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Abstract
Aims and background Italy, like most western populations, is sharply aging and changing its age structure with a striking increase in the oldest segment of the elderly. Since age is related to an exponential growth of cancer incidence rates and to a worsening of prognosis, the progressive aging of the population will constitute, in the future, an issue increasingly more important for public health. The present study is the first effort to present and analyze survival rates in Italian elderly cancer patients in order to provide a starting point for the development of better clinical strategies addressed to the aged. Materials and methods The presented data come from a large data set consisting of survival data relating to 25,798 men and 20,479 women, aged 65–84 years at diagnosis, collected by Italian cancer registries participating in the ITACARE project. Relative survival rates of patients have been calculated by sex, quinquennial age classes and the considered entire age class for overall malignant neoplasms and the 10 most frequent cancer sites in the elderly. Results When all Italian data for all cancers in the 65–84 year age group were pooled, survival rates at 5 years from the diagnosis was 27% and 39% in men and women, respectively. As regards specific sites, survival rates below 50% were observed for lung, stomach and ovary cancer at 1 year from diagnosis. At 5 years from diagnosis, the rates were less than 50% for colon, prostate, cervix, multiple myeloma, non-Hodgkin's lymphoma and melanoma (only in men). The best survival at 5 years from diagnosis (above 50%) was in women for melanoma and corpus uteri and breast cancer. For all cancers, the prognosis for women was better in each considered age group even though a dramatic decrease in survival with age was observed in both sexes. In general, a similar decline in survival with increasing age characterized all considered specific sites. However, at closer observation, the patterns of a decrease revealed some differences. The ratio between the survival rates of 55–64 vs 65–84 year age class indicated that the sites with the greatest advantage of survival for younger patients (ratio >1.5) were ovary, lung and melanoma (only in men), whereas the least advantage was observed for colon, corpus uteri, breast and prostate. By calendar periods, excluding non-Hodgkin's lymphoma for women, an increase in survival was observed for all considered sites, improving an encouraging successful trend in diagnostic and therapeutic progresses.
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Affiliation(s)
- M Vercelli
- Dipartimento di Oncologia Clinica e Sperimentale dell'Università, Genova, Italy.
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Peltzer K, Phaswana-Mafuya N. Breast and cervical cancer screening and associated factors among older adult women in South Africa. Asian Pac J Cancer Prev 2015; 15:2473-6. [PMID: 24761849 DOI: 10.7314/apjcp.2014.15.6.2473] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the cancer screening prevalence and correlates in older adults from different racial backgrounds. In the context of heightened efforts for prevention and early diagnosis, we collected information on screening for two major types of cancers: cervical and breast cancer in order to establish their prevalence estimates and correlates among older South African women who participated in the Study of Global Ageing and Adults Health (SAGE) in 2008. MATERIALS AND METHODS We conducted a national population-based cross-sectional study with a multi-stage stratified cluster sample of 3,840 individuals aged 50 years or older in South Africa in 2008. In this analysis, we only considered the female subsample of (n=2202). The measures used included socio-demographic characteristics, health variables, anthropometric and blood pressure measurements. Multivariable regression analysis was performed to assess the association of socio-demographic factors, health variables and cancer screening. RESULTS Overall, regarding cervical cancer screening, 24.3% ever had a Papanicolaou (PAP) smear test, and regarding breast cancer screening, 15.5% ever had a mammography. In multivariate logistic regression analysis, younger age, higher education, being from the White or Coloured population group, urban residence, greater wealth, and suffering from two or more chronic conditions were associated with cervical cancer screening, and higher education, being from the White or Indian/Asian population group, greater wealth, having a health insurance, and suffering from two or more chronic conditions were associated with breast cancer screening. CONCLUSIONS Cancer screening coverage remains low among elderly women in South Africa in spite of the national guideline recommendations for regular screening in order to reduce the risk of dying from these cancers if not detected early. There is a need to improve accessibility and affordability of early cervical and breast cancer screening for all women to ensure effective prevention and management of cervical and breast cancer.
