101
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LIU ZHEYU, ZHANG YEFEI, FRANZIN LUISA, CORMIER JANICEN, CHAN WENYAW, XU HUA, DU XIANGLINL. Trends and variations in breast and colorectal cancer incidence from 1995 to 2011: a comparative study between Texas Cancer Registry and National Cancer Institute's Surveillance, Epidemiology and End Results data. Int J Oncol 2015; 46:1819-26. [PMID: 25672365 PMCID: PMC4356494 DOI: 10.3892/ijo.2015.2881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2014] [Accepted: 12/23/2014] [Indexed: 12/18/2022] Open
Abstract
Few studies have examined the cancer incidence trends in the state of Texas, and no study has ever been conducted to compare the temporal trends of breast and colorectal cancer incidence in Texas with those of the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) in the United States. This study aimed to conduct a parallel comparison between the Texas Cancer Registry and the National Cancer Institute's SEER on cancer incidence from 1995 to 2011. A total of 951,899 breast and colorectal cancer patients were included. Age-adjusted breast cancer incidence was 134.74 per 100,000 in Texas and 131.78 per 100,000 in SEER in 1995-2011, whereas age-adjusted colorectal cancer incidence was 50.52 per 100,000 in Texas and 49.44 per 100,000 in SEER. Breast cancer incidence increased from 1995 to 2001, decreased from 2002 to 2006, and then remained relatively stable from 2007 to 2011. For colorectal cancer, the incidence increased in 1995-1997, and then decreased continuously from 1998 to 2011 in Texas and SEER areas. Incidence rates and relative risks by age, gender and ethnicity were identical between Texas and SEER.
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Affiliation(s)
- ZHEYU LIU
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - YEFEI ZHANG
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - LUISA FRANZIN
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
| | - JANICE N. CORMIER
- The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - WENYAW CHAN
- Department of Biostatistics, University of Texas Health Science Center, Houston, TX, USA
| | - HUA XU
- The University of Texas School of Biomedical Informatics, Houston, TX, USA
| | - XIANGLIN L. DU
- Department of Epidemiology, Human Genetics, and Environmental Sciences, University of Texas Health Science Center, Houston, TX, USA
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, USA
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102
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Howard JH, Hiles JM, Leung AM, Stern SL, Bilchik AJ. Race Influences Stage-specific Survival in Gastric Cancer. Am Surg 2015. [DOI: 10.1177/000313481508100327] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Gastric adenocarcinoma studies show improved survival for Asians but have not reported stage-specific overall survival (OS) or disease-specific survival (DSS) by race. The Surveillance, Epidemiology and End Results database was queried for cases of gastric adenocarcinoma between 1998 and 2008. We evaluated OS and DSS by race and stage. Number of assessed lymph nodes was compared among surgical patients. Of 49,058 patients with complete staging data, 35,300 were white, 7709 were Asian, and 6049 were black. Asians had significantly better OS for all stages ( P < 0.001) and significantly better DSS for Stages I ( P < 0.0001) and II ( P = 0.0006). As compared with blacks, whites had significantly better DSS for Stages I ( P < 0.0001), II ( P = 0.0055), III ( P = 0.0165), and IV ( P < 0.0001). Among the 28,133 (57%) surgical patients, average number of evaluated lymph nodes was highest for Asians ( P < 0.0001). Among surgical patients with 15 or more nodes evaluated, DSS was worse in blacks with Stage I disease ( P < 0.05). Blacks with gastric adenocarcinoma have a worse DSS, which disappears when surgical treatment includes adequate lymphadenectomy. Race-associated survival differences for gastric adenocarcinoma might simply reflect variations in surgical staging techniques and socioeconomic factors.
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Affiliation(s)
- J. Harrison Howard
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
- The Ohio State University, Columbus, Ohio; and the
| | - Jason M. Hiles
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Anna M. Leung
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Stacey L. Stern
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
| | - Anton J. Bilchik
- John Wayne Cancer Institute at Saint John's Health Center, Santa Monica, California
- California Oncology Research Institute, Los Angeles, California
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103
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Sewali B, Okuyemi KS, Askhir A, Belinson J, Vogel RI, Joseph A, Ghebre RG. Cervical cancer screening with clinic-based Pap test versus home HPV test among Somali immigrant women in Minnesota: a pilot randomized controlled trial. Cancer Med 2015; 4:620-31. [PMID: 25653188 PMCID: PMC4402076 DOI: 10.1002/cam4.429] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2014] [Revised: 12/23/2014] [Accepted: 12/01/2014] [Indexed: 12/28/2022] Open
Abstract
Cervical cancer is more common in the Somali immigrant population than the general population in the United States (US). There are low rates of cervical cancer screening among Somali women. This study compares cervical cancer screening test completion rates for a home human papilloma virus (HPV) test and standard clinic Pap test. Sixty-three Somali immigrant women aged 30–70 years who had not undergone cervical cancer screening within the past 3 years were randomly assigned to a home HPV test group (intervention) or a clinic Pap test group (control). Test completion rates were measured at 3 months. Univariate and multivariate logistic regression models were used to explore factors associated with test completion (intention-to-treat analysis). Participants in the HPV test group were 14 times more likely to complete the test compared to those in the Pap test group (P = 0.0002). Women who reported having friends/family members to talk about cancer screening were approximately three times more likely to complete any screening test than those who did not (P = 0.127) and participants who reported residing in the US longer were more likely to complete a screening test (P = 0.011). Future research should explore the potential of using the home-based HPV test kits as an initial approach to cervical cancer screening. Impact: The use of a self-sampling HPV kit has the potential to increase cervical cancer screening in under-served communities in the US.
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Affiliation(s)
- Barrett Sewali
- Program in Health Disparities Research, University of Minnesota Medical School, Minneapolis, Minnesota; Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, Minnesota
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104
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Fernández ME, Savas LS, Wilson KM, Byrd TL, Atkinson J, Torres-Vigil I, Vernon SW. Colorectal cancer screening among Latinos in three communities on the Texas-Mexico border. HEALTH EDUCATION & BEHAVIOR 2015; 42:16-25. [PMID: 24786793 PMCID: PMC4214900 DOI: 10.1177/1090198114529592] [Citation(s) in RCA: 19] [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
OBJECTIVE To assess colorectal cancer screening (CRCS) prevalence and psychosocial correlates of CRCS among Latinos in South Texas. METHOD Using multivariable analyses, we examined the association of perceived susceptibility, self-efficacy, pros and cons, subjective norms, knowledge and fatalism on CRCS among 544 Latinos (50 years and older). RESULTS In this socioeconomically disadvantaged population, 40% had never heard of any CRCS test, only 34% reported ever completing any type of CRCS, and only 25% were adherent to CRCS guidelines. Insurance status, gender, perceived cons, CRCS self-efficacy, and CRCS norms were significantly associated with CRCS. CONCLUSION CRCS interventions in this population should focus on improving access, increasing self-efficacy and perceived norms, and decreasing negative perceptions of CRCS.
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Affiliation(s)
| | - Lara S Savas
- University of Texas School of Public Health, Houston, TX, USA
| | | | - Theresa L Byrd
- Department of Family and Community Medicine, Texas Tech Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
| | - John Atkinson
- University of Texas School of Public Health, Houston, TX, USA
| | - Isabel Torres-Vigil
- Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA Dorothy I. Height Center for Health Equity & Evaluation Research, University of Houston Graduate College of Social Work, Houston, TX, USA
| | - Sally W Vernon
- University of Texas School of Public Health, Houston, TX, USA
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105
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Singh KE, Taylor TH, Pan CJG, Stamos MJ, Zell JA. Colorectal Cancer Incidence Among Young Adults in California. J Adolesc Young Adult Oncol 2014; 3:176-184. [PMID: 25538862 DOI: 10.1089/jayao.2014.0006] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Purpose: Colorectal cancer (CRC) incidence has decreased over the past three decades, due largely to screening efforts. Relatively little is known about CRC incidence among the young adult (YA) population ages 20-39, as screening typically commences at age 50 for average-risk individuals. We examined CRC incidence with a focus on YAs in order to identify high-risk subgroups. Methods: We analyzed 231,544 incident CRC cases from 1988-2009 (including 5617 YAs 20-39 years of age) from the California Cancer Registry. We assessed age-specific incidence rates by race/ethnicity, gender, and colorectal tumor location, and calculated the biannual percent change (BAPC) to monitor change in incidence over the 22-year study period. Results: The absolute incidence of CRC per 100,000 was low among YAs 20-29 and 30-39 years old (ranging from 0.7 per 100,000 among Hispanic and African American females aged 20-29 up to 5.0 per 100,000 among Asian/Pacific Islander males aged 30-39). However, we observed increasing CRC incidence rates over time among both males and females in the YA population, particularly for distal colon cancer in Hispanic females aged 20-29 (BAPC=+15.9%; p<0.042). Conclusion: The absolute incidence of CRC remains far lower for YAs than among adults aged 50 and over. However, CRC incidence is increasing among young adults, in contrast to the decreasing rates observed for adults in the screened population (aged 50 and above). More research is needed to better characterize YAs at increased risk for CRC.
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Affiliation(s)
- Kathryn E Singh
- Division of Genetic and Genomic Medicine, Department of Pediatrics, University of California , Irvine, Irvine, California
| | - Thomas H Taylor
- Department of Epidemiology, University of California , Irvine, Irvine, California. ; Chao Family Comprehensive Cancer Center, University of California , Irvine, Irvine, California. ; Genetic Epidemiology Research Institute, University of California , Irvine, Irvine, California
| | - Chuan-Ju G Pan
- Chao Family Comprehensive Cancer Center, University of California , Irvine, Irvine, California. ; Division of Hematology/Oncology, Department of Medicine, University of California , Irvine, Irvine, California
| | - Michael J Stamos
- Division of Colon and Rectal Surgery, Department of Surgery, University of California , Irvine, Irvine, California
| | - Jason A Zell
- Department of Epidemiology, University of California , Irvine, Irvine, California. ; Chao Family Comprehensive Cancer Center, University of California , Irvine, Irvine, California. ; Genetic Epidemiology Research Institute, University of California , Irvine, Irvine, California. ; Division of Hematology/Oncology, Department of Medicine, University of California , Irvine, Irvine, California
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106
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Raymond NC, Osman W, O’Brien JM, Ali N, Kia F, Mohamed F, Mohamed A, Goldade KB, Pratt R, Okuyemi K. Culturally informed views on cancer screening: a qualitative research study of the differences between older and younger Somali immigrant women. BMC Public Health 2014; 14:1188. [PMID: 25410824 PMCID: PMC4289337 DOI: 10.1186/1471-2458-14-1188] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Accepted: 10/30/2014] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Somali women are infrequently screened for breast or cervical cancer, and there is a paucity of evidence-based interventions to increase cancer screening in this community. In order to create a culturally relevant intervention for Somali women living in Minnesota, we sought to understand what Somali immigrant women know about breast and cervical cancer, what are the attitudes toward screening and what cultural barriers are there to screen as well as cultural factors that would facilitate screening. METHODS In partnership with a community-based organization, New American Community Services (NACS), focus groups were conducted to explore the issues described above. Two focus groups were held with younger women age 20 to 35 and two were held with women age 36 to 65. RESULTS Twenty-nine women participated in the four focus groups. The women identified 1) differences in health care seeking behavior in Somalia verses the United States; 2) cultural understanding of cancer and disease; 3) barriers to mammogram or Pap screening; 4) facilitators to seeking preventive cancer screening; and 5) risk factors for developing cancer. CONCLUSIONS Cultural misperceptions and attitudes need to be addressed in developing culturally-appropriate interventions to improve screening uptake for Somali women. A nuanced response is required to address barriers specific to younger and older groups. Culturally informed beliefs can be integrated into intervention development, preventive care and screening promotion.
