 West Broadway, Vancouver, British Columbia, V5Z 1H5, Canada
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90
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Mammographic screening for young women with a family history of breast cancer: knowledge and views of those at risk. Br J Cancer 2008; 99:1007-12. [PMID: 18827822 PMCID: PMC2567085 DOI: 10.1038/sj.bjc.6604672] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Although the effectiveness of mammography for women under the age of 50 years with a family history of breast cancer (FHBC) has not yet been proven, annual screening is being offered to these women to manage breast cancer risk. This study investigates women's awareness and interpretation of their familial risk and knowledge and views about mammographic screening. A total of 2231 women from 21 familial/breast/genetics centres who were assessed as moderate risk (17–30% lifetime risk) or high risk (>30% lifetime risk) completed a questionnaire before their mammographic screening appointment. Most women (70%) believed they were likely, very likely or definitely going to develop breast cancer in their lifetime. Almost all women (97%) understood that the purpose of mammographic screening was to allow the early detection of breast cancer. However, 20% believed that a normal mammogram result meant there was definitely no breast cancer present, and only 4% understood that screening has not been proven to save lives in women under the age of 50 years. Women held positive views on mammography but did not appear to be well informed about the potential disadvantages. These findings suggest that further attention should be paid to improving information provision to women with an FHBC being offered routine screening.
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91
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Ockhuysen-Vermey CF, Henneman L, van Asperen CJ, Oosterwijk JC, Menko FH, Timmermans DRM. Design of the BRISC study: a multicentre controlled clinical trial to optimize the communication of breast cancer risks in genetic counselling. BMC Cancer 2008; 8:283. [PMID: 18834503 PMCID: PMC2576334 DOI: 10.1186/1471-2407-8-283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2008] [Accepted: 10/03/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding risks is considered to be crucial for informed decision-making. Inaccurate risk perception is a common finding in women with a family history of breast cancer attending genetic counseling. As yet, it is unclear how risks should best be communicated in clinical practice. This study protocol describes the design and methods of the BRISC (Breast cancer RISk Communication) study evaluating the effect of different formats of risk communication on the counsellee's risk perception, psychological well-being and decision-making regarding preventive options for breast cancer. METHODS AND DESIGN The BRISC study is designed as a pre-post-test controlled group intervention trial with repeated measurements using questionnaires. The intervention-an additional risk consultation-consists of one of 5 conditions that differ in the way counsellee's breast cancer risk is communicated: 1) lifetime risk in numerical format (natural frequencies, i.e. X out of 100), 2) lifetime risk in both numerical format and graphical format (population figures), 3) lifetime risk and age-related risk in numerical format, 4) lifetime risk and age-related risk in both numerical format and graphical format, and 5) lifetime risk in percentages. Condition 6 is the control condition in which no intervention is given (usual care). Participants are unaffected women with a family history of breast cancer attending one of three participating clinical genetic centres in the Netherlands. DISCUSSION The BRISC study allows for an evaluation of the effects of different formats of communicating breast cancer risks to counsellees. The results can be used to optimize risk communication in order to improve informed decision-making among women with a family history of breast cancer. They may also be useful for risk communication in other health-related services. TRIAL REGISTRATION Current Controlled Trials ISRCTN14566836.
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Affiliation(s)
- Caroline F Ockhuysen-Vermey
- Department of Public and Occupational Health, EMGO Institute, VU University Medical Center, Amsterdam, the Netherlands.
