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Taymoori P, Berry T, Roshani D. Differences in health beliefs across stage of adoption of mammography in Iranian women. Cancer Nurs 2015; 37:208-17. [PMID: 23624601 DOI: 10.1097/ncc.0b013e31829194bc] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Despite evidence that screening for breast cancer is effective, adherence with screening recommendations in Iranian women is low. OBJECTIVES The aims of this study were to (a) examine the relationships between related beliefs and (b) to determine to what extent women in stages of mammography adoption differ in their agreement of individual perceived health beliefs. METHODS A sample of 686 Iranian women completed a questionnaire including selected constructs of the Health Belief Model and stages of mammography adoption. RESULTS Proportions of participants who were in the preadoption and adoption stages were 75% and 17.8%, respectively. Precontemplators showed significantly lower positive attitude and greater agreement for most of the barrier items than did those in other adoption stages. In terms of specific items, women in the relapse and maintenance stages endorsed greatest agreement for the barrier items "not knowing how to get a mammogram" and "forget to schedule," respectively. Common barriers for women in preadoption stages were being painful, taking much time, and embarrassing. CONCLUSION Iranian women are less likely than other Asian women to be in the maintenance and action stages. Identifying the associations between perceived related beliefs items and stages of mammography adoption may provide detailed information to allow for future research and guide the development of interventions not only for Iranian women but also for similar cultural and immigrant groups that have been neglected to date in the breast cancer literature. IMPLICATIONS FOR PRACTICE Examining the interactions between perceived related beliefs items and other beliefs such as perceived control and self-efficacy to having a mammography is warranted.
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Affiliation(s)
- Parvaneh Taymoori
- Author Affiliations: Kurdistan Research Center for Social Determinants of Health, School of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran (Dr Taymooi); Department of Faculty of Physical Education and Recreation, University of Alberta, Edmonton, Canada (Dr Berry); and Kurdistan Research Center for Social Determinants of Health, School of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran (Dr Roshani)
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Taymoori P, Moshki M, Roshani D. Facilitator psychological constructs for mammography screening among Iranian women. Asian Pac J Cancer Prev 2015; 15:7309-16. [PMID: 25227834 DOI: 10.7314/apjcp.2014.15.17.7309] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND While many researchers often use a theoretical framework for mammogram repeat interventions, it seems they do not apply an identified mediation analysis method. The aim of this study was to determine the mediators of mammogram replication behavior in two tailored interventions for non-adherent Iranian women. MATERIALS AND METHODS A sample population of 184 women over 50 years old in Sanandaj, Iran, was selected for an experiment. Participants were randomly allocated into one of the three conditions: 1) an intervention based on the Health Belief Model (HBM) 2) an intervention based on an integration of the HBM and selected constructs from the Theory of Planned Behavior (TPB), and 3) a control group. Constructs were measured before the intervention, and after a 6-month follow-up. RESULTS Perceived self-efficacy, behavioral control, and subjective norms were recognized as mediators in the HBM and selected constructs from the TPB intervention. Perceived susceptibility, severity, barriers, self-efficacy and behavioral control met the criteria for mediation in the HBM intervention. CONCLUSIONS This study was successful in establishing mediation in a sample of women. Our findings enrich the literature on mammography repeat, indicating key intervention factors, and relegating redundant ones in the Iranian populations. The use of strategies to increase mammography repeat, such HBM and TPB constructs is suggested to be important for maintaining a screening behavior, once the behavior has been adopted.