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Affiliation(s)
- Nancy C Raymond
- />Department of Psychiatry and Deborah E. Powell Center for Women’s Health, University of Minnesota Medical School, Minneapolis, USA
| | - Warfa Osman
- />New American Community Services, St. Paul, USA
| | - Jennifer M O’Brien
- />Department of Psychiatry and Deborah E. Powell Center for Women’s Health, University of Minnesota Medical School, Minneapolis, USA
| | - Nora Ali
- />University of Minnesota Medical School, Minneapolis, USA
| | - Farnaaz Kia
- />University of Minnesota Medical School, Minneapolis, USA
| | | | | | | | - Rebekah Pratt
- />Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
| | - Kolawole Okuyemi
- />Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, USA
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107
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Decker KM, Singh H. Reducing inequities in colorectal cancer screening in North America. J Carcinog 2014; 13:12. [PMID: 25506266 PMCID: PMC4253036 DOI: 10.4103/1477-3163.144576] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Accepted: 10/14/2014] [Indexed: 12/26/2022] Open
Abstract
Colorectal cancer (CRC) is an important cause of mortality and morbidity in North America. Screening using a fecal occult blood test, flexible sigmoidoscopy, or colonoscopy reduces CRC mortality through the detection and treatment of precancerous polyps and early stage CRC. Although CRC screening participation has increased in recent years, large inequities still exist. Minorities, new immigrants, and those with lower levels of education or income are much less likely to be screened. This review provides an overview of the commonly used tests for CRC screening, disparities in CRC screening, and promising methods at the individual, provider, and system levels to reduce these disparities. Overall, to achieve high CRC participation rates and reduce the burden of CRC in the population, a multi-faceted approach that uses strategies at all levels to reduce CRC screening disparities is urgently required.
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Affiliation(s)
- Kathleen M Decker
- Department of Community Health Sciences, University of Manitoba, Canada ; Screening Programs, Cancer Care Manitoba, Canada
| | - Harminder Singh
- Department of Community Health Sciences, University of Manitoba, Canada ; Department of Internal Medicine, University of Manitoba, Canada ; Department of Haematology and Medical Oncology, Cancer Care Manitoba, Canada
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108
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Lee YY, Jun JK, Suh M, Park BY, Kim Y, Choi KS. Barriers to cancer screening among medical aid program recipients in the Republic of Korea: a qualitative study. Asian Pac J Cancer Prev 2014; 15:589-94. [PMID: 24568462 DOI: 10.7314/apjcp.2014.15.2.589] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Few studies have examined reasons why those with low socioeconomic status do not adequately receive cancer screening. We therefore conducted a qualitative study to assess the barriers to cancer screening in people with low socioeconomic status, and to examine the reasons why Medical Aid Program (MAP) recipients do not participate in the National Cancer Screening Program (NCSP). A focus group methodology was used. Participants included MAP recipients (men aged 45-79 years, women aged 35-79 years) who had been invited to cancer screening at least twice based on the NCSP protocol, but had not been screened for any cancer from 2009-2012. We recruited participants living in the cities of Goyang and Paju. A total of 23 MAP recipients participated in four focus group discussions, including 12 men and 11 women. In this qualitative study, we identified six barriers to screening: lack of trust in the NCSP and cancer screening units; fear of being diagnosed with cancer; discomfort or pain from the screening procedure; lack of time, lack of knowledge about cancer screening or lack of awareness of the existence of the NCSP; physical disability or underlying disease; and logistic barriers. Interventions such as individualized counseling, letters and reminders, or other individually-targeted strategies, especially for those with lower socioeconomic status are required to increase participation and reduce disparities in cancer screening.
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Affiliation(s)
- Yoon Young Lee
- National Cancer Control Institute, National Cancer Centre, Goyang, Republic of Korea E-mail :
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109
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Thompson CA, Gomez SL, Chan A, Chan JK, McClellan SR, Chung S, Olson C, Nimbal V, Palaniappan LP. Patient and provider characteristics associated with colorectal, breast, and cervical cancer screening among Asian Americans. Cancer Epidemiol Biomarkers Prev 2014; 23:2208-17. [PMID: 25368396 PMCID: PMC4221799 DOI: 10.1158/1055-9965.epi-14-0487] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Routinely recommended screening for breast, cervical, and colorectal cancers can significantly reduce mortality from these types of cancer, yet screening is underutilized among Asians. Surveys rely on self-report and often are underpowered for analysis by Asian ethnicities. Electronic health records (EHR) include validated (as opposed to recall-based) rates of cancer screening. In this article, we seek to better understand cancer screening patterns in a population of insured Asian Americans. METHODS We calculated rates of compliance with cervical, breast, and colorectal cancer screening among Asians from an EHR population and compared them with non-Hispanic whites. We performed multivariable modeling to evaluate potential predictors (at the provider- and patient-level) of screening completion among Asian patients. RESULTS Aggregation of Asian subgroups masked heterogeneity in screening rates. Asian Indians and native Hawaiians and Pacific Islanders had the lowest rates of screening in our sample, well below that of non-Hispanic whites. In multivariable analyses, screening completion was negatively associated with patient-physician language discordance for mammography [OR, 0.81; 95% confidence interval (CI), 0.71-0.92] and colorectal cancer screening (OR, 0.79; CI, 0.72-0.87) and positively associated with patient-provider gender concordance for mammography (OR, 1.16; CI, 1.00-1.34) and cervical cancer screening (OR, 1.66; CI, 1.51-1.82). In addition, patient enrollment in online health services increased mammography (OR, 1.32; CI, 1.20-1.46) and cervical cancer screening (OR, 1.31; CI, 1.24-1.37). CONCLUSIONS Language- and gender-concordant primary care providers and culturally tailored online health resources may help improve preventive cancer screening in Asian patient populations. IMPACT This study demonstrates how the use of EHR data can inform investigations of primary prevention practices within the healthcare delivery setting.
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Affiliation(s)
| | - Scarlett Lin Gomez
- Cancer Prevention Institute of California, Fremont, California. Department of Epidemiology, Stanford University School of Medicine, Palo Alto, California
| | - Albert Chan
- Palo Alto Medical Foundation Research Institute, Palo Alto, California. Palo Alto Medical Foundation Medical Group, Mountain View, California
| | | | - Sean R McClellan
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Cliff Olson
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
| | - Vani Nimbal
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
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Ekechi C, Olaitan A, Ellis R, Koris J, Amajuoyi A, Marlow LA. Knowledge of cervical cancer and attendance at cervical cancer screening: a survey of Black women in London. BMC Public Health 2014; 14:1096. [PMID: 25339243 PMCID: PMC4216339 DOI: 10.1186/1471-2458-14-1096] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2014] [Accepted: 10/15/2014] [Indexed: 11/15/2022] Open
Abstract
Background Women from ethnic minority backgrounds are less likely to attend cervical screening, but further understanding of ethnic inequalities in cervical screening uptake is yet to be established. This study aimed to explore the socio-demographic and ethnicity-related predictors of cervical cancer knowledge, cervical screening attendance and reasons for non-attendance among Black women in London. Methods A questionnaire was completed by women attending Black and ethnic hair and beauty specialists in London between February and April 2013. A stratified sampling frame was used to identify Black hair specialists in London subdivisions with >10% Black population (including UK and foreign-born). Fifty-nine salons participated. Knowledge of cervical cancer risk factors and symptoms, self-reported screening attendance and reasons for non-attendance at cervical screening were assessed. Results Questionnaires were completed by 937 Black women aged 18–78, describing themselves as being predominantly from African or Caribbean backgrounds (response rate 26.5%). Higher educational qualifications (p < .001) and being born in the UK (p = .011) were associated with greater risk factor knowledge. Older age was associated with greater symptom knowledge (p < .001). Being younger, single, African (compared to Caribbean) and attending religious services more frequently were associated with being overdue for screening. Women who had migrated to the UK more than 10 years ago were less likely to be overdue than those born in the UK. Of those overdue for screening who endorsed a barrier (67/133), ‘I meant to go but didn’t get round to it’ (28%), fear of the test procedure (18%) and low risk perception (18%) were the most common barriers. Conclusions Ethnicity, migration and religiosity play a role in predicting cervical screening attendance among women from Black backgrounds. African women, those born in the UK and those who regularly attend church are most likely to put off attending. Additional research is needed to explore the attitudes, experiences and beliefs that explain why these groups might differ. Electronic supplementary material The online version of this article (doi:10.1186/1471-2458-14-1096) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | | | | | | | - Laura Av Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, University College London, Gower Street, London WC1E 6BT, England.
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Harsha Kumar H, Tanya S. A Study on Knowledge and Screening for Cervical Cancer among Women in Mangalore City. Ann Med Health Sci Res 2014; 4:751-6. [PMID: 25328788 PMCID: PMC4199169 DOI: 10.4103/2141-9248.141547] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Most of the cervical cancer cases are diagnosed late leading to poor outcomes. Very few studies have explored the role of doctor and source of information for awareness of women about cervical cancer in India. Aim: Hence, this study was conducted with the objective of knowing the knowledge of women about cervical cancer, its screening, role of doctor, source of information, and reasons for not undergoing screening if the women had not undergone testing for cervical cancer. Subjects and Methods: This was a questionnaire based cross-sectional study conducted among the women attending the outpatient departments of teaching hospitals attached to Kasturba Medical College. A sample size of 83 was calculated. A semi-structured questionnaire was developed. After obtaining permission from Institutional Ethics Committee, the questionnaire was administered to the women in the language of their preference. Women were educated after the data collection and a hand-out was provided. Data was analyzed using SPSS Version 10. Student's independent ‘t’ test was used to compare mean knowledge scores across sociodemographic groups. Results: Majority of the women have poor knowledge about cervical cancer (81.9% [68/83]) and it's screening (85.5% [71/83]). Only 6 out of 83 women had undergone screening. Though women had come into contact with doctors earlier, they were neither educated about cervical cancer nor were they told about the screening. Whatever little knowledge the women had was obtained from mass media. Conclusions: Majority of women had poor knowledge. Mass media could be used to educate the women. There is a need to conduct community based study to know the practices of doctors and assess if they are educating and offering suggestions for screening.
