Breast cancer screening in older black women

Mammography Screening for Older Minority Women

This project facilitated access to mammography screening for older ethnic minority women through health education and coordination of service networks for aging and health care services. Health education sessions were held in senior centers, followed by a mammography screening in a mammography van or at a health care facility. Of the participants in the education sessions, 38% received a mammogram. More women who did not obtain a mammogram believed that cancer treatments were worse than the disease. Also, more African American and White women than Hispanic women did not recognize age as a risk factor for cancer Of the Hispanic women, 30% believed that early diagnosis did not make a difference in one's outcome, compared with 20% of White women and 8% of African American women.

Lay health advisors: promoting cancer screening and reducing disparities

Cancer health disparities between racial and ethnic minorities have led to the use of lay health advisors to educate minority populations about cancer and promote cancer screening and other healthy behaviors. This article discusses the benefits of using lay health advisors to increase cancer awareness and screening in African American, Vietnamese, and Hispanic women in the United States.

Dissemination of a breast and cervical cancer early detection program through a network of community-based organizations

ENCORE (plus) , a breast and cervical cancer outreach, education, and screening referral program, was implemented by the YWCA of the United States and funded by Avon's Breast Cancer Awareness Crusade. ENCORE (plus) was designed to address the educational and access needs of low socioeconomic status and minority women who experience substantial barriers to breast and cervical cancer screening. This article describes the dissemination of ENCORE (plus) to 78 YWCAs in 30 states. It illustrates the application of social cognitive theory and diffusion theory to increase program adoption, implementation, and maintenance among community organizations that have not traditionally provided public health related services. The article highlights elements of the program that enhanced its adoption and implementation and describes procedures for accelerating the diffusion of the program across the country.

Bone health of immigrant Chinese women living in New York City

Osteoporosis is a serious national and global public health problem, but data on bone health are limited for Asian women living in the U.S., the majority of whom are Chinese. For this study, we measured bone mineral density (BMD) by dual energy X-ray densitometry (DXA) at the lumbar spine and hip region in 300 immigrant Chinese women, ages 40-90 y, living in New York City. We also collected demographic and health data, information about knowledge and care for osteoporosis, and anthropometric measures, and estimated calcium intake from the women. In our sample, 55% had osteoporosis and 38% had low bone mass (osteopenia). Older age, lower body mass index (BMI), and shorter height were associated with lower BMD at all sites. Years lived in the U.S. and number of children were also associated with lower BMD of the lumbar spine. Chinese women who emigrated from Mainland China had lower BMD at the lumbar spine and femoral neck than Chinese women who emigrated from Hong Kong, after adjusting for potential confounders. Both groups of immigrant women had lower BMD at all sites than a national sample of U.S. Caucasian women. Although the women in our study had generally poor knowledge about osteoporosis, most could identify at least one food rich in calcium. The large number of immigrant Chinese women in New York City with osteoporosis calls for major efforts to increase awareness, prevention, diagnosis, and treatment of this condition in this susceptible population.

Factors associated with mammographic decisions of Chinese-Australian women

BreastScreen (a free breast cancer screening service) has been implemented in Australia since 1991. Surveys conducted overseas consistently report that women of Chinese ancestry have low participation rates in breast cancer screening. Although Chinese women's use of breast cancer screening services has been investigated abroad, to date there are few studies of mammographic screening behavior among Chinese-Australian women. The purpose of this study is to explore and investigate the factors associated with mammographic decisions of Chinese-Australian women. Using a qualitative approach, in-depth interviews were conducted with 20 Chinese-Australian women. These were augmented by additional data from ethnographic observations. The findings show two facilitators: organizational factors (an invitation letter from BreastScreen and seniors' clubs arrangements) and the influence of 'significant others'. Barriers identified were fear perceptions of mammography, modesty and fear of stigmatization. This study provides a useful framework for designing and implementing mammographic screening services for Chinese-Australian women that may improve their participation rates.

Modifying a breast cancer risk factor survey for African American women

PURPOSE/OBJECTIVES

To evaluate a breast cancer risk factor survey for use with African American women.