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92
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Breast self-examination in long-term breast cancer survivors. J Cancer Surviv 2008; 2:243-52. [PMID: 18810644 DOI: 10.1007/s11764-008-0066-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2008] [Accepted: 09/04/2008] [Indexed: 10/21/2022]
Abstract
INTRODUCTION For many breast cancer survivors, continued surveillance will be necessary to increase the possibility of finding a new diagnosis in an early stage. One such surveillance approach, breast self-examination, has not been studied specifically in breast cancer survivors. The current study was designed to assess the practice of BSE in a sample of long-term breast cancer survivors, and to examine the personal, emotional, cognitive, and health-care provider factors that may contribute to its performance. METHODS Three hundred forty-five breast cancer survivors (34% response rate, 345/1,001) diagnosed with in situ-stage II breast cancer between 1997-2004 at a community hospital provided answers to a mailed, self-report questionnaire. RESULTS Seventy-six percent of respondents reported that they had performed a BSE in the last 30-days. Forty percent reported performing BSE once/month, 39% more than once/month, and 21% less than once/month since their diagnosis. Most of the women (90%) reported that a doctor or nurse told them to perform a BSE once/month since their diagnosis, although only 69% had actually been shown how to perform a BSE. Consistently, the perception of increased barriers to BSE performance was associated with performance of BSE less than once/month (OR = 1.4, 95% CI 1.2, 1.6; OR = 0.8, 95% CI 0.8, 0.9). In addition, depending on the model, age (OR = 1.1, 95% CI 1.0, 1.2), perceived effectiveness of cancer treatments (OR = 0.7, 95% CI 0.5, 0.9), and perceived benefits of BSE (OR = 0.8, 95% CI 0.7, 0.9) also was associated with differences in BSE performance. CONCLUSION The current study suggests that breast cancer survivors between 4 and 11 years from diagnosis practice BSE, although their perception of the barriers to conducting BSE influences the frequency of this behavior. Further examination is needed to understand why some survivors perceive greater barriers to BSE performance than others. Also needed is a prospective examination of BSE performance using behavioral measures in relation to self-report. IMPLICATIONS FOR CANCER SURVIVORS Increased attention should be paid to this particular screening behavior performed by a majority of breast cancer survivors by both researchers and health-care providers alike. Whether survivors perform the behavior correctly and the impact it has on their emotional and cognitive well-being should be further explored.
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93
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Mueller CM, Mai PL, Bucher J, Peters JA, Loud JT, Greene MH. Complementary and alternative medicine use among women at increased genetic risk of breast and ovarian cancer. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2008; 8:17. [PMID: 18447953 PMCID: PMC2391138 DOI: 10.1186/1472-6882-8-17] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2008] [Accepted: 04/30/2008] [Indexed: 11/10/2022]
Abstract
BACKGROUND Complementary and alternative medicine (CAM) use is well documented among breast cancer patients and survivors, but little evidence is available to describe rates and patterns of use among women at increased genetic risk of breast cancer. METHODS A pre-visit telephone interview was conducted to ascertain CAM use among the BRCA mutation carriers enrolled in a high-risk breast cancer screening study. Participants were asked to report on their use of thirteen therapies within the year prior to enrollment into the study. Logistic regression was used to evaluate the association between various factors and CAM use in this population. RESULTS Among the 164 BRCA1 or BRCA2 mutation-positive (BRCA+) women in this analysis, 78% reported CAM use, with prayer and lifestyle diet being the two most commonly reported modalities. Many subjects used multiple CAM therapies, with 34% reporting use of three or more modalities. The most commonly used modalities were mind-body therapies and biologically-based practices, 61.6% and 51.8%, respectively. High-risk women were more likely to use CAM if they were older, more educated, more worried about ovarian cancer risk, or had a previous cancer diagnosis. CONCLUSION This study suggests that the prevalence of CAM use is high among BRCA mutation carriers, with frequency of use comparable to that of breast cancer patients and survivors. Given the high prevalence of CAM use in our subjects, especially biologically-based therapies including herbal supplements, whose safety and efficacy in relation to cancer risk are unknown, our study suggests that future research is necessary to clarify these risks, and that it is important for providers to inquire about and to discuss the pros and cons of CAM use with their BRCA+ patients.