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Affiliation(s)
- Hn Harsha Kumar
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
| | - Shubham Tanya
- Department of Community Medicine, Kasturba Medical College, Manipal University, Mangalore, Karnataka, India
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Hurtado-de-Mendoza A, Song M, Kigen O, Jennings Y, Nwabukwu I, Sheppard VB. Addressing cancer control needs of African-born immigrants in the US: a systematic literature review. Prev Med 2014; 67:89-99. [PMID: 25034729 PMCID: PMC4203373 DOI: 10.1016/j.ypmed.2014.07.006] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2013] [Revised: 04/03/2014] [Accepted: 07/07/2014] [Indexed: 12/31/2022]
Abstract
Compared to non-Hispanic Whites, African immigrants have worse cancer outcomes. However, there is little research about cancer behaviors and/or interventions in this growing population as they are generally grouped with populations from America or the Caribbean. This systematic review examines cancer-related studies that included African-born participants. We searched PsycINFO, Ovid Medline, Pubmed, CINHAL, and Web of Science for articles focusing on any type of cancer that included African-born immigrant participants. Twenty articles met study inclusion criteria; only two were interventions. Most articles focused on one type of cancer (n=11) (e.g., breast cancer) and were conducted in disease-free populations (n=15). Studies included African participants mostly from Nigeria (n=8) and Somalia (n=6). However, many papers (n=7) did not specify nationality or had small percentages (<5%) of African immigrants (n=5). Studies found lower screening rates in African immigrants compared to other subpopulations (e.g. US-born). Awareness of screening practices was limited. Higher acculturation levels were associated with higher screening rates. Barriers to screening included access (e.g. insurance), pragmatic (e.g. transportation), and psychosocial barriers (e.g. shame). Interventions to improve cancer outcomes in African immigrants are needed. Research that includes larger samples with diverse African subgroups including cancer survivors is necessary to inform future directions.
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Affiliation(s)
- Alejandra Hurtado-de-Mendoza
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA.
| | - Minna Song
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Ocla Kigen
- Cancer Biology, Prevention & Control, University District of Columbia, Lombardi Cancer Center Cancer Prevention Master's Degree Program, Washington, DC, USA
| | - Yvonne Jennings
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
| | - Ify Nwabukwu
- African Women's Cancer Awareness Association, Silver Spring, MD, USA
| | - Vanessa B Sheppard
- Breast Cancer Program and Office of Minority Health and Health Disparities, Lombardi Comprehensive Cancer Center, Department of Oncology, Georgetown University Medical Center, Washington, DC, USA
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113
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Colorectal testing utilization and payments in a large cohort of commercially insured US adults. Am J Gastroenterol 2014; 109:1513-25. [PMID: 24980877 DOI: 10.1038/ajg.2014.64] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 02/18/2014] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Screening decreases colorectal cancer (CRC) mortality. The national press has scrutinized colonoscopy charges. Little systematic evidence exists on colorectal testing and payments among commercially insured persons. Our aim was to characterize outpatient colorectal testing utilization and payments among commercially insured US adults. METHODS We conducted an observational cohort study of outpatient colorectal test utilization rates, indications, and payments among 21 million 18-64-year-old employees and dependants with noncapitated group health insurance provided by 160 self-insured employers in the 2009 Truven MarketScan Databases. RESULTS Colonoscopy was the predominant colorectal test. Among 50-64-year olds, 12% underwent colonoscopy in 1 year. Most fecal tests and colonoscopies were associated with screening/surveillance indications. Testing rates were higher in women, and increased with age. Mean payments for fecal occult blood and immunochemical tests were $5 and $21, respectively. Colonoscopy payments varied between and within sites of service. Mean payments for diagnostic colonoscopy in an office, outpatient hospital facility, and ambulatory surgical center were $586 (s.d. $259), $1,400 (s.d. $681), and $1,074 (s.d. $549), respectively. Anesthesia and pathology services accompanied 35 and 52% of colonoscopies, with mean payments of $494 (s.d. $354) and $272 (s.d. $284), respectively. Mean payments for the most prevalent colonoscopy codes were 1.4- to 1.9-fold the average Medicare payments. CONCLUSIONS Most outpatient colorectal testing among commercially insured adults was associated with screening or surveillance. Payments varied widely across sites of service, and payments for anesthesia and pathology services contributed substantially to total payments. Cost-effectiveness analyses of CRC screening have relied on Medicare payments as proxies for costs, but cost-effectiveness may differ when analyzed from the perspectives of Medicare or commercial insurers.
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114
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Lee HY, Jung Y. Older Korean American men's prostate cancer screening behavior: the prime role of culture. J Immigr Minor Health 2014; 15:1030-7. [PMID: 23504334 DOI: 10.1007/s10903-013-9804-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
East and South Asian male immigrants show markedly low odds of prostate cancer screening as compared to U.S.-born men. However, knowledge about these immigrants' culture-based screening behavior and barriers to screening is extremely limited. This study investigates factors influencing receipt of prostate cancer screening among Korean American immigrant men, particularly investigating culture's impact on screening behaviors. Data were collected through a convenience and purposive sampling technique from 134 Korean American males aged 50 and older recruited in New York City. A structured questionnaire was used and cultural variables were measured by adopting items from Tang and colleagues' work. Approximately 60 % of the sample had received a prostate-specific antigen (PSA) test in their lifetime, and of these, about 66 % reported having done so in the previous 12 months. Logistic regression analysis revealed that a crisis-oriented intervention approach was associated with a substantially reduced likelihood of screening. A positive correlation was noted between the use of Eastern medicine and PSA test receipt. Further analysis revealed a significant interaction effect between use of Eastern medicine and age in predicting PSA test uptake. Culture-specific intervention strategies for increasing prostate cancer screening in this group are discussed, with particular attention to increasing pertinent health literacy. Health professionals should consider the cultural domain when working with Korean immigrant men in order to provide culturally competent care.
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Affiliation(s)
- Hee Yun Lee
- School of Social Work, University of Minnesota, Twin Cities,105 Peters Hall, 1404 Gortner Avenue, St. Paul, MN, 55108, USA,
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Ekwueme DU, Uzunangelov VJ, Hoerger TJ, Miller JW, Saraiya M, Benard VB, Hall IJ, Royalty J, Li C, Myers ER. Impact of the National Breast and Cervical Cancer Early Detection Program on cervical cancer mortality among uninsured low-income women in the U.S., 1991-2007. Am J Prev Med 2014; 47:300-8. [PMID: 25015564 DOI: 10.1016/j.amepre.2014.05.016] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 04/12/2014] [Accepted: 05/07/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND The benefits of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) on cervical cancer screening for participating uninsured low-income women have never been measured. PURPOSE To estimate the benefits in life-years (LYs) gained; quality-adjusted life-years (QALYs) gained; and deaths averted. METHODS A cervical cancer simulation model was constructed based on an existing cohort model. The model was applied to NBCCEDP participants aged 18-64 years. Screening habits for uninsured low-income women were estimated using National Health Interview Survey data from 1990 to 2005 and NBCCEDP data from 1991 to 2007. The study was conducted during 2011-2012 and covered all 68 NBCCEDP grantees in 50 states, the District of Columbia, five U.S. territories, and 12 tribal organizations. Separate simulations were performed for the following three scenarios: (1) women who received NBCCEDP (Program) screening; (2) women who received screening without the program (No Program); and (3) women who received no screening (No Screening). RESULTS Among 1.8 million women screened in 1991-2007, the Program added 10,369 LYs gained compared to No Program, and 101,509 LYs gained compared to No Screening. The Program prevented 325 women from dying of cervical cancer relative to No Program, and 3,829 relative to No Screening. During this time period, the Program accounted for 15,589 QALYs gained when compared with No Program, and 121,529 QALYs gained when compared with No Screening. CONCLUSIONS These estimates suggest that NBCCEDP cervical cancer screening has reduced mortality among medically underserved low-income women who participated in the program.
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Affiliation(s)
| | | | | | | | - Mona Saraiya
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Vicki B Benard
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Janet Royalty
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Chunyu Li
- Division of Cancer Prevention and Control, CDC, Atlanta, Georgia
| | - Evan R Myers
- Department of Obstetrics & Gynecology, Duke University, Durham, North Carolina
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Liu BY, O'Malley J, Mori M, Fagnan LJ, Lieberman D, Morris CD, Buckley DI, Heintzman JD, Carney PA. The association of type and number of chronic diseases with breast, cervical, and colorectal cancer screening. J Am Board Fam Med 2014; 27:669-81. [PMID: 25201936 PMCID: PMC4273642 DOI: 10.3122/jabfm.2014.05.140005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to examine associations between the number and types of patients' chronic diseases and being up to date for breast, cervical, and colorectal cancer screening. METHODS Data were abstracted from medical charts at 4 primary care clinics located in 2 rural Oregon communities. Eligibility criteria included being at least 55 years old and having at least 1 clinic visit in the past 2 years. RESULTS Of 3433 patients included, 503 (15%) had no chronic illness, 646 (19%) had 1, 786 (23%) had 2, and 1498 (44%) had ≥3 chronic conditions. Women with asthma/chronic lung disease and with cardiovascular disease were less likely to be up o date for mammography screening (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.43-0.80), and those with chronic digestive disorders were more likely to be up to date for mammography (OR, 1.31; 95% CI, 1.03-1.66) compared with those without chronic conditions. Women with arthritis, diabetes mellitus, and hypertension were less likely to be up to date for cervical cancer screening (OR, 0.38; 95% CI, 0.21-0.68) compared with those without chronic conditions. Men with cardiovascular disease were less likely to be up to date for colorectal cancer screening (adjusted OR, 0.59; 95% CI, 0.44-0.80), and women with depression were less likely to be up to date (OR, 0.71; 95% CI, 0.56-0.91) compared with men and women without chronic conditions. CONCLUSION Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.
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Affiliation(s)
- Betty Y Liu
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Jean O'Malley
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Motomi Mori
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Lyle J Fagnan
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - David Lieberman
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Cynthia D Morris
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - David I Buckley
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - John D Heintzman
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Patricia A Carney
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland.
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Levano W, Miller JW, Leonard B, Bellick L, Crane BE, Kennedy SK, Haslage NM, Hammond W, Tharpe FS. Public education and targeted outreach to underserved women through the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2591-6. [PMID: 25099902 PMCID: PMC4460797 DOI: 10.1002/cncr.28819] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Revised: 04/18/2014] [Accepted: 04/21/2014] [Indexed: 12/11/2022]
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) was established to provide low-income, uninsured, and underinsured women access to cancer screening and diagnostic services with the goal of increasing the early detection and prevention of breast and cervical cancer. Although this is a valuable resource for women who might not have the means to get screened otherwise, providing services at no cost, by itself, does not guarantee uptake of screening services. Public education and targeted outreach facilitate the critical link between public service programs and the communities they serve. The purpose of public education and outreach in the NBCCEDP is to increase the number of women who use breast and cervical cancer screening services by raising awareness, providing education, addressing barriers, and motivating women to complete screening exams and follow-up. Effective strategies focus on helping to remove structural, physical, interpersonal, financial, and cultural barriers; educate women about the importance of screening and inform women about the services available to them. This article provides an overview of the importance of public education and targeted outreach activities for cancer screening through community-based programs including examples from NBCCEDP grantees that highlight successes, challenges, and solutions, encountered when conducting these types of interventions.