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Affiliation(s)
- Parvaneh Taymoori
- Kurdistan Environmental Health Research Center, School of Medicine, Kurdistan University of Medical Sciences, Kurdistan, Iran E-mail :
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Borstelmann NA, Rosenberg SM, Ruddy KJ, Tamimi RM, Gelber S, Schapira L, Come S, Borges V, Morgan E, Partridge AH. Partner support and anxiety in young women with breast cancer. Psychooncology 2015; 24:1679-85. [DOI: 10.1002/pon.3780] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 01/20/2015] [Accepted: 01/29/2015] [Indexed: 01/06/2023]
Affiliation(s)
- Nancy A. Borstelmann
- Dana-Farber Cancer Institute; Boston MA USA
- School of Social Work; Simmons College; Boston MA USA
| | - Shoshana M. Rosenberg
- Dana-Farber Cancer Institute; Boston MA USA
- Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
| | | | - Rulla M. Tamimi
- Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
- Harvard School of Public Health; Boston MA USA
| | | | - Lidia Schapira
- Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
- Massachusetts General Hospital; Boston MA USA
| | - Steven Come
- Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
- Beth Israel Deaconess Medical Center; Boston MA USA
| | | | | | - Ann H. Partridge
- Dana-Farber Cancer Institute; Boston MA USA
- Dana-Farber Cancer Institute; Harvard Medical School; Boston MA USA
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Davis TC, Arnold CL, Bennett CL, Wolf MS, Liu D, Rademaker A. Sustaining mammography screening among the medically underserved: a follow-up evaluation. J Womens Health (Larchmt) 2015; 24:291-8. [PMID: 25692910 DOI: 10.1089/jwh.2014.4967] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Our previous three-arm comparative effectiveness intervention in community clinic patients who were not up-to-date with screening resulted in mammography rates over 50% in all arms. OBJECTIVE Our aim was to evaluate the effectiveness and cost-effectiveness of the three interventions on improving biennial screening rates among eligible patients. METHODS A three-arm quasi-experimental evaluation was conducted in eight community clinics from 2008 to 2011. Screening efforts included (1) enhanced care: Participants received an in-person recommendation from a research assistant (RA) in year 1, and clinics followed usual clinic protocol for scheduling screening mammograms; (2) education intervention: Participants received education and in-person recommendation from an RA in year 1, and clinics followed usual clinic protocol for scheduling mammograms; or (3) nurse support: A nurse manager provided in-person education and recommendation, scheduled mammograms, and followed up with phone support. In all arms, mammography was offered at no cost to uninsured patients. RESULTS Of 624 eligible women, biennial mammography within 24-30 months of their previous test was performed for 11.0% of women in the enhanced-care arm, 7.1% in the education- intervention arm, and 48.0% in the nurse-support arm (p<0.0001). The incremental cost was $1,232 per additional woman undergoing screening with nurse support vs. enhanced care and $1,092 with nurse support vs. education. CONCLUSIONS Biennial mammography screening rates were improved by providing nurse support but not with enhanced care or education. However, this approach was not cost-effective.
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Affiliation(s)
- Terry C Davis
- 1 Department of Medicine, Louisiana State University Health Sciences Center , Shreveport, Louisiana
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Ho SSM, Choi KC, Wong CL, Chan CWH, Chan HYL, Tang WPY, Lam WWT, Shiu ATY, Goggins WB, So WKW. Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey. Public Health 2014; 128:1009-16. [PMID: 25443128 DOI: 10.1016/j.puhe.2014.09.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 05/23/2014] [Accepted: 09/03/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the uptake of breast screening and its associated factors among Hong Kong Chinese women aged ≥50 years. STUDY DESIGN Cross-sectional population-based survey. METHODS A sample of Hong Kong Chinese women was recruited through telephone random-digit dialling. The survey consisted of six sections: perceived health status, use of complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of breast screening were analysed using logistic regression analysis. RESULTS In total, 1002 women completed the (anonymous) telephone survey. The mean age was 63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong Chinese women aged ≥50 years was 34%. The primary reasons for undertaking breast screening were as part of a regular medical check-up (74%), prompted by local signs and symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram. CONCLUSIONS This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies.
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Affiliation(s)
- S S M Ho
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - K C Choi
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - C L Wong
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - C W H Chan
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - H Y L Chan
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - W P Y Tang
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - W W T Lam
- Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Sassoon Road, Hong Kong, China
| | - A T Y Shiu
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China
| | - W B Goggins
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China
| | - W K W So
- Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China.
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Kratzke C, Amatya A, Vilchis H. Differences among college women for breast cancer prevention acquired information-seeking, desired apps and texts, and daughter-initiated information to mothers. J Community Health 2014; 39:291-300. [PMID: 23979671 DOI: 10.1007/s10900-013-9759-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The purpose of this study was to examine among college women acquired breast cancer prevention information-seeking, desired apps and texts, and information given to mothers. Using a cross-sectional study, a survey was administered to college women at a southwestern university. College women (n = 546) used the Internet (44 %) for active breast cancer prevention information-seeking and used the Internet (74 %), magazines (69 %), and television (59 %) for passive information receipt. Over half of the participants desired breast cancer prevention apps (54 %) and texts (51 %). Logistic regression analyses revealed predictors for interest to receive apps were ethnicity (Hispanic), lower self-efficacy, actively seeking online information, and older age and predictors for interest to receive texts were lower self-efficacy and higher university level. Eighteen percent of college women (n = 99) reported giving information to mothers and reported in an open-ended item the types of information given to mothers. Predictors for giving information to mothers were actively and passively seeking online information, breast self-exam practice, and higher university level. Screenings were the most frequent types of information given to mothers. Breast cancer prevention information using apps, texts, or Internet and daughter-initiated information for mothers should be considered in health promotion targeting college students or young women in communities. Future research is needed to examine the quality of apps, texts, and online information and cultural differences for breast cancer prevention sources.