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Affiliation(s)
- Karl Peltzer
- HIV AIDS STIs and TB Research Programme, Human Sciences Research Council, Private, South Africa E-mail :
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Costanza ME, Luckmann R, White MJ, Rosal MC, LaPelle N, Cranos C. Moving mammogram-reluctant women to screening: a pilot study. Ann Behav Med 2009; 37:343-9. [PMID: 19517203 DOI: 10.1007/s12160-009-9107-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2007] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Effective interventions are needed for women long overdue for screening mammography. PURPOSE The purpose of this study is to pilot test an intervention for motivating overdue women to receive a mammogram. METHODS Subjects aged 45-79 without a mammogram in > or =27 months and enrolled in study practices were identified from claims data. The intervention included a mailed, educational booklet, computer-assisted barrier-specific tailored counseling and motivational interviewing, and facilitated, short-interval mammography scheduling. RESULTS Of 127 eligible women, 45 (35.4%) agreed to counseling and data collection. Most were > or =3 years overdue. Twenty-six (57.8%) of the counseled women got a mammogram within 12 months. Thirty-one (72.1%) of 43 counseled women moved > or =1 stage closer to screening, based on a modified Precaution Adoption Process Model. CONCLUSION It is feasible to reach and counsel women who are long overdue for a mammogram and to advance their stage of adoption. The intervention should be formally evaluated in a prospective trial comparing it to control or to proven interventions.
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LaPelle N, Costanza ME, Luckmann R, Rosal MC, White MJ, Stark JR. Staging mammography nonadherent women: a qualitative study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2008; 23:114-121. [PMID: 18569247 DOI: 10.1080/08858190802039094] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Few studies have related stages of mammography screening nonadherence with the rationale used by overdue women. METHODS We used a grounded theory approach to obtain and analyze data from focus groups, telephone interviews, and surveys. Emergent specific themes were compared with emerging decision levels of nonadherence. Each decision level was then compared with the Precaution Adoption Process Model and the Transtheoretical Model. RESULTS A total of 6 key themes influencing mammogram nonadherence emerged as did 6 decision levels. Variability within themes was associated with specific decision levels. The decision levels were not adequately classified by either stage model. CONCLUSIONS Stage-based educational strategies may benefit by tailoring interventions to these 6 decision levels.
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Affiliation(s)
- Nancy LaPelle
- University of Massachusetts Medical School, Worcester, MA 01655, USA
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Étude ELIPPSE 65-80. Med Sci (Paris) 2007; 23 Spec No 3:52-4. [DOI: 10.1051/medsci/2007233s52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Mandelblatt J, Schechter CB, Lawrence W, Yi B, Cullen J. Chapter 8: The SPECTRUM Population Model of the Impact of Screening and Treatment on U.S. Breast Cancer Trends From 1975 to 2000: Principles and Practice of the Model Methods. J Natl Cancer Inst Monogr 2006:47-55. [PMID: 17032894 DOI: 10.1093/jncimonographs/lgj008] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This stochastic simulation model was developed to estimate the impact of screening and treatment diffusion on U.S. breast cancer mortality between 1975 and 2000. MODELING APPROACH We use an event-driven continuous-time state transition model. Women who are destined to develop breast cancer may be screen detected, present with symptoms, or die of other causes before cancer is diagnosed. At presentation, the cancer has a stage assigned on the basis of mode of detection. Cancers are assumed to be estrogen receptor (ER) positive or negative. Data on screening and treatment diffusion are based on national datasets; other parameters are based on a synthesis of the evidence available in the literature. MODEL METHODS The model is calibrated to predict incidence and stage distribution (in situ, local, regional, and distant). Other than screening or treatment, background events that affect mortality are not explicitly modeled but are captured in the deviation between model projections of mortality trends and actual trends. We assume that: 1) tumors progress more slowly in older age groups, 2) screen- and clinically detected disease have the same survival conditional on age and stage, 3) women do not die of breast cancer within the "lead time" period, 4) screening benefits are captured by shifts in stage at diagnosis, 4) tamoxifen benefits only ER-positive women, and 5) preclinical sojourn time and dwell times in each of the clinical stages are stochastically independent. MODEL RESULTS Dissemination of screening and therapeutic advances had a substantial impact on mortality trends. We estimate that, by the year 2000, diffusion of screening lowered mortality by 12.4% and treatment improvements and dissemination lowered mortality by 14.6%. CONCLUSIONS Models such as this one can be useful to translate clinical trial findings to general populations. This model can also be used inform policy debates about how to best achieve targeted reductions in breast cancer morbidity and mortality.