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Affiliation(s)
- Whitney Levano
- Utah Department of Health, Cancer Control Program, Salt Lake City, Utah
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Sawadogo B, Gitta SN, Rutebemberwa E, Sawadogo M, Meda N. Knowledge and beliefs on cervical cancer and practices on cervical cancer screening among women aged 20 to 50 years in Ouagadougou, Burkina Faso, 2012: a cross-sectional study. Pan Afr Med J 2014; 18:175. [PMID: 25419302 PMCID: PMC4236918 DOI: 10.11604/pamj.2014.18.175.3866] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/19/2014] [Indexed: 12/16/2022] Open
Abstract
Introduction In Burkina Faso, 1230 women are diagnosed with cervical cancer every year and 838 die from the disease. Little is known about women's practices, knowledge and beliefs regarding cervical cancer. This study aims to describe women's practices regarding cervical cancer screening and to assess their knowledge and beliefs. Methods Cross-sectional study was carried out in Ouagadougou from 1st to 31st December 2012 interviewing 840 women aged 20 to 50 years about their knowledge, beliefs and practices regarding cervical cancer. Cluster sampling was used. Univariate and multivariate logistic regression analysis were performed. Chi square test was used and p-value < 0.05 was considered. Results Out of 840 women enrolled with mean age 29.5±7.77 years, 66.31% were married, 59.28% have not been to school or left school at primary level. While 64.2% of participants heart about cervical cancer, 8.5% heart about Human papillomavirus, 69.05% don't know that cervical cancer is preventable. 90.4% of participants were worried to develop cervical cancer, 96.67% would accept to be screened and 11.07% were screened for cervical cancer. In multivariate analysis, heart about cervical cancer (OR = 5.7; 95% CI: 2.21-14.69), know contamination mode of HPV (OR = 3.81; 95% CI: 2.27-6.39), heart about HPV (OR = 2.05; 95% CI: 1.11-3.81) and use of oral contraceptive (OR = 2.06; 95% CI: 1.25-3.39) were independently associated with screening history with p < 0.05. Conclusion Knowledge and belief regarding cervical cancer is limited among Ouagadougou women and screening rate is low. There is need to enhance health education regarding Human papillomavirus and cervical cancer.
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Affiliation(s)
- Bernard Sawadogo
- Centre of International Research for Health, University of Ouagadougou, Burkina Faso
| | | | | | - Mamadou Sawadogo
- Centre of International Research for Health, University of Ouagadougou, Burkina Faso
| | - Nicola Meda
- Centre of International Research for Health, University of Ouagadougou, Burkina Faso
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Philip EJ, Shelton RC, Thompson HS, Efuni E, Itzkowitz S, Jandorf L. Is obesity associated with colorectal cancer screening for African American and Latino individuals in the context of patient navigation? Cancer Causes Control 2014; 25:1227-31. [PMID: 24946743 DOI: 10.1007/s10552-014-0415-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Accepted: 06/10/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE The association between excess body weight and colorectal cancer screening is not well established. The purpose of this analysis was to explore, in the context of patients receiving navigation, whether obesity influences receipt of screening colonoscopy among lower-income Latinos and African Americans. METHODS This sub-analysis was conducted among Latinos and African American participants who received patient navigation and had complete body mass index (BMI) data (n = 520). Cross-sectional survey data were collected at baseline among individuals 50 years and older who were referred by their primary care providers for a colonoscopy at Mount Sinai's Primary Care Clinic. BMI was based on height and weight data from chart review at baseline, and colonoscopy completion status was collected at 1 year post-baseline. RESULTS The mean BMI of the sample was 31.17 kg/m(2), with over half (53 %) of the sample categorized as obese. Rates of colonoscopy screening were high (~80 %), regardless of weight status. Adjusting for age, gender, race/ethnicity, family history of colorectal cancer, smoking status, comorbid conditions, income, marital status, insurance, and education, obesity status was not significantly associated with screening behavior among the entire sample (adjusted OR 0.81, CI 0.49-1.32, p = 0.39) or among stratified race/ethnicity and gender groups. CONCLUSIONS These findings suggest that obesity may not negatively influence receipt of colonoscopy screening in the context of patient navigation among minority participants. Further studies are needed to determine whether this finding will be observed in other populations, with and without the assistance of a patient navigator.
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Affiliation(s)
- Errol J Philip
- Memorial Sloan Kettering Cancer Center, 641 Lexington Street, 7th Floor, New York, NY, 10022, USA,
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Rajan SS, Begley CE, Kim B. Breast cancer stage at diagnosis among medically underserved women screened through the Texas Breast and Cervical Cancer Services. Popul Health Manag 2014; 17:202-10. [PMID: 24921895 DOI: 10.1089/pop.2013.0079] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Texas Breast and Cervical Cancer Services (BCCS) program was established to address the socioeconomic disparities in stage at diagnosis and outcomes among breast cancer patients. This study examines the impact of Texas BCCS on stage at diagnosis among low socioeconomic status (SES) breast cancer patients. This is a retrospective analysis of women aged 40-64 years who were screened and diagnosed with breast cancer through the Texas BCCS program (participants) as compared with similar women living in low-SES census tracts and diagnosed outside the program (comparison group) during 1995-2008. Incident cases among the participants were compared with the comparison group as well. Stage at diagnosis was also analyzed separately for the years 1995-2002 and 2003-2008 in order to estimate the effect of BCCS-related Medicaid expansion in 2002. Over the study period of 1995-2008, BCCS participants had a 1.23 (P value<0.0001) times higher odds, and BCCS incident cases had 40% (P value<0.0001) lower odds of advanced stage at diagnosis as compared with the comparison group. A statistically significant difference in stage at diagnosis between the participants and the comparison group only existed for the 2003-2008 (post-Medicaid) period (odds ratio: 1.39, P value<0.0001). Texas BCCS program acts as a source of diagnosis and treatment access to many suspected cancer cases, especially since the 2002 Medicaid expansion, leading to more advanced stage at diagnosis among the BCCS cases as compared with other low-SES cases. Significant expansion of the program to serve a higher proportion of the eligible population is needed to achieve its goals as a screening program.
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Affiliation(s)
- Suja S Rajan
- 1 Division of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston , Houston, Texas
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Clinical impact of de-regulated Notch-1 and Notch-3 in the development and progression of HPV-associated different histological subtypes of precancerous and cancerous lesions of human uterine cervix. PLoS One 2014; 9:e98642. [PMID: 24905589 PMCID: PMC4048181 DOI: 10.1371/journal.pone.0098642] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 05/06/2014] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Cervical cancer is the leading cause of cancer related deaths among women in India. Limited reports are available for Notch-1 and Notch-3 protein in cervical carcinoma, which play crucial role in cell proliferation, differentiation, and apoptosis. METHODS This study was designed to evaluate the role of Notch-1 and Notch-3 with context to HPV infection in cervical carcinoma. A total of 168 tissue biopsy samples comprising of tumor specimens (n = 98), precancer (n = 30) and non-neoplastic cervical tissues (n = 40) were screened for HPV infection by PCR and expression of Notch-1 and Notch-3 protein by Immunohistochemistry and Immunoblotting. RESULTS 80% (24/30) were found to be positive for HPV in precancer and 86.7% (85/98) in cancer patients. Notch-1 expression of precancer and cancer cases was found to be significantly down-regulated with severity of disease in nuclear (3.43±0.29; 2.04±0.19, p = 0.0001, p = 0.0001) and cytoplasm (3.07±0.29; 2.29±0.17, p = 0.0001, p = 0.0001) obtained from different stages as compared to normal cervix tissue (5.40±0.19, 4.97±0.15; p<0.001; p<0.001). However, Notch-3 expression of above cases was significantly up-regulated with severity of disease and showed intense nuclear (4.17±0.39; 4.74±0.18, p = 0.0001, p = 0.0001) and cytoplasm (3.67±0.36; 4.48±0.18, p = 0.0001, p = 0.0001) of different stages as compared to normal cervix tissue (0.95±0.20, 0.70±0.20; p<0.001; p<0.001) respectively. CONCLUSIONS These findings suggest that Notch-1 and Notch-3 may play an important role with synergistic effect of HPV in regulating development and proliferation of cervical cancer through the deregulation of Notch signalling. This study also shows the clinical utility of both proteins which may be used as predictable biomarkers in diagnosing different histological sub-types of HPV associated cervical cancer. Nevertheless, abnormal activation of this pathway may provide legitimate targets for cervical cancer therapy.
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Discrete improvement in racial disparity in survival among patients with stage IV colorectal cancer: a 21-year population-based analysis. J Gastrointest Surg 2014; 18:1194-204. [PMID: 24733258 DOI: 10.1007/s11605-014-2515-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2013] [Accepted: 03/24/2014] [Indexed: 01/31/2023]
Abstract
PURPOSE Recently, multiple clinical trials have demonstrated improved outcomes in patients with metastatic colorectal cancer. This study investigated if the improved survival is race dependent. PATIENTS AND METHODS Overall and cancer-specific survival of 77,490 White and Black patients with metastatic colorectal cancer from the 1988-2008 Surveillance Epidemiology and End Results registry were compared using unadjusted and multivariable adjusted Cox proportional hazard regression as well as competing risk analyses. RESULTS Median age was 69 years, 47.4 % were female and 86.0 % White. Median survival was 11 months overall, with an overall increase from 8 to 14 months between 1988 and 2008. Overall survival increased from 8 to 14 months for White, and from 6 to 13 months for Black patients. After multivariable adjustment, the following parameters were associated with better survival: White, female, younger, better educated and married patients, patients with higher income and living in urban areas, patients with rectosigmoid junction and rectal cancer, undergoing cancer-directed surgery, having well/moderately differentiated, and N0 tumors (p < 0.05 for all covariates). Discrepancies in overall survival based on race did not change significantly over time; however, there was a significant decrease of cancer-specific survival discrepancies over time between White and Black patients with a hazard ratio of 0.995 (95 % confidence interval 0.991-1.000) per year (p = 0.03). CONCLUSION A clinically relevant overall survival increase was found from 1988 to 2008 in this population-based analysis for both White and Black patients with metastatic colorectal cancer. Although both White and Black patients benefitted from this improvement, a slight discrepancy between the two groups remained.