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Affiliation(s)
- Cynthia Kratzke
- Department of Public Health Sciences, MSC 3HLS, New Mexico State University, P.O. Box 30001, Las Cruces, NM, 88003, USA,
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Kratzke C, Wilson S. Ethnic differences in breast cancer prevention information-seeking among rural women: will provider mobile messages work? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2014; 29:541-547. [PMID: 24163017 DOI: 10.1007/s13187-013-0576-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Although growing research supports cancer survivor information-seeking, little is known about breast cancer prevention information-seeking among women. The purpose of the study was to examine differences in breast cancer risk factor knowledge, information sources, and desired mobile messages among Hispanic and non-Hispanic rural women. Women were recruited to complete a survey at an imaging center during a mammography screening visit. A total of 156 women (mean age = 61, SD = 12.07) completed the survey. Breast cancer risk factor knowledge was significantly higher for non-Hispanic women compared to Hispanic women (p = .035). Television, magazines, and Internet were the most frequent information sources. Providers were the most frequent interpersonal information source. Nearly 87 % used cell phones and 47 % used texting. Hispanic women were more likely to desire breast cancer prevention cell voice messages (p < .001) and text messages (p = .001) compared to non-Hispanic women. No significant differences were found for text appointment reminders by ethnicity. Health educators and clinicians must promote mobile messages for Hispanics and non-Hispanics for mammography adherence, breast cancer prevention education, and best practices to manage screening appointments.
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Affiliation(s)
- Cynthia Kratzke
- Department of Public Health Sciences, New Mexico State University, MSC 3HLS, P.O. Box 30001, Las Cruces, NM, 88003, USA,
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Stanton AL, Petrie KJ, Partridge AH. Contributors to nonadherence and nonpersistence with endocrine therapy in breast cancer survivors recruited from an online research registry. Breast Cancer Res Treat 2014; 145:525-34. [PMID: 24781972 DOI: 10.1007/s10549-014-2961-3] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/07/2014] [Indexed: 11/26/2022]
Abstract
Rates of adherence and persistence with endocrine therapy regimens (i.e., tamoxifen, aromatase inhibitors) by breast cancer survivors are suboptimal, with negative implications for prognosis. This study identified potential contributors to nonadherence and nonpersistence. From an online breast cancer research registry (Army of Women) including approximately 51,000 breast cancer survivors, we recruited 1,371 women who currently were taking endocrine therapy and 94 nonpersisters (i.e., diagnosed during the prior 5 years and on endocrine therapy within the prior 12 months, but no longer taking it). Participants completed an online questionnaire assessing demographic/medical characteristics, general and cancer-related psychosocial variables (i.e., depressive symptoms, anxiety, patient-oncologist relationship quality, cancer recurrence worry, general symptoms), and endocrine therapy-specific variables (i.e., endocrine therapy-related symptoms, perceived endocrine therapy necessity, long-term therapy use concern, endocrine therapy-related emotions). Two weeks later, current users were re-contacted to complete an endocrine therapy adherence measure. In a final regression model, patient-reported nonadherence among current users was significantly associated with lower financial status, a prior switch in endocrine therapies, a poorer relationship with the oncologist, and lower perceived need for and more negative emotions regarding endocrine therapy (adjusted R (2) = 0.15, P < 0.001). In a final logistic regression model, endocrine therapy nonpersisters were significantly more likely than current users to report depressive symptoms, as well as more negative emotions and lower positive emotions related to endocrine therapy (adjusted R (2) = 0.10, P < 0.001). In addition to demographic/medical variables, several potentially modifiable psychosocial characteristics are likely to contribute to endocrine therapy nonadherence and nonpersistence.