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Affiliation(s)
- Jeanne Mandelblatt
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20007, USA.
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Rosen S, Weintraub N. The efficacy of performing screening mammograms in the frail elderly population. J Am Med Dir Assoc 2006; 7:230-3. [PMID: 16698509 DOI: 10.1016/j.jamda.2006.01.026] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Sonja Rosen
- UCLA Multicampus Program in Geriatrics and Gerontology, Los Angeles, CA, USA
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Sharp PC, Michielutte R, Spangler JG, Cunningham L, Freimanis R. Primary care providers' concerns and recommendations regarding mammography screening for older women. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2005; 20:34-8. [PMID: 15876180 DOI: 10.1207/s15430154jce2001_11] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Abstract
BACKGROUND Morbidity and mortality from breast cancer increase with age; however, mammography screening does not reflect this increased risk for older women. Lack of provider recommendation is a major barrier to screening. METHODS This is a descriptive study of mammography screening recommendations of community primary care providers in North Carolina (N = 96) participating in a National Cancer Institute funded research project. Providers self-reported screening recommendations for typical patients of different ages and issues and concerns that might influence the decision. Chart reviews compared actual practices with policies stated. RESULTS Of the providers, 51% recommended biannual, 45% annual for women ages 50 through 74; 4% recommended biannual, 80% annual, 5% did not recommend screening, and 10% had no general policy for women over 75. Cost, inconsistent guidelines, comorbidity, functional status, value of mammography, and patient resistance influenced screening recommendations. Chart review showed even lower rates of recommendation than self-reported figures. CONCLUSIONS Although the use of screening mammography has increased over the past decade, older women are one of the last subgroups to derive benefit from this screening test. Our survey revealed lower rates for mammography referral in older women. The primary care provider appears to be essential to increasing participation for these older women in breast cancer screening.
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Affiliation(s)
- Penny C Sharp
- Wake Forest University School of Medicine, Department of Family & Community Medicine, Winston-Salem, NC 27157-1084, USA.
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Honda K, Neugut AI. Associations between perceived cancer risk and established risk factors in a national community sample. ACTA ACUST UNITED AC 2004; 28:1-7. [PMID: 15041071 DOI: 10.1016/j.cdp.2003.12.001] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2003] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Perceptions of personal cancer risk may not accurately reflect individual's exposure to established risk factors. The purpose of this study was to assess associations between perceived cancer risk and selected established risk factors, using a large nationally representative sample. METHODS We used data from the 2000 National Health Interview Survey (NHIS) to perform a cross-sectional analysis of 30,223 adults without a cancer diagnosis. Multinominal logistic regression analyses were used to assess factors associated with medium and high perceived cancer risk. RESULTS The effects of age, family history, and smoking status on perceived risk were linear and more pronounced on those with high perceived risk. High perceived risk was associated with every day smoking (relative risk ratio [RRR] = 4.27, 95% confidence intervals [CI] = 3.65-5.01), alcohol consumption (e.g. RRR = 1.26, 95% CI = 1.01-1.56 for current drinker), number of relatives with cancer (e.g. RRR = 20.64, 95% CI = 16.37-26 for those with both parents positive), low income (RRR = 1.25, 95% CI = 1.08-1.45), and female (RRR = 1.39, 95% CI = 1.23-1.57). Obesity (RRR = 1.32, 95% CI 1.1-1.6), but not overweight, was identified as an independent determinant. High perceived risk was inversely related to age (e.g. RRR = 0.19, 95% CI = 0.16-0.24 for adults 60 and older). Ethnic minorities were less likely to perceive cancer risk. Physical inactivity was not associated with high perceived risk. CONCLUSIONS Among established risk factors, family history appears to be most reflected in the single measure of perceived cancer risk. The relationship between perceived cancer risk and exposure to established risk factors differs in important ways from what public campaigns have communicated with the public. Prevention messages should highlight that cancer risk increases with age and certain modifiable risk factors, including overweight and physical inactivity. The relationship between cancer risk perceptions and ethnicity merits further exploration.