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Affiliation(s)
- Christine M Mueller
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Phuong L Mai
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jaime Bucher
- College of Medicine, University of Toledo, Toledo, Ohio, USA
| | - June A Peters
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer T Loud
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Mark H Greene
- Clinical Genetics Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA
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Eborall HC, Griffin SJ, Prevost AT, Kinmonth AL, French DP, Sutton S. Psychological impact of screening for type 2 diabetes: controlled trial and comparative study embedded in the ADDITION (Cambridge) randomised controlled trial. BMJ 2007; 335:486. [PMID: 17761995 PMCID: PMC1971192 DOI: 10.1136/bmj.39303.723449.55] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify the psychological impact of primary care based stepwise screening for type 2 diabetes. DESIGN Controlled trial and comparative study embedded in a randomised controlled trial. SETTING 15 practices (10 screening, five control) in the ADDITION (Cambridge) trial in the east of England. PARTICIPANTS 7380 adults (aged 40-69) in the top fourth for risk of having undiagnosed type 2 diabetes (6416 invited for screening, 964 controls). INTERVENTIONS Invited for screening for type 2 diabetes or not invited (controls), incorporating a comparative study of subgroups of screening attenders. Attenders completed questionnaires after a random blood glucose test and at 3-6 months and 12-15 months later. Controls were sent questionnaires at corresponding time points. Non-attenders were sent questionnaires at 3-6 months and 12-15 months. MAIN OUTCOME MEASURES State anxiety (Spielberger state anxiety inventory), anxiety and depression (hospital anxiety and depression scale), worry about diabetes, and self rated health. RESULTS No significant differences were found between the screening and control participants at any time-for example, difference in means (95% confidence intervals) for state anxiety after the initial blood glucose test was -0.53, -2.60 to 1.54, at 3-6 months was 1.51 (-0.17 to 3.20), and at 12-15 months was 0.57, -1.11 to 2.24. After the initial test, compared with participants who screened negative, those who screened positive reported significantly poorer general health (difference in means -0.19, -0.25 to -0.13), higher state anxiety (0.93, -0.02 to 1.88), higher depression (0.32, 0.08 to 0.56), and higher worry about diabetes (0.25, 0.09 to 0.41), although effect sizes were small. Small but significant trends were found for self rated health across the screening subgroups at 3-6 months (P=0.047) and for worry about diabetes across the screen negative groups at 3-6 months and 12-15 months (P=0.001). CONCLUSIONS Screening for type 2 diabetes has limited psychological impact on patients. Implementing a national screening programme based on the stepwise screening procedure used in the ADDITION (Cambridge) trial is unlikely to have significant consequences for patients' psychological health. TRIAL REGISTRATION Current Controlled Trials ISRCTN99175498 [controlled-trials.com].
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Affiliation(s)
- Helen C Eborall
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge CB2 0SR.
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95
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Stewart KA, Neumann PJ, Fletcher SW, Barton MB. The effect of immediate reading of screening mammograms on medical care utilization and costs after false-positive mammograms. Health Serv Res 2007; 42:1464-82. [PMID: 17610433 PMCID: PMC1955276 DOI: 10.1111/j.1475-6773.2006.00660.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To investigate whether decreased anxiety associated with immediate reading of screening mammograms resulted in lower downstream utilization and costs among women with false-positive mammograms. DATA SOURCES/STUDY SETTING We identified 1,140 women, > or =age 40, with false-positive mammograms and 12-month follow-up after participating in a trial of immediate versus batch mammographic reading between February 1999 and January 2001 in a multispecialty group managed care practice in Massachusetts. STUDY DESIGN We determined downstream utilization and costs for study participants by immediate and batch reading status. DATA COLLECTION/EXTRACTION METHODS Demographic, comorbidity, and medical care utilization data were obtained from survey data and computerized medical record databases. Costs included direct medical costs, patient time, travel and copayments, and additional professional time costs associated with immediate reading. PRINCIPAL FINDINGS Immediate reading cost an additional $4.40 per screening mammogram. Women with immediate readings had more follow-up mammograms (781 versus 750, p=.018) and fewer diagnostic ultrasounds (176 versus 219, p=.016) than women with batch readings. Costs to the health plan for breast care were approximately 10 percent higher for immediate readings in multivariable analyses (p=.046), but no significant difference was seen in total societal costs (p=.072). CONCLUSIONS Immediate mammogram reading was associated with increased costs to the health plan and changes in follow-up radiology procedures. These costs must be examined alongside beneficial effects of immediate reading.