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Affiliation(s)
- Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, Center for Cancer Prevention and Control Research, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, 1285 Franz Hall, Box 90095-1563, Los Angeles, CA, USA,
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Vyas A, Madhavan S, Kelly K, Metzger A, Schreiman J, Remick S. Predictors of self-reported adherence to mammography screening guidelines in West Virginia women visiting a stationary facility. THE WEST VIRGINIA MEDICAL JOURNAL 2014; 110:20-26. [PMID: 24902464 PMCID: PMC4896067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The objectives of this study are to describe the characteristics of women age 40 years and above who utilize a stationary mammography facility and to determine the predictors of self-reported adherence to mammography screening guidelines. Data were analyzed using the expanded version of Andersen Behavioral Model of Healthcare Utilization. Of the 1,104 women included in the analysis, 1,019 women (92.3%) reported having had a mammogram in the past two years. In logistic regression after adjusting for all the variables, older age, having health insurance, not having delayed medical care due to transportation problem, being adherent to clinical breast exam (CBE), Pap test and other routine screenings and having positive views about mammography screening significantly predicted adherence to mammography screening. Adherence to mammography screening was very high in this sample, and enabling and need-related factors and positive views about mammography screening predicted adherence to mammography screening guidelines.
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Folse HJ, Green LE, Kress A, Allman R, Dinh TA. Cost-effectiveness of a Genetic Test for Breast Cancer Risk. Cancer Prev Res (Phila) 2013; 6:1328-36. [DOI: 10.1158/1940-6207.capr-13-0056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mammography Utilization: Patient Characteristics and Breast Cancer Stage at Diagnosis. AJR Am J Roentgenol 2013; 201:1057-63. [DOI: 10.2214/ajr.13.10733] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Somerall DW. Screening for breast and cervical cancer: understanding the different recommendations. Nurs Womens Health 2013; 17:331-335. [PMID: 23957799 DOI: 10.1111/1751-486x.12052] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Evidence-based screening guidelines issued by national organizations sometimes contradict each other, leading to confusion among health care providers and the women they care for. This article summarizes the most recent guidelines for breast and cervical cancer screening and notes where they concur and where they diverge.
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Affiliation(s)
- D'Ann W Somerall
- School of Nursing, University of Alabama in Birmingham, AL, USA.
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Hui SKA, Engelman KK, Shireman TI, Ellerbeck EF. Adherence to cancer screening guidelines and predictors of improvement among participants in the Kansas State Employee Wellness Program. Prev Chronic Dis 2013; 10:E115. [PMID: 23845176 PMCID: PMC3711498 DOI: 10.5888/pcd10.120212] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Introduction Employee wellness programs (EWPs) have been used to implement worksite-based cancer prevention and control interventions. However, little is known about whether these programs result in improved adherence to cancer screening guidelines or how participants’ characteristics affect subsequent screening. This study was conducted to describe cancer screening behaviors among participants in a state EWP and identify factors associated with screening adherence among those who were initially nonadherent. Methods We identified employees and their dependents who completed health risk assessments (HRAs) as part of the Kansas state EWP in both 2008 and 2009. We examined baseline rates of adherence to cancer screening guidelines in 2008 and factors associated with adherence in 2009 among participants who were initially nonadherent. Results Of 53,095 eligible participants, 13,222 (25%) participated in the EWP in 2008 and 6,205 (12%) participated in both years. Among the multiyear participants, adherence was high at baseline to screening for breast (92.5%), cervical (91.8%), and colorectal cancer (72.7%). Of participants who were initially nonadherent in 2008, 52.4%, 41.3%, and 33.5%, respectively, became adherent in the following year to breast, cervical, and colorectal cancer screening. Suburban/urban residence and more frequent doctor visits predicted adherence to breast and colorectal cancer screening guidelines. Conclusion The effectiveness of EWPs for increasing cancer screening is limited by low HRA participation rates, high rates of adherence to screening at baseline, and failure of nonadherent participants to get screening. Improving overall adherence to cancer screening guidelines among employees will require efforts to increase HRA participation, stronger interventions for nonadherent participants, and better access to screening for rural employees.
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Affiliation(s)
- Siu-kuen Azor Hui
- Fox Chase Cancer Center, Department of Psychosocial and Behavioral Medicine, 333 Cottman Ave, Young Pavilion 4141, Philadelphia, PA 19111, USA.