DESIGN

Two focus groups consisting of women randomly selected from the patient population of Henry Ford Health System in Detroit, MI.

SETTING

A large, vertically integrated, private, nonprofit health system.

SAMPLE

Focus Group I consisted of 11 African American women aged 18-50, with a mean age of 41 years. Focus Group II consisted of nine African American women aged 51 and older, with a mean age of 60.9 years.

METHODS

A qualitative approach was used to gather and interpret the focus group data.

MAIN RESEARCH VARIABLES

Perceptions of a breast cancer risk factor survey and perceptions of breast cancer risk factors.

FINDINGS

The focus group participants suggested ways to improve the survey. Women in the younger age group appeared to lack awareness regarding breast cancer risk factors. Women in the older age group reported not knowing their family health histories.

CONCLUSIONS

Based on comments made by the focus group participants, the survey was modified substantially. Breast cancer risk factors were perceived differently by women in the two age groups.

IMPLICATIONS FOR NURSING

Results of a survey of a large, ethnically diverse sample of women could inform the development of culturally and age-appropriate nursing interventions designed to address breast cancer risk perceptions and enhance the likelihood of adherence to recommended mammography screening guidelines.

An intervention study on screening for breast cancer among single African-American women aged 65 and older

BACKGROUND

Older African-American women with single marital status are least likely to use screening procedures. This study aimed to evaluate a breast screening intervention program conducted in this population.

METHODS

Ten public housing complexes were randomly assigned to either the intervention or the control group. African-American women aged 65 and over were recruited into the study if they were widowed, divorced, separated, or never married and did not have a history of breast cancer (n = 325). The intervention program was delivered by lay health educators at the participant's apartment and was designed to increase knowledge about breast screening, reduce psychological problems, and increase support from significant others. Breast-screening-related cognition and behavior were measured at baseline and at 1 and 2 years postintervention.

RESULTS

Comparisons of the preintervention and postintervention measurements showed that while the proportion of women who had a clinical breast examination or mammogram in the preceding year was decreased at 1 year postintervention in the control group, it was increased in the intervention group. However, the differences did not reach a significant level. No consistent patterns could be found in changes of breast self-examination and variables in knowledge, attitudes, and beliefs. When analyses were restricted to women whose significant others had provided information or help on breast screening, results were better, but the differences between the intervention and control groups still did not reach statistical significance.

CONCLUSIONS

These results did not suggest significant effects of an intervention program that used lay health educators to promote breast cancer screening in older single African-American women.

Breast screening and ethnic minority women: a literature review

The incidence of breast cancer is reported to be low among ethnic minority women. However, the number of women diagnosed with breast cancer in this group is expected to rise over the next decade, as a result of changes in lifestyle and environmental factors. Despite the introduction of the NHS Breast Screening Programme in 1988, the uptake of breast cancer screening services remains low among minority women. The main reasons identified for this low uptake are a lack of knowledge among women from the ethnic communities about screening services and a lack of referral/recommendations by healthcare professionals and physicians. Future initiatives need to target appropriate education strategies for healthcare professionals on the needs of ethnic groups, as for many women this will be their first point of contact within the screening programme.

Managed care organizations and mammography: opportunities to serve underserved women

Breast cancer is one of the major causes of mortality and morbidity among women. Breast cancer screening (mammography) has been shown to be an effective preventive service. Significant proportions of women for whom mammography would be an appropriate intervention, especially older, low-income, and minority women, do not receive it. A large proportion of American women (including those in the workforce or who are Medicare and Medicaid beneficiaries) is now enrolled in managed care plans and that trend is likely to continue. Analysts have identified several concerns related to access and use of preventive services by low-income and other vulnerable populations. Research related to these concerns is summarized. Many research-based interventions have been identified that increase the likelihood of women receiving mammography. These are summarized and recommendations are made for managed care organizations to implement them.