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Affiliation(s)
- Kate A Stewart
- Department of Health Care Policy, 180 Longwood Avenue, Boston, MA 02115, USA
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96
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Carney PA, Yi JP, Abraham LA, Miglioretti DL, Aiello EJ, Gerrity MS, Reisch L, Berns EA, Sickles EA, Elmore JG. Reactions to uncertainty and the accuracy of diagnostic mammography. J Gen Intern Med 2007; 22:234-41. [PMID: 17356992 PMCID: PMC1824735 DOI: 10.1007/s11606-006-0036-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Reactions to uncertainty in clinical medicine can affect decision making. OBJECTIVE To assess the extent to which radiologists' reactions to uncertainty influence diagnostic mammography interpretation. DESIGN Cross-sectional responses to a mailed survey assessed reactions to uncertainty using a well-validated instrument. Responses were linked to radiologists' diagnostic mammography interpretive performance obtained from three regional mammography registries. PARTICIPANTS One hundred thirty-two radiologists from New Hampshire, Colorado, and Washington. MEASUREMENT Mean scores and either standard errors or confidence intervals were used to assess physicians' reactions to uncertainty. Multivariable logistic regression models were fit via generalized estimating equations to assess the impact of uncertainty on diagnostic mammography interpretive performance while adjusting for potential confounders. RESULTS When examining radiologists' interpretation of additional diagnostic mammograms (those after screening mammograms that detected abnormalities), a 5-point increase in the reactions to uncertainty score was associated with a 17% higher odds of having a positive mammogram given cancer was diagnosed during follow-up (sensitivity), a 6% lower odds of a negative mammogram given no cancer (specificity), a 4% lower odds (not significant) of a cancer diagnosis given a positive mammogram (positive predictive value [PPV]), and a 5% higher odds of having a positive mammogram (abnormal interpretation). CONCLUSION Mammograms interpreted by radiologists who have more discomfort with uncertainty have higher likelihood of being recalled.
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Affiliation(s)
- Patricia A Carney
- Department of Community and Family Medicine, Dartmouth Medical School, Hanover and Lebanon, NH, USA.
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97
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Young D, McLeish L, Sullivan F, Pitkethly M, Reis M, Goudie D, Vysny H, Ozakinci G, Steel M. Familial breast cancer: management of 'lower risk' referrals. Br J Cancer 2006; 95:974-8. [PMID: 17047645 PMCID: PMC2360713 DOI: 10.1038/sj.bjc.6603389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Up to 40% of referrals from primary care to ‘breast cancer family clinics’ prove to be of women whose assessed risk falls below the guidelines' threshold for management in secondary or tertiary care, despite recommendations that they should be screened out at primary care level. A randomised trial, involving 87 such women referred to the Tayside Familial Breast Cancer Service compared two ways of communicating risk information, letter or personal interview. Both were found to be acceptable to referred women and to their family doctors, although the former expressed a slight preference for interview. Only four women returned to their family doctors with continuing concerns about breast cancer. Nevertheless, understanding of information provided by either route was unsatisfactory, with apparent confusion about both absolute and relative risks of breast cancer. Substantial minorities appear to believe that they are at no increased risk at all, or even below the population level of risk, while others remain convinced that their personal risk has been underestimated. Family history record forms, completed by the referred women, preferably with the assistance of relatives, are crucial to full assessment of familial risk but one quarter of women referred to the Tayside Familial Breast Cancer Service currently do not complete and return these forms ahead of their clinic appointment. Further collaboration between primary care and the Breast Cancer Family Service is required to improve provision for concerned women whose risks fall below the threshold for special surveillance and to maximise effective use of the family history record form.