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Bergmans R, Soliman AS, Ruterbusch J, Meza R, Hirko K, Graff J, Schwartz K. Cancer incidence among Arab Americans in California, Detroit, and New Jersey SEER registries. Am J Public Health 2014; 104:e83-91. [PMID: 24825237 DOI: 10.2105/ajph.2014.301954] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We calculated cancer incidence for Arab Americans in California; Detroit, Michigan; and New Jersey, and compared rates with non-Hispanic, non-Arab Whites (NHNAWs); Blacks; and Hispanics. METHODS We conducted a study using population-based data. We linked new cancers diagnosed in 2000 from the Surveillance, Epidemiology, and End Results Program (SEER) to an Arab surname database. We used standard SEER definitions and methodology for calculating rates. Population estimates were extracted from the 2000 US Census. We calculated incidence and rate ratios. RESULTS Arab American men and women had similar incidence rates across the 3 geographic regions, and the rates were comparable to NHNAWs. However, the thyroid cancer rate was elevated among Arab American women compared with NHNAWs, Hispanics, and Blacks. For all sites combined, for prostate and lung cancer, Arab American men had a lower incidence than Blacks and higher incidence than Hispanics in all 3 geographic regions. Arab American male bladder cancer incidence was higher than that in Hispanics and Blacks in these regions. CONCLUSIONS Our results suggested that further research would benefit from the federal recognition of Arab Americans as a specified ethnicity to estimate and address the cancer burden in this growing segment of the population.
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Affiliation(s)
- Rachel Bergmans
- Rachel Bergmans is with the Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor. Amr S. Soliman is with the Department of Epidemiology, University of Nebraska Medical Center College of Public Health, Omaha. Julie Ruterbusch is with the Department of Oncology, Wayne State School of Medicine, Detroit, MI. Rafael Meza and Kelly Hirko are with the Department of Epidemiology, University of Michigan School of Public Health. John Graff is with the New Jersey Registry, SEER Registry, Trenton. Kendra Schwartz is with Family Medicine and Public Health Sciences, Wayne State University School of Medicine
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Abstract
There is an excess burden of colorectal cancer (CRC) in the Appalachian region of the United States, which could be reduced by increased uptake of CRC screening tests. Thus, we examined correlates of screening among Appalachian residents at average-risk for CRC. Using a population-based sample, we conducted interviews with and obtained medical records of Appalachian Ohio residents 51-75 years between September 2009 and April 2010. Using multivariable logistic regression, we identified correlates of being within CRC screening guidelines by medical records. About half of participants were within CRC screening guidelines. Participants who were older (OR = 1.04, 95 % CI 1.01, 1.07), had higher income ($30,000-$60,000, OR = 1.92, 95 % CI 1.29, 2.86; ≥$60,000, OR = 1.80, 95 % CI 1.19, 2.72), a primary care provider (OR = 4.22, 95 % CI 1.33, 13.39), a recent check-up (OR = 2.37, 95 % CI 1.12, 4.99), had been encouraged to be screened (OR = 1.57, 95 % CI 1.11, 2.22), had been recommended by their doctor to be screened (OR = 6.68, 95 % CI 3.87, 11.52), or asked their doctor to order a screening test (OR = 2.24, 95 % CI 1.36, 3.69) had higher odds of being screened within guidelines in multivariable analysis. Findings suggest that access to and utilization of healthcare services, social influence, and patient-provider communication were the major factors associated with CRC screening. Researchers and healthcare providers should develop and implement strategies targeting these barriers/facilitators to improve CRC screening rates and reduce the CRC burden among residents of Appalachia.
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Kang M, Yoo KB, Park EC, Kwon K, Kim G, Kim DR, Kwon JA. Factors Associated with Organized and Opportunistic Cancer Screening: Results of the Korea National Health and Nutrition Examination Survey (KNHANES) 2007-2011. Asian Pac J Cancer Prev 2014; 15:3279-86. [DOI: 10.7314/apjcp.2014.15.7.3279] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Shekhar S, Sharma C, Thakur S, Raina N. Cervical cancer screening: knowledge, attitude and practices among nursing staff in a tertiary level teaching institution of rural India. Asian Pac J Cancer Prev 2014; 14:3641-5. [PMID: 23886159 DOI: 10.7314/apjcp.2013.14.6.3641] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Assessment of the nursing staff knowledge, attitude and practices about cervical cancer screening in a tertiary care teaching institute of rural India. MATERIALS AND METHODS A cross sectional, descriptive, interview- based survey was conducted with a pretested questionnaire among 262 staff nurses of a tertiary care teaching and research institute. RESULTS In this study 77% respondents knew that Pap smear is used for detection of cervical cancer, but less than half knew that Pap smear can detect even precancerous lesions of cervix. Only 23.4% knew human papilloma virus infection as a risk factor. Only 26.7% of the respondents were judged as having adequate knowledge based on scores allotted for questions evaluating knowledge about cervical cancer and screening. Only 17 (7%) of the staff nurses had themselves been screened by Pap smear, while 85% had never taken a Pap smear of a patient. Adequate knowledge of cervical cancer and screening, higher parity and age >30 years were significantly associated with self screening for cervical cancer. Most nurses held a view that Pap test is a doctor procedure, and nearly 90% of nurses had never referred a patient for Pap testing. CONCLUSIONS The majority of nursing staff in rural India may have inadequate knowledge about cervical cancer screening, and their attitude and practices towards cervical cancer screening could not be termed positive.
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Affiliation(s)
- Shashank Shekhar
- Department of Obstetrics and Gynecology, AIIMS Jodhpur, Rajasthan, India
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Hines R, Markossian T, Johnson A, Dong F, Bayakly R. Geographic residency status and census tract socioeconomic status as determinants of colorectal cancer outcomes. Am J Public Health 2014; 104:e63-71. [PMID: 24432920 DOI: 10.2105/ajph.2013.301572] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of geographic residency status and census tract (CT)-level socioeconomic status (SES) on colorectal cancer (CRC) outcomes. METHODS This was a retrospective cohort study of patients diagnosed with CRC in Georgia for the years 2000 through 2007. Study outcomes were late-stage disease at diagnosis, receipt of treatment, and survival. RESULTS For colon cancer, residents of lower-middle-SES and low-SES census tracts had decreased odds of receiving surgery. Rural, lower-middle-SES, and low-SES residents had decreased odds of receiving chemotherapy. For patients with rectal cancer, suburban residents had increased odds of receiving radiotherapy, but low SES resulted in decreased odds of surgery. For survival, rural residents experienced a partially adjusted 14% (hazard ratio [HR] = 1.14; 95% confidence interval [CI] = 1.07, 1.22) increased risk of death following diagnosis of CRC that was somewhat explained by treatment differences and completely explained by CT-level SES. Lower-middle- and low-SES participants had an adjusted increased risk of death following diagnosis for CRC (lower-middle: HR = 1.16; 95% CI = 1.10, 1.22; low: HR = 1.24; 95% CI = 1.16, 1.32). CONCLUSIONS Future efforts should focus on developing interventions and policies that target rural residents and lower SES areas to eliminate disparities in CRC-related outcomes.
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Affiliation(s)
- Robert Hines
- Robert Hines and Frank Dong are with the Department of Preventive Medicine and Public Health, University of Kansas School of Medicine, Wichita. At the time of the study, Talar Markossian was with the Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro. Asal Johnson is with the Center for International Studies, Georgia Southern University. Rana Bayakly is with the Chronic Disease, Healthy Behaviors and Injury Epidemiology Section, Health Protection Division, Georgia Department of Public Health, Atlanta
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Sanson-Fisher RW, D'Este CA, Carey ML, Noble N, Paul CL. Evaluation of systems-oriented public health interventions: alternative research designs. Annu Rev Public Health 2014; 35:9-27. [PMID: 24387088 DOI: 10.1146/annurev-publhealth-032013-182445] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The need to provide sound evidence of the costs and benefits of real-world public health interventions has driven advances in the development and analysis of designs other than the controlled trial in which individuals are randomized to an experimental condition. Attention to methodological quality is of critical importance to ensure that any evaluation can accurately answer three fundamental questions: (a) Has a change occurred, (b) did the change occur as a result of the intervention, and (c) is the degree of change significant? A range of alternatives to the individual randomized controlled trial (RCT) can be used for evaluating such interventions, including the cluster RCT, stepped wedge design, interrupted time series, multiple baseline, and controlled prepost designs. The key features and complexities associated with each of these designs are explored.
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Affiliation(s)
- Robert W Sanson-Fisher
- Priority Research Center for Health Behavior and Hunter Medical Research Institute, University of Newcastle, Callaghan, NSW 2308, Australia; , , ,
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Get screened: a randomized trial of the incremental benefits of reminders, recall, and outreach on cancer screening. J Gen Intern Med 2014; 29:90-7. [PMID: 24002626 PMCID: PMC3889981 DOI: 10.1007/s11606-013-2586-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Rates of breast cancer (BC) and colorectal cancer (CRC) screening are particularly low among poor and minority patients. Multifaceted interventions have been shown to improve cancer-screening rates, yet the relative impact of the specific components of these interventions has not been assessed. Identifying the specific components necessary to improve cancer-screening rates is critical to tailor interventions in resource limited environments. OBJECTIVE To assess the relative impact of various components of the reminder, recall, and outreach (RRO) model on BC and CRC screening rates within a safety net practice. DESIGN Pragmatic randomized trial. PARTICIPANTS Men and women aged 50-74 years past due for CRC screen and women aged 40-74 years past due for BC screening. INTERVENTIONS We randomized 1,008 patients to one of four groups: (1) reminder letter; (2) letter and automated telephone message (Letter + Autodial); (3) letter, automated telephone message, and point of service prompt (Letter + Autodial + Prompt); or (4) letter and personal telephone call (Letter + Personal Call). MAIN MEASURES Documentation of mammography or colorectal cancer screening at 52 weeks following randomization. KEY RESULTS Compared to a reminder letter alone, Letter + Personal Call was more effective at improving screening rates for BC (17.8 % vs. 27.5 %; AOR 2.2, 95 % CI 1.2-4.0) and CRC screening (12.2 % vs. 21.5 %; AOR 2.0, 95 % CI 1.1-3.9). Compared to letter alone, a Letter + Autodial + Prompt was also more effective at improving rates of BC screening (17.8 % vs. 28.2 %; AOR 2.1, 95 % CI 1.1-3.7) and CRC screening (12.2 % vs. 19.6 %; AOR 1.9, 95 % CI 1.0-3.7). Letter + Autodial was not more effective than a letter alone at improving screening rates. CONCLUSIONS The addition of a personal telephone call or a patient-specific provider prompt were both more effective at improving mammogram and CRC screening rates compared to a reminder letter alone. The use of automated telephone calls, however, did not provide any incremental benefit to a reminder letter alone.
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Affiliation(s)
- Navkiran K Shokar
- Paul L Foster School of Medicine, Texas Tech University Health Sciences Center, 9849 Kenworthy Street, El Paso, TX, 79924, USA,
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Guideline-inconsistent breast cancer screening for women over 50: a vignette-based survey. J Gen Intern Med 2014; 29:82-9. [PMID: 23943421 PMCID: PMC3889955 DOI: 10.1007/s11606-013-2567-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Revised: 06/18/2013] [Accepted: 06/27/2013] [Indexed: 02/04/2023]
Abstract
BACKGROUND Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. OBJECTIVE This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. DESIGN We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. PARTICIPANTS 1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. MAIN MEASURE Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. KEY RESULTS 36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. CONCLUSIONS Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.