Attitudes about breast cancer and mammography: racial, income, and educational differences

This study examined the effect of race, income, and education on perceived susceptibility to and control over breast cancer, perceived benefits of and barriers to mammography, and knowledge about breast cancer and mammography use, in addition to determining if predictors for mammography use differed between races. Self-reported mailed survey data were obtained from a convenience sample of 1083 church women (78% Caucasian, 22% African-American) > or = 50 years with no history of breast cancer. ANOVA identified higher susceptibility and lower knowledge scores for African-American women; higher knowledge scores for upper income women of both races; interactions between race and income for benefits and perceived control; and interactions between race and education for barriers. African-American women were more likely to regard fear of radiation as a barrier to mammography (OR = .34; CI = .20, .57) and were more likely to worry about getting breast cancer (OR = .50; CI = .30, .82). Caucasian women were more likely to regard cost as a barrier (OR = 2.36, CI = 1.27, 4.40). For both races, variables predictive of ever having a mammogram were perceived control (White: OR = .69, CI = .54, .88; Black: OR = .50, CI = .38, .92), perceived barriers (White: OR = .88, CI = .83, .95; Black: OR = .75, CI = .64, .88), and knowledge (White: OR = 1.18, CI = 1.04, 1.33; Black: OR = 1.28, CI = 1.02, 1.61). Perceived benefits was predictive only for Caucasians (OR = 1.71, CI = 1.42, 2.06). Racial differences in perceived barriers to mammography and findings about the knowledge differences related to race, income, and education provide direction for health education efforts. The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography.

Predicting mammography and breast self-examination in African American women

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.

Evaluation of factors potentially associated with inadequate follow-up of mammographic abnormalities

BACKGROUND

To increase the proportion of women who receive the recommended follow-up for mammographic abnormalities, factors which inhibit follow-up must be identified. Patient and health care delivery related factors were evaluated, stratified by type of follow-up recommendation, to determine reasons for inadequate follow-up.

METHODS

All Caucasian and African American women at the Henry Ford Medical Group, in southeastern Michigan, with an abnormal screening mammogram result between January 1, 1992 and July 31, 1992 were identified. All women with inadequate follow-up, and a random sample of women with adequate follow-up, were invited to participate in a telephone interview that assessed three major dimensions of the Health Belief Model (susceptibility, benefits, and barriers), general health and health behaviors, and related characteristics. The relationship between these factors and inadequate follow-up was evaluated separately for women with immediate and 6-month follow-up recommendations, using univariate and multivariate analyses.

RESULTS

A total of 555 women were invited to participate in the study (219 with inadequate follow-up and 336 with adequate follow-up). Interviews were completed for 418 women (75.3%). Women who were not notified of their mammographic abnormality were excluded from this study, leaving 399 women available for analysis. Among the women who had the recommended immediate follow-up, those who reported difficulty in obtaining medical appointments were 4 times more likely to have inadequate follow-up (95% confidence interval [CI] 1.5, 11.3), after adjusting for other variables. Among the women with six-month follow-up recommended, those who received fewer mammograms in the past 5 years were more likely to have inadequate follow-up (odds ratio [OR] = 4.0; 95% CI 1.6, 10.4). In this group, sociodemographic characteristics were not associated with inadequate follow-up, although women with transportation problems were at a higher risk (crude OR = 5.2; 95% CI 1.6, 16.7; adjusted OR = 3. 1; 95% CI 0.5, 18.3). Among women with 6-month follow-up recommended, those who perceived their health as poor or fair (crude OR = 2.4; 95% CI 1.2, 5.1; adjusted OR = 2.3; 95% CI 0.8, 6.8) and those who did not examine their own breasts frequently (crude OR = 2.3; 95% CI 1.0, 5.4; adjusted OR = 2.7; 95% CI 0.5, 18.3) were also more likely to have inadequate follow-up.

CONCLUSIONS

Results from this study demonstrate that the relative importance of factors associated with inadequate follow-up of abnormal mammograms differs according to the type of follow-up recommended. For both types of recommendations, the factors identified are noteworthy because they are amenable to intervention. Efforts should be made to facilitate appointment scheduling for follow-up of abnormal mammograms, and information about previous mammography screening should be obtained to identify women who are at a high risk for inadequate follow-up.