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Lo SH, Waller J, Wardle J, von Wagner C. Comparing barriers to colorectal cancer screening with barriers to breast and cervical screening: a population-based survey of screening-age women in Great Britain. J Med Screen 2013; 20:73-9. [DOI: 10.1177/0969141313492508] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Objective Uptake of cancer screening tends to be lower for colorectal cancer (CRC) than cervical or breast cancer. Dislike of the test itself has often been identified as a barrier to CRC screening with the Faecal Occult Blood (FOB) test, but there have been no head-to-head comparisons of the three tests. Methods Women aged 50–80 ( n = 890) were recruited in spring 2012 as part of a population-based TNS Research International survey in Great Britain. Those in the eligible age range were asked if they had ever participated in breast, cervical or CRC screening. For each screening test, women who had never participated were asked for their ‘main reason’ using a checklist of barriers. Results Among eligible women, 67%, 83% and 90% reported ever having been screened for CRC, cervical and breast cancer respectively. More socioeconomically deprived women were less likely to report any screening, and single women were less likely to report CRC or breast screening than married women. Age was not associated with participation. Overall there were few differences between tests in the reported barriers, but dislike of the test was endorsed more often for CRC screening. Conclusion This was the first study to compare barriers to participation in organised screening programmes for CRC, breast and cervical cancer. Cancer screening tests share many barriers, but dislike of the test appears to be a stronger barrier to CRC screening. Women who are non-participants in more than one programme may have more global barriers to screening, such as cancer fatalism. The findings suggest that uptake of CRC screening could be improved by targeting the unpleasantness of stool sampling.
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Affiliation(s)
- Siu Hing Lo
- PhD, Research Associate, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street London, WC1E 6BT, UK
| | - Jo Waller
- PhD, Senior Research Associate, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street London, WC1E 6BT, UK
| | - Jane Wardle
- PhD, Professor of Clinical Psychology, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street London, WC1E 6BT, UK
| | - Christian von Wagner
- PhD, Senior Research Associate, Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street London, WC1E 6BT, UK
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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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Tan A, Kuo YF, Goodwin JS. Integrating age and comorbidity to assess screening mammography utilization. Am J Prev Med 2012; 42:229-34. [PMID: 22341159 PMCID: PMC3289514 DOI: 10.1016/j.amepre.2011.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Revised: 08/31/2011] [Accepted: 11/15/2011] [Indexed: 11/30/2022]
Abstract
BACKGROUND Most studies use age as a cutoff to evaluate screening mammography utilization, generally examining screening up to age 75 years (the age-cutoff method). However, many experts and guidelines encourage clinicians to consider patient health and/or life expectancy. PURPOSE To compare the accuracy of estimating screening mammography utilization in older women using the age-cutoff method versus using a method based on the projected life expectancy. METHODS Two cohorts were selected from female Medicare beneficiaries aged 67-90 years living in Texas in 2001 and 2006. The 2001 cohort (n=716,279) was used to generate life-expectancy estimates by age and comorbidity, which were then applied to the 2006 cohort (n=697,825). Screening mammography utilization during 2006-2007 was measured for the 2006 cohort. Data were collected in 2000-2007 and analyzed in 2011. RESULTS The screening rate was 52.7% in women aged 67-74 years based on age alone, compared to 53.5% in women in the same age group with a life expectancy of ≥7 years. A large proportion (63.4%) of women aged 75-90 years (n=370,583) had a life expectancy of ≥7 years. Those women had a screening rate of 42.7%. The screening rate was 35.7% in women aged 75-90 years based on age alone, compared to 16.3% in women in the same age group with a life expectancy of <5 years. CONCLUSIONS Estimating screening mammography utilization among older women can be improved by using projected life expectancy rather than the age-cutoff method.
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Affiliation(s)
- Alai Tan
- Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas 77555-1148, USA.
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Lin JH, Zhang SM, Manson JE. Predicting adherence to tamoxifen for breast cancer adjuvant therapy and prevention. Cancer Prev Res (Phila) 2012; 4:1360-5. [PMID: 21893499 DOI: 10.1158/1940-6207.capr-11-0380] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Treatment with the selective estrogen receptor modulator (SERM) tamoxifen for 5 years has produced dramatic breast cancer-related benefits in (a) the adjuvant setting, with 30% to 50% reductions in recurrence, contralateral disease, and mortality and (b) the prevention setting of healthy high-risk women, where tamoxifen reduces the risk of invasive and noninvasive breast cancer by 50%. Despite these striking data, adherence to tamoxifen is low, and low adherence is associated with poor survival. Although toxicity is a major predictor of poor adherence after starting therapy, pretreatment (baseline) predictors of poor tamoxifen adherence have been minimally studied. The adherence-survival link underscores the critical need to identify early predictors of poor adherence, and recent work is beginning to address this need. A major baseline predictor of poor adherence to prevention is current smoking, which is interestingly absent from studies of adherence to adjuvant therapy. Other important prevention adherence factors include breast cancer risk, extremes of age, non-white ethnicity, low socioeconomic status, and alcohol use. The strongest adjuvant therapy predictors are age (especially very young), ethnicity, and socioeconomic status. Future studies involving prospective systematic evaluation of these and other potential predictors in endocrine chemoprevention (e.g., other SERMs and aromatase inhibitors) are critical, as is the development of effective/targeted interventions to improve adherence and thus treatment outcomes in at-risk women.