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Al-Amoudi S, Cañas J, Hohl SD, Distelhorst SR, Thompson B. Breaking the silence: breast cancer knowledge and beliefs among Somali Muslim women in Seattle, Washington. Health Care Women Int 2013; 36:608-16. [PMID: 24351062 DOI: 10.1080/07399332.2013.857323] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
We elicited the perspectives of Somali women in Seattle, Washington, about breast cancer. We conducted a focus group of 14 Somali immigrant women at a community center in Seattle, Washington. Participants reported barriers to seeking cancer screening, including fear of pain, difficulty with transport, and lack of knowledge. Participants explained that Somali women tended not to discuss breast cancer or breast cancer screening, and said religion played a central role in their care and treatment decisions and coping mechanisms. If such barriers are addressed, fewer women may present with late-stage breast cancer, resulting in greater chances for long-term breast cancer survival.
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Affiliation(s)
- Samia Al-Amoudi
- a Department of Obstetrics & Gynecology, Faculty of Medicine; and Sheikh Mohammed Hussein Al-Amoudi Center of Excellence in Breast Cancer, King Abdulaziz University , Jeddah , Saudi Arabia
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Prostate specific antigen testing in family practice: a cross sectional survey of self-reported rates of and reasons for testing participation and risk disclosure. BMC FAMILY PRACTICE 2013; 14:186. [PMID: 24321004 PMCID: PMC4029150 DOI: 10.1186/1471-2296-14-186] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 12/04/2013] [Indexed: 12/31/2022]
Abstract
Background Despite controversy about the benefits of routine prostate specific antigen (PSA) testing, rates of participation continue to rise. It is important to ensure that men are fully informed about the potential risks associated with this test. Little is known about the processes of shared decision making for PSA testing in the family practice setting. This study aimed to explore men’s experiences of PSA testing participation and risk disclosure for PSA testing. Methods A cross-sectional survey of male family practice attendees aged 40 years or older, with no previous history of prostate cancer, between June 2010 and November 2011. Questions related to whether participants had undertaken PSA testing or discussed this with their doctor over the past 5 years, whether the patient or doctor had initiated the discussion, reasons for undergoing testing, and whether their doctor had discussed particular risks associated with PSA testing. Results Sixty-seven percent (215/320) of men recalled having a PSA test in the past five years. Of the respondents who reported not having a test, 14% had discussed it with their doctor. The main reasons for having a PSA test were doctor recommendation and wanting to keep up to date with health tests. Thirty-eight percent or fewer respondents reported being advised of each potential risk. Conclusions Despite debate over the benefits of routine PSA testing, a high proportion of male family practice attendees report undertaking this test. Risks associated with testing appear to be poorly disclosed by general practitioners. These results suggest the need to improve the quality of informed consent for PSA testing in the family practice setting.
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Ndukwe EG, Williams KP, Sheppard V. Knowledge and perspectives of breast and cervical cancer screening among female African immigrants in the Washington D.C. metropolitan area. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2013; 28:748-54. [PMID: 23900622 PMCID: PMC3815517 DOI: 10.1007/s13187-013-0521-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Black women in the USA have both a higher percentage of late-stage diagnoses as well as the highest rates of mortality from breast cancer when compared to women of other ethnic subgroups. Additionally, Black women have the second highest prevalence of cervical cancer. Many reports evaluating the cancer outcomes of Black women combine data on African-born immigrants and US-born Blacks. This categorization ignores subtle yet important cultural differences between the two groups, which may ultimately affect breast and cervical cancer screening practices. Therefore, this study investigated knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the USA residing in the Washington D.C. metropolitan area. Data were collected from 38 participants through key informant interviews, focus group sessions, and a sociodemographic questionnaire over a 3-month study period. Results suggest that fatalism, stigma, and privacy are among the major factors that affect the decision to seek preventative screening measures for breast and cervical cancer among this population. Additionally, the study implies that cervical cancer awareness is significantly lower among this population when compared to breast cancer. This study highlights differences between women of African descent residing in the USA and the need for continued research to increase understanding of the manner in which immigrant status affects health-seeking behavior. This information is critical for researchers, physicians, and public health educators aiming to design culturally appropriate interventions to effectively reduce the prevalence of breast and cervical cancer among female African immigrants living in the USA.
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Affiliation(s)
| | | | - Vanessa Sheppard
- Georgetown University Lombardi Cancer Center, Washington, DC, USA
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Ryu SY, Crespi CM, Maxwell AE. What factors explain disparities in mammography rates among Asian-American immigrant women? A population-based study in California. Womens Health Issues 2013; 23:e403-10. [PMID: 24183415 PMCID: PMC3833860 DOI: 10.1016/j.whi.2013.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 07/30/2013] [Accepted: 08/22/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The purpose of this study was to compare rates of screening mammography among immigrant women in five Asian-American ethnic groups in California, and ascertain the extent to which differences in mammography rates among these groups are attributable to differences in known correlates of cancer screening. METHODS Using 2009 data from the California Health Interview Survey, we compared the rates of mammography among Chinese, Filipino, Japanese, Korean, and Vietnamese immigrants 40 years and older. To assess the impact of Asian ethnicity on participation in screening, we performed multiple logistic regression analysis with models that progressively adjusted for acculturation, sociodemographic characteristics, access to health care, and breast cancer risk factors, and examined the predicted probabilities of screening after adjusting for these factors. FINDINGS Participation in screening mammography differed according to ethnicity, with Filipina and Vietnamese Americans having the highest rates and Korean Americans having the lowest rates of lifetime and recent (past 2 years) screening. These differences decreased substantially after adjusting for acculturation, sociodemographic factors, and risk factors of breast cancer, but differences remained, most notably for Korean Americans, who continued to have the lowest predicted probability of screening even after adjustment for these factors. CONCLUSIONS This analysis draws attention to low mammography screening rates among Asian-American immigrants, especially recent immigrants who lack health insurance. Given that their breast cancer incidence is rising with length of stay in the United States, it is important to increase regular mammography screening in these groups.
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Affiliation(s)
- So Yeon Ryu
- Department of Preventive Medicine, Chosun University Medical School, 309 Pilmun-daero, Dong-gu, Gwangju, 501-759, Korea; Tel:+82-62-230-6483;
| | - Catherine M. Crespi
- University of California, Los Angeles, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-206-9364;
| | - Annette E. Maxwell
- University of California, Los Angeles, Fielding School of Public Health, Department of Health Policy and Management & Jonsson Comprehensive Cancer Center, 650 Charles Young Drive South, Room A2-125, CHS, Los Angeles, CA 90095, USA; Tel:+1-310-794-9282;
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Cowburn S, Carlson MJ, Lapidus JA, DeVoe JE. The association between insurance status and cervical cancer screening in community health centers: exploring the potential of electronic health records for population-level surveillance, 2008-2010. Prev Chronic Dis 2013; 10:E173. [PMID: 24157076 PMCID: PMC3809921 DOI: 10.5888/pcd10.130034] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Cervical cancer incidence and mortality rates in the United States have decreased 67% over the past 3 decades, a reduction mainly attributed to widespread use of the Papanicolaou (Pap) test for cervical cancer screening. In the general population, receipt of cervical cancer screening is positively associated with having health insurance. Less is known about the role insurance plays among women seeking care in community health centers, where screening services are available regardless of insurance status. The objective of our study was to assess the association between cervical cancer screening and insurance status in Oregon and California community health centers by using data from electronic health records. METHODS We used bilevel log-binomial regression models to estimate prevalence ratios and 95% confidence intervals for receipt of a Pap test by insurance status, adjusted for patient-level demographic factors and a clinic-level random effect. RESULTS Insurance status was a significant predictor of cervical cancer screening, but the effect varied by race/ethnicity and age. In our study uninsured non-Hispanic white women were less likely to receive a Pap test than were uninsured women of other races. Young, uninsured Hispanic women were more likely to receive a Pap test than were young, fully insured Hispanic women, a finding not previously reported. CONCLUSION Electronic health records enable population-level surveillance in community health centers and can reveal factors influencing use of preventive services. Although community health centers provide cervical cancer screening regardless of insurance status, disparities persist in the association between insurance status and receipt of Pap tests. In our study, after adjusting for demographic factors, being continuously insured throughout the study period improved the likelihood of receiving a Pap test for many women.
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Affiliation(s)
- Stuart Cowburn
- OCHIN, Inc, 1881 SW Naito Parkway, Portland, Oregon 97201. E-mail:
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Cantor SB, Volk RJ, Krahn MD, Cass AR, Gilani J, Weller SC, Spann SJ. Concordance of couples' prostate cancer screening recommendations from a decision analysis. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2013; 1:11-9. [PMID: 22272754 DOI: 10.2165/01312067-200801010-00004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine whether different utilities for prostate cancer screening outcomes for couples, and husbands and wives separately, lead to incongruent screening recommendations. METHODS We evaluated survey results of 168 married couples from three family practice centers in Texas, USA. Utilities for eight adverse outcomes of prostate cancer screening and treatment were assessed using the time trade-off method. We assessed utilities separately for each partner and jointly for each couple. Using a previously published decision-analytic model of prostate cancer screening, we input the husband's age (starting point) and utilities for outcomes from the husband's, wife's, and couple's perspectives (to adjust for quality of life). Both group-level and individualized models were run. We also asked husbands (and wives) if they intended to be screened (or have their husbands screened) for prostate cancer in the future. RESULTS Husbands' lower tolerance for adverse outcomes (lower utilities) was associated with lower quality-adjusted life expectancy (than their wives) for the choice of screening versus not screening. Depending on the perspective, 48 husbands (28.6%), 89 wives (53.0%), and 58 couples (34.5%) preferred screening in the individual decision-analytic models. Comparing the three perspectives, agreement in model recommendations was greatest between the husbands and the couples (82.1%), intermediate between the wives and couples (63.7%), and lowest between the husbands and wives (55.4%). Using group-aggregated utilities in the decision-analytic model tended to mask the variation in recommended strategies amongst individuals. There was no relationship between screening preferences from the model and the husbands' and wives' reported desire for screening, as the majority of subjects wanted screening. CONCLUSIONS Discordant health preferences may yield conflicting recommendations for prostate cancer screening. The results have broad implications for informed healthcare decision making for couples.