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Affiliation(s)
- D Young
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - L McLeish
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - F Sullivan
- Community Health Sciences Division, University of Dundee Medical School, McKenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - M Pitkethly
- Community Health Sciences Division, University of Dundee Medical School, McKenzie Building, Kirsty Semple Way, Dundee DD2 4BF, UK
| | - M Reis
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - D Goudie
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
| | - H Vysny
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
- Bute Medical School, University of St Andrews, St Andrews, Fife KY16 9TS, UK
| | - G Ozakinci
- Bute Medical School, University of St Andrews, St Andrews, Fife KY16 9TS, UK
| | - M Steel
- Tayside Breast Cancer Family Clinic, Ninewells Hospital and Medical School, Dundee DD1 9SY, UK
- Bute Medical School, University of St Andrews, St Andrews, Fife KY16 9TS, UK
- Bute Medical School, University of St Andrews, St Andrews, Fife KY16 9TS, UK. E-mail:
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98
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Abstract
Colorectal cancer (CRC) is the second most common cancer among Latinos; screening can reduce mortality from CRC. The aims of this study are; to assess the current compliance with free colorectal cancer screening among Hispanic women who are participating in a national breast and cervical cancer screening program (NBCCEDP), and to examine the effects of a set of key constructs from the HBM and the TPB on compliance with the Fecal Occult Blood Test (FOBT). We consecutively recruited 950 women from among those attending an initial appointment at an NBCCEDP site in northern Manhattan, and administered a questionnaire. Patients were offered a free Hemoccult kit, alongside instructions and print materials. The rate of FOBT compliance (in kit return) was 77.3%. Fatalism remained a statistically significant influence on FOBT compliance in the multivariate models, and there was a trend for higher FOBT return among West Indies women (primarily from the Dominican Republic). The findings of this study demonstrate the feasibility and acceptability of distributing FOBT kits through an existing national program for cancer screening of women. The results justify replication in a more heterogeneous group of Hispanics, with longer-term followup.
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99
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Holloway S, Porteous M, Cetnarskyj R, Rush R, Appleton S, Gorman D, Campbell H. Referrals of patients to colorectal cancer genetics services in south-east Scotland. Fam Cancer 2005; 4:151-61. [PMID: 15951967 DOI: 10.1007/s10689-004-4488-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2004] [Accepted: 09/30/2004] [Indexed: 12/25/2022]
Abstract
The discovery that genetic factors are involved in the aetiology of colorectal cancer, has prompted many relatives of affected individuals to seek genetic counselling and screening. This paper describes the demand for genetic services by families with colorectal cancer in south-east Scotland, their expectations and views of the service offered. The annual referral rate over the 21-month study period, for patients with a family history of colorectal cancer, was 0.11 per 1000 patients on general practitioner lists. This is one third of the rate for patients with a family history of breast cancer and in comparison with the breast cancer group, relatives of colorectal cancer patients were significantly older and less socially deprived. Approximately one third were referred via a hospital specialist unit. One hundred patients were included in the study. Mean (+/- standard deviation) age was 43 (+/- 10.7 years), 75 were female and 31 were self referrals. Before the consultation, almost half the patients had an inflated perception of their risk and there was little change at follow-up. There was an improvement in objective understanding after counselling which was sustained up to 6 months but only two thirds remembered their objective risk accurately. Most patients were satisfied with the consultation. Our findings suggest the need to educate individuals, in particular men, younger people and the more socially deprived, about the relevance of a family history of colorectal cancer and to facilitate patients' comprehension of their risk status.
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Affiliation(s)
- Susan Holloway
- Department of Clinical Genetics, Molecular Medicine Centre, Western General Hospital, Edinburgh, Scotland, UK
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100
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Abstract
A theoretically-based, multivariate approach was used to identify factors associated with emotional distress for pregnant women undergoing maternal serum alpha fetoprotein (MSAFP or AFP) testing, used to detect abnormalities of the fetal brain and spinal cord. Participants were those who received normal results (N = 87). Study results supported the hypothesis that different factors would predict distress before and after testing. Satisfaction with information about testing predicted lower emotional distress early in the testing process; concerns about the child having other medical conditions and low-dispositional optimism predicted distress later. Study findings indicate that even in women who receive normal test results, AFP testing is associated with a modest degree of emotional disturbance which declines, but does not completely abate, after testing.
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Affiliation(s)
- Marci Lobel
- Department of Psychology, State University of New York, Stony Brook, NY, USA.
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