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Affiliation(s)
- Jennifer H Lin
- Division of Preventive Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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Watson-Johnson LC, DeGroff A, Steele CB, Revels M, Smith JL, Justen E, Barron-Simpson R, Sanders L, Richardson LC. Mammography adherence: a qualitative study. J Womens Health (Larchmt) 2011; 20:1887-94. [PMID: 22023414 DOI: 10.1089/jwh.2010.2724] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened. METHODS We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. RESULTS All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography. CONCLUSIONS Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.
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Affiliation(s)
- Lisa C Watson-Johnson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Kobetz E, Menard J, Dietz N, Hazan G, Soler-Vila H, Lechner S, Diem J, Auguste P. Contextualizing the survivorship experiences of Haitian immigrant women with breast cancer: opportunities for health promotion. Oncol Nurs Forum 2011; 38:555-60. [PMID: 21875842 DOI: 10.1188/11.onf.555-560] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To examine challenges faced by Haitian immigrant women managing a breast cancer diagnosis. RESEARCH APPROACH Trained community health workers conducted focus groups with Haitian women who were breast cancer survivors. A grounded theory approach guided analysis of transcripts. SETTING A large community-based organization in Miami, FL. PARTICIPANTS 18 women took part in three focus groups. Participants were 40 years or older, were ethnically Haitian, and had been diagnosed with breast cancer 6-12 months prior to the study. METHODOLOGIC APPROACH Data were collected as part of an ongoing community-based participatory research initiative in Little Haiti, the largest enclave of Haitian settlement in Miami, FL. Community health workers, integral to the initiative, recruited participants through their extensive social networks and community contacts. MAIN RESEARCH VARIABLES Screening knowledge, illness beliefs, social and economic consequences of a breast cancer diagnosis, and advice for breast health education. FINDINGS Emergent themes suggest that Haitian breast cancer survivors face multiple challenges, including misperceptions about screening guidelines, disease etiology, and risk; a reduced capacity to earn a living because of physical debility; and diminished social support. CONCLUSIONS Future research must continue to examine the impact of breast cancer on Haitian immigrant women and identify key strategies, such as community outreach and support programs, to improve their quality of life. INTERPRETATION Nurses can play an essential role in such strategies by providing culturally relevant clinical care and partnering with community stakeholders to define the scope and focus of public health intervention.
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Affiliation(s)
- Erin Kobetz
- Department of Epidemiology and Public Health, Miller School of Medicine, University of Miami, Florida, USA.
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Ganai S, Winchester DJ. Screening mammography. Cancer 2011; 117:3062-3. [DOI: 10.1002/cncr.26319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Smith RA, Cokkinides V, Brooks D, Saslow D, Shah M, Brawley OW. Cancer screening in the United States, 2011: A review of current American Cancer Society guidelines and issues in cancer screening. CA Cancer J Clin 2011; 61:8-30. [PMID: 21205832 DOI: 10.3322/caac.20096] [Citation(s) in RCA: 188] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Each year the American Cancer Society (ACS) publishes a summary of its recommendations for early cancer detection, a report on data and trends in cancer screening rates, and select issues related to cancer screening. This article summarizes the current ACS guidelines, describes the anticipated impact of new health care reform legislation on cancer screening, and discusses recent public debates over the comparative effectiveness of different colorectal cancer screening tests. The latest data on the utilization of cancer screening from the National Health Interview Survey is described, as well as several recent reports on the role of health care professionals in adult utilization of cancer screening.
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Affiliation(s)
- Robert A Smith
- Director of Cancer Screening, Cancer Control Science Department, American Cancer Society, Atlanta, GA, USA.
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