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Affiliation(s)
- Scott B Cantor
- 1 Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas, USA 2 Department of Family and Community Medicine, Baylor College of Medicine and Houston Center for Education and Research on Therapeutics, Houston, Texas, USA 3 Division of Clinical Decision-Making & Health Care, Toronto General Research Institute, Toronto, Ontario, Canada 4 Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA 5 Department of Preventive Medicine and Community Health, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
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EED gene polymorphism in patients with colorectal cancer. Int J Biol Markers 2013; 28:274-9. [PMID: 23709348 DOI: 10.5301/jbm.5000024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2013] [Indexed: 01/21/2023]
Abstract
BACKGROUND Our previous work indicated that, first, the embryonic ectoderm development (EED) gene is a candidate gene associated with the pathogenesis of ulcerative colitis (UC) and, second, that the haplotypes of the EED polymorphism are one of the markers for UC susceptibility. The risk of developing colorectal cancer (CRC) increases in patients with inflammatory bowel disease.
AIM The present study aimed at determining the association between polymorphisms in the EED gene and CRC.
METHODS Genotype analysis of EED single nucleotide polymorphisms (SNPs) was performed with high-resolution melting analysis, and the genotype and allele frequencies of the EED SNPs were compared between CRC patients and healthy controls. The haplotype frequencies of EED for multiple loci were estimated using the expectation maximization (EM) algorithm.
RESULTS Our study had a power of 76.6% at a 0.05 significance level. Genotype and allele frequencies of the SNPs and haplotype frequencies of the EED gene in CRC patients were not significantly different from those in healthy controls. Only the allele frequency of g.-1850G>C in the rectal cancer (RC) patient group was significantly different from that of the control group (p=0.04). Similarly, the genotype and allelic frequencies of the EED SNPs for either tumor site (left or right) or tumor stage were not significantly different from those in healthy controls. However, our data show an association between the g.-993G>C polymorphism in the EED gene and the presence of lymph node metastasis in CRC.
CONCLUSIONS These results suggest that the SNPs of the EED gene might not be associated with susceptibility to CRC. However, this study shows that the allele frequency of g.-1850G>C in the RC patient group was significantly different from that in the control group (p=0.04) and that g.-993G>C may play a role in the lymph node metastatic process of CRC.
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Abstract
BACKGROUND Our objectives were to: (1) compare colorectal cancer screening (CRCS) among US born citizens (USBs), naturalized citizens (NACs), and noncitizens (NOCs) and (2) evaluate clinical factors and potential barriers associated with CRCS in these populations. METHODS Screening-eligible patients were identified from the 2007 California Health Interview Survey. Up-to-date CRCS was defined as a fecal occult blood test within 1 year, a sigmoidoscopy within 5 years, or a colonoscopy within 10 years. Using logistic regression, we determined the effects of immigrant status on CRCS. Stratified analyses based on location of residence, health insurance status, and English proficiency were conducted. RESULTS A total of 30,434 average-risk adults aged 50 years or older completed the survey. Only 67% of USBs, 61% of NACs, and 46% of NOCs underwent CRCS. Advanced age, male sex, high-income earners, nonsmokers, and those who were married or visited their physicians frequently were more likely to receive CRCS (all P < 0.05). Compared with USBs, both NACs and NOCs showed decreased odds of CRCS (odds ratio 0.88, 95% confidence interval, 0.74-1.06 and odds ratio 0.68, 95% confidence interval, 0.53-0.88, respectively; P = 0.011). Stratified analyses revealed that the associations between immigrants and decreased CRCS were more prominent for those who lived in rural areas, lacked insurance, or were not English proficient. CONCLUSIONS CRCS remains suboptimal, especially in new US immigrants. Improving health care access and mitigating language barriers may minimize this disparity.
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St-Jacques S, Philibert MD, Langlois A, Daigle JM, Pelletier É, Major D, Brisson J. Geographic access to mammography screening centre and participation of women in the Quebec Breast Cancer Screening Programme. J Epidemiol Community Health 2013; 67:861-7. [DOI: 10.1136/jech-2013-202614] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Jafri NS, Gould M, El-Serag HB, Duan Z, Davila JA. Incidence and survival of colorectal cancer among Hispanics in the United States: a population-based study. Dig Dis Sci 2013; 58:2052-60. [PMID: 23086126 DOI: 10.1007/s10620-012-2454-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Accepted: 10/04/2012] [Indexed: 12/09/2022]
Abstract
BACKGROUND Hispanics are the largest and fastest growing ethnic group in the United States (US). AIMS We evaluated the incidence and survival of colorectal cancer (CRC) among this population. METHODS Data from the surveillance, epidemiology, and end results program were used to calculate CRC age-adjusted and age-specific incidence rates in Hispanics during 1993-2007. Temporal trends in CRC incidence were examined using annual percent change (APC) and Poisson regression. The 1- and 5-year survival rates were calculated. RESULTS The annual age-adjusted incidence rates for CRC in Hispanics of all ages declined from 47.4 per 100,000 in 1993-1997 to 43.8 per 100,000 in 2003-2007, with an APC during 1993-2007 equal to -0.8/year. However, there was a 45 % increase in CRC incidence among Hispanic men and women aged 20-49 years that affected both the right and left colon. The proportions of CRC cases with regional (+37 %) and distant (+18 %) spread increased, now constituting 72 % of cases diagnosed at that age. The Poisson model confirmed the increasing CRC incidence in Hispanics aged 20-49 years during 1993-2007 while adjusting for sex and geographic region. The 1-year survival improved in younger Hispanics from approximately 86 % in 1993-1997 to 91 % in 2003-2007 with no significant improvement in 5-year survival. In Hispanics aged >50 years, no significant improvements in survival were observed. CONCLUSIONS The incidence of CRC in young Hispanic men and women has increased in the US. Most are diagnosed with regional or distant disease. No significant improvement in long-term survival was observed in young Hispanics with CRC.
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Affiliation(s)
- Nadim S Jafri
- Section of Gastroenterology, The Michael E DeBakey VA Medical Center and Baylor College of Medicine, Houston, TX, USA
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Han PKJ, Kobrin S, Breen N, Joseph DA, Li J, Frosch DL, Klabunde CN. National evidence on the use of shared decision making in prostate-specific antigen screening. Ann Fam Med 2013; 11:306-14. [PMID: 23835816 PMCID: PMC3704490 DOI: 10.1370/afm.1539] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
PURPOSE Recent clinical practice guidelines on prostate cancer screening using the prostate-specific antigen (PSA) test (PSA screening) have recommended that clinicians practice shared decision making-a process involving clinician-patient discussion of the pros, cons, and uncertainties of screening. We undertook a study to determine the prevalence of shared decision making in both PSA screening and nonscreening, as well as patient characteristics associated with shared decision making. METHODS A nationally representative sample of 3,427 men aged 50 to 74 years participating in the 2010 National Health Interview Survey responded to questions on the extent of shared decision making (past physician-patient discussion of advantages, disadvantages, and scientific uncertainty associated with PSA screening), PSA screening intensity (tests in past 5 years), and sociodemographic and health-related characteristics. RESULTS Nearly two-thirds (64.3%) of men reported no past physician-patient discussion of advantages, disadvantages, or scientific uncertainty (no shared decision making); 27.8% reported discussion of 1 to 2 elements only (partial shared decision making); 8.0% reported discussion of all 3 elements (full shared decision making). Nearly one-half (44.2%) reported no PSA screening, 27.8% reported low-intensity (less-than-annual) screening, and 25.1% reported high-intensity (nearly annual) screening. Absence of shared decision making was more prevalent in men who were not screened; 88% (95% CI, 86.2%-90.1%) of nonscreened men reported no shared decision making compared with 39% (95% CI, 35.0%-43.3%) of men undergoing high-intensity screening. Extent of shared decision making was associated with black race, Hispanic ethnicity, higher education, health insurance, and physician recommendation. Screening intensity was associated with older age, higher education, usual source of medical care, and physician recommendation, as well as with partial vs no or full shared decision making. CONCLUSIONS Most US men report little shared decision making in PSA screening, and the lack of shared decision making is more prevalent in nonscreened than in screened men. Screening intensity is greatest with partial shared decision making, and different elements of shared decision making are associated with distinct patient characteristics. Shared decision making needs to be improved in decisions for and against PSA screening.
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Affiliation(s)
- Paul K J Han
- Maine Medical Center Research Institute, Portland, ME 04101, USA.
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143
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Bellinger JD, Brandt HM, Hardin JW, Bynum S, Sharpe PA, Jackson D. The role of family history of cancer on cervical cancer screening behavior in a population-based survey of women in the Southeastern United States. Womens Health Issues 2013; 23:e197-204. [PMID: 23722075 PMCID: PMC3700594 DOI: 10.1016/j.whi.2013.03.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 03/05/2013] [Accepted: 03/29/2013] [Indexed: 11/29/2022]
Abstract
BACKGROUND Our objective was to determine the association of self-reported family history of cancer (FHC) on cervical cancer screening to inform a potential link with cancer preventive behaviors in a region with persistent cancer disparities. METHODS Self-reported FHC, Pap test behavior, and access to care were measured in a statewide population-based survey of human papillomavirus and cervical cancer (n = 918). Random-digit dial, computer-assisted telephone interviews were used to contact eligible respondents (adult [ages 18-70] women in South Carolina with landline telephones]. Logistic regression models were estimated using STATA 12. FINDINGS Although FHC+ was not predictive (odds ratio [OR], 1.17; 95% confidence interval [CI], 0.55-2.51), private health insurance (OR, 2.35; 95% confidence interval [CI], 1.15-4.81) and younger age (18-30 years: OR, 7.76; 95% CI, 1.91, 3.16) were associated with recent Pap test behavior. FHC and cervical cancer screening associations were not detected in the sample. CONCLUSIONS Findings suggest targeting older women with screening recommendations and providing available screening resources for underserved women.
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Affiliation(s)
- Jessica D. Bellinger
- Department of Health Services Policy and Management, South Carolina Rural Health Research Center, Arnold School of Public Health, University of South Carolina, 220 Stoneridge Drive, Suite 204, Columbia, SC 29210, Tel: (803) 251-6317, Fax: (803) 251-6399
| | - Heather M. Brandt
- Department of Health Promotion Education & Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street HESC 312A, Columbia, SC 29208; Tel: (803) 777-4561, Fax: (803) 777-6290
- Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Room 230, Columbia, SC 29208
| | - James W. Hardin
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, Biostatistics Collaborative Unit, University of South Carolina, 1600 Hampton Street, Suite 507, Columbia, SC 28208; Tel: (803) 777-0379, Fax: (803) 777-0391
| | - Shalanda Bynum
- Department of Preventive Medicine & Biometrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, Tel: (301) 295-1585; Fax: (301) 295-1933
| | - Patricia A. Sharpe
- Prevention Research Center, Arnold School of Public Health, University of South Carolina, 921 Assembly Street, Columbia, SC 29208; Tel: (803) 777-4253, Fax: (803) 777-9007
| | - Dawnyéa Jackson
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 800 Sumter Street HESC, Columbia, SC 29208
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144
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Levy BT, Daly JM, Luxon B, Merchant ML, Xu Y, Levitz CE, Wilbur JK. The "Iowa get screened" colon cancer screening program. J Prim Care Community Health 2013; 1:43-9. [PMID: 23804068 DOI: 10.1177/2150131909352191] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To implement a colon cancer screening program for uninsured or underinsured Iowans. METHODS All 1995 uninsured patients or patients with Iowa Care insurance aged 50 to 64 years attending the University of Iowa Clinic or the Iowa City Free Medical Clinic were mailed information about the project. Recruitment also took place in person, by having the clinic receptionist hand subjects a research packet, and through community posters. Individuals with colonic symptoms or who were up to date with screening were ineligible. Eligible subjects received a free fecal immunochemical test (FIT), and those with positive FITs were provided with a colonoscopy at no cost to them. RESULTS Of 449 individuals who completed eligibility forms (23% of the study population), 297 (66%) were eligible and were provided with an FIT. Two-hundred thirty-five (79%) returned a stool sample, with 49 (21%) testing positive. Thirty of the 49 (61%) individuals had a colonoscopy, and 20 individuals had at least 1 polyp biopsied. Thirteen individuals had at least 1 tubular adenoma; 2 had adenomas more than 1 cm in diameter, with no colon cancers identified. Face-to-face recruitment had the highest rate of returned FITs (72%) compared with handing the subject a research packet (3%) or a mailing only (9%) (Chi-square, P < .001). CONCLUSION There was high interest in and compliance with colon cancer screening using a FIT among underinsured individuals. Although the FIT positivity rate was higher than expected, many individuals did not complete recommended follow-up colonoscopies. Population-based strategies for offering FIT could significantly increase colon cancer screening among disadvantaged individuals, but programs will have to develop sustainable mechanisms to include the necessary organization and address substantial costs of providing mass screening, as well as facilitating and providing colonoscopies for those who test positive.
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Affiliation(s)
- Barcey T Levy
- Department of Family Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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145
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Ibrayev Y, Oda K, Fraser GE, Knutsen SF. Utilization of prostate cancer screening according to dietary patterns and other demographic variables. The adventist health study-2. J Cancer 2013; 4:416-26. [PMID: 23833686 PMCID: PMC3701811 DOI: 10.7150/jca.6442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/05/2013] [Indexed: 11/07/2022] Open
Abstract
Background: Prostate-specific antigen test and digital rectal examination are considered important screening methods for early detection of prostate cancer. However, the utilization of prostate cancer screening varies widely and there is limited knowledge of the predictors of utilization. Methods: Self-reported prostate cancer screening utilization within the last 2 years was investigated among 11,162 black and non-black North American Seventh-day Adventist men, aged 50-75 years, with different dietary patterns and lifestyle characteristics. Results: Blacks were more likely to screen for prostate cancer than non-blacks (Odds Ratio (OR)=1.38 (95% confidence interval (CI): 1.20-1.57). Those with a vegetarian diet, especially vegans, were less likely to follow screening guidelines, particularly among non-Blacks: vegans (OR=0.47, 0.39-0.58), lacto-ovo-vegetarians (OR=0.75, 0.66-0.86), and pesco-vegetarians (OR=0.74, 0.60-0.91) compared to non-vegetarians after adjusting for age, BMI, marital status, education, income, and family history of cancer. Trends for dietary patterns remained unchanged after stratification on age, family history of cancer, education, personal income, marital status, and BMI. Among black men, diet patterns showed no significant associations with utilization of prostate cancer screening, although vegans tended to underutilize screening compared to non-vegetarians (OR=0.70, 0.44-1.10). Conclusions: Vegetarians, especially non-black vegans, are less likely to follow recommended prostate cancer screening guidelines. The effect of diet was attenuated, and not statistically significant, among black men. Impact: Since only about 60% of US men follow prostate cancer screening guidelines, it is important to study reasons for non-compliance in order to increase utilization of preventive measures against prostate cancer.
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Affiliation(s)
- Yermek Ibrayev
- Department of Epidemiology, Biostatistics, and Population Medicine, Loma Linda University, Loma Linda, CA 92350, USA
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146
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Vart P, Gansevoort RT, Coresh J, Reijneveld SA, Bültmann U. Socioeconomic measures and CKD in the United States and The Netherlands. Clin J Am Soc Nephrol 2013; 8:1685-93. [PMID: 23813554 DOI: 10.2215/cjn.12521212] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND OBJECTIVES According to the cost of health care utilization systems, there may be regional differences in the relative strength of association of income and education-based socioeconomic status measures with CKD. This study investigated the relative strength of the association of income and education with CKD in a United States and a Dutch population. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS This cross-sectional study examined individuals who participated in the 1999-2002 National Health and Nutritional Examination Survey (NHANES) and in Prevention of Renal and Vascular End-stage Disease (PREVEND 1997-1998), general population-based cohorts in the United States and The Netherlands, respectively. The main outcome was CKD, defined as estimated GFR <60 ml/min per 1.73 m(2) (using creatinine) or albuminuria ≥ 30 mg/24 hours or albumin-to-creatinine ratio ≥ 30 mg/g. RESULTS In NHANES (n=6428), income was strongly associated with CKD (adjusted odds ratio, 2.34 [95% confidence interval (CI), 1.68 to 3.27]; P for trend<0.001) but education was not (adjusted odds ratio, 1.62 [95% CI, 0.87 to 2.25]; P for trend=0.05]. In contrast, in PREVEND (n=7983), low income was weakly associated with CKD whereas low education had a strong association. The fit of the logistic regression model estimating association of income and education with CKD was significantly improved only after income was added in NHANES (P<0.001) and education was added in PREVEND (P=0.01). Sensitivity analyses that used other CKD-defining variables and restricted analyses to participants <65 years of age resulted in similar findings. CONCLUSION In the United States, where access to health care is traditionally income dependent, income appeared more strongly associated with CKD than in The Netherlands, where education showed a stronger association.
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Affiliation(s)
- Priya Vart
- Department of Health Sciences, Community and Occupational Medicine and, †Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands, and, ‡Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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147
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Chowdhury S, Robinson D, Cahill D, Rodriguez-Vida A, Holmberg L, Møller H. Causes of death in men with prostate cancer: an analysis of 50 000 men from the Thames Cancer Registry. BJU Int 2013; 112:182-9. [DOI: 10.1111/bju.12212] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Simon Chowdhury
- Department of Medical Oncology; Guy's Hospital; King's College London; London; UK
| | - David Robinson
- Thames Cancer Registry; Section of Cancer Epidemiology; London; UK
| | - Declan Cahill
- Department of Urology; Guy's Hospital; King's College London; London; UK
| | - Alejo Rodriguez-Vida
- Department of Medical Oncology; Guy's Hospital; King's College London; London; UK
| | | | - Henrik Møller
- Thames Cancer Registry; Section of Cancer Epidemiology; London; UK
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Harhra NA, Basaleem HO. Trends of breast cancer and its management in the last twenty years in Aden and adjacent governorates, Yemen. Asian Pac J Cancer Prev 2013; 13:4347-51. [PMID: 23167341 DOI: 10.7314/apjcp.2012.13.8.4247] [Citation(s) in RCA: 10] [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 Breast cancer is the most common cancer of women and the principal cause of death in middle aged women. The objective of this study was to describe the trend of breast cancer and its management in Aden and adjacent south-eastern governorates of Yemen during the last 20 years. PATIENTS AND METHODS This is a retrospective analysis of previous studies on patients with breast cancer in Aden and adjacent south-eastern governorates, Yemen (January 1989 through December 2007). The studied variables were: sex, age, time and type of presentation, disease stage, pathological types and the performed surgical treatment. The sources of information were the treatment registry of Aden health office, archives of Al-Gamhouria teaching hospital; major referral and other public and private hospitals in Aden and Aden Cancer Registry. RESULTS The total number of patients was 476, 99% being females. The age range was 19-88 years. The most affected age was 30-50 years (60.5%), 95% presenting after one month of having breast symptoms. Forty-five percent presented with signs of advanced local disease, while 59.2% had palpable axillary lymph nodes on presentation. Early breast cancer (stages I-II) occurred in 47%, and late breast cancer (stages III-IV) in 51.5%. Invasive ductal carcinoma was the commonest pathology (89.3%). The main surgical treatment was mastectomy (modified radical mastectomy (50%). CONCLUSION Breast cancer is predominantly a disease of young with late presentation and advanced disease. Improving health awareness and earlier diagnosis of the disease by health education, encouraging breast self-examination, and providing the mammography equipment and mammary clinics in hospitals are recommended. Establishment of oncology and radiotherapy centers in Aden is a necessity.
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Affiliation(s)
- Nasser Aa Harhra
- Department of Surgery, Faculty of Medicine, University of Aden, Yemen.
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149
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Dehal A, Abbas A, Johna S. Racial disparities in clinical presentation, surgical treatment and in-hospital outcomes of women with breast cancer: analysis of nationwide inpatient sample database. Breast Cancer Res Treat 2013; 139:561-9. [PMID: 23690143 DOI: 10.1007/s10549-013-2567-1] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023]
Abstract
To examine racial/ethnic disparities in stage of disease and comorbidity (pre-treatment), surgical treatment allocation (breast-conserving surgery versus mastectomy), and in-hospital outcomes after surgery (post-treatment) among women with breast cancer. Nationwide inpatient sample is a nationwide clinical and administrative database compiled from 44 states representing 95 % of all hospital discharges in the Unites States. Discharges of adult women who underwent surgery for breast cancer from 2005 to 2009 were identified. Information about patients and hospitals characteristics was obtained. Multivariate logistic regression analyses were used to examine the risk adjusted association between race/ethnicity and the aforementioned outcomes (pre-treatment, treatment, and post-treatment). We identified 75,100 patient discharges. Compared to Whites, African-Americans (1.17, p < 0.001), and Hispanics (1.20, p < 0.001) were more likely to present with regional or metastatic disease. Similarly, African-American (1.58, p < 0.001) and Hispanics (1.11, p 0.003) were more likely to have comorbidity. Compared to Whites, African-Americans (0.71, p < 0.001), and Hispanics (0.77, p < 0.001) were less likely to receive mastectomy. Compared to Whites, African-Americans were more likely to develop post-operative complications (1.35, p < 0.001) and in-hospital mortality (1.87, p 0.13). Other racial groups showed no statistically significant difference compared to Whites. After controlling for potential confounders, we found racial/ethnic disparities in stage, comorbidity, surgical treatment allocation, and in-hospital outcomes among women with breast cancer. Future researches should examine the underlying factors of these disparities.
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Affiliation(s)
- Ahmed Dehal
- Arrowhead Regional Medical Center, Colton, CA 92324, USA.
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150
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Tejeda S, Darnell JS, Cho YI, Stolley MR, Markossian TW, Calhoun EA. Patient barriers to follow-up care for breast and cervical cancer abnormalities. J Womens Health (Larchmt) 2013; 22:507-17. [PMID: 23672296 DOI: 10.1089/jwh.2012.3590] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care. METHODS Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers. RESULTS The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier. CONCLUSION In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.
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Affiliation(s)
- Silvia Tejeda
- Institute for Health Research and Policy, School of Public Health, University of Illinois at Chicago, Chicago, Illinois 60608, USA.
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