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Affiliation(s)
- Keiko Honda
- Department of Epidemiology, Columbia University, 722 West 168th St., Room 719, New York, NY 10034, USA.
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Messina CR, Lane DS, Grimson R. Effectiveness of women's telephone counseling and physician education to improve mammography screening among women who underuse mammography. Ann Behav Med 2003; 24:279-89. [PMID: 12434939 DOI: 10.1207/s15324796abm2404_04] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
The effect on women's breast cancer screening utilization of a barrier-specific telephone counseling (BSTC) intervention, with and without a concurrent continuing medical education (CME) activity for their physicians, was evaluated. All participants (50-80 years of age) were not regular mammography users at baseline. A 4-arm quasi-experimental design was employed. Women were randomized to the BSTC or no BSTC group and assigned (with their physicians) to the CME or no CME group based on place of residence. Pre- and postintervention data were obtained for 1,601 women using telephone interviews conducted during 1995 and 1998, respectively. Among women who had ever used mammography at baseline, those who received BSTC were more likely than the control group to become regular mammography users at follow-up (OR = 1.4, p = .033). Greater reductions in perceived barriers to mammography, from baseline to follow-up, were significantly associated with receiving BSTC compared with the control group (p = .001), among women with previous mammography experience. Findings suggest that CME may have potential for initiating mammography use among women who never had a previous mammogram. However, because of the small sample available for analyses of the CME intervention and differential attrition among women who never had a previous mammogram, further study is needed to confirm this hypothesis.
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Affiliation(s)
- Catherine R Messina
- Department of Preventive Medicine, School of Medicine, State University of New York at Stony Brook, 11794-8036, USA.
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Abstract
OBJECTIVES To identify differences in the prevalence of ever having had a mammogram and having had a recent mammogram between older black and white women and to compare factors associated with mammography use in older black and white women. DESIGN Data analysis and comparative study using nationally representative multistage sampling survey. SETTING Data were obtained from the 1998 National Health Interview Survey. PARTICIPANTS Four hundred forty-nine black and 3,328 white older women were examined. MEASUREMENTS The outcome variables included never having had a mammogram (yes/no) and not having had a mammogram in the past 3 years (yes/no). RESULTS The results of chi-square tests showed that older blacks were less likely to have ever had a mammogram than older whites, but there was no difference in having had a recent mammogram between older blacks and whites. After adjusting for other related factors, race was not related to mammography use in older blacks and whites. Health insurance was related to mammography use in older whites but not in older blacks. Family income was associated with never having had a mammogram in older whites but not in older blacks. Older blacks with less than 12 years of education were less likely to have had a mammogram (recently or ever) than older whites with less than 12 years of education. CONCLUSIONS Even though race, per se, was not associated with mammography use in older black and white women, many barriers to mammography use between older black and white women were different or did not have similar effects. To promote mammography use in older black and white women, barriers need to be specifically targeted for each group to enhance the effectiveness of breast cancer screening programs.
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Affiliation(s)
- Beth Han
- Division of Programs for Special Populations, Bureau of Primary Health Care, Health Resources and Services Administration, U.S.Department of Health and Human Services, Bethesda, Maryland, USA.
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McPherson CP, Swenson KK, Lee MW. The effects of mammographic detection and comorbidity on the survival of older women with breast cancer. J Am Geriatr Soc 2002; 50:1061-8. [PMID: 12110066 DOI: 10.1046/j.1532-5415.2002.50261.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To determine an upper age limit or quantifiable level of comorbidity that would render mammography screening ineffectual in decreasing mortality in women aged 65 and older. DESIGN Retrospective cohort study. SETTING Upper midwestern United States. PARTICIPANTS Five thousand one hundred eighty-six predominantly Caucasian women aged 65 to 101 diagnosed with invasive breast cancer from 1986 through 1994. Data were obtained from The Upper Midwest Tumor Registry System, a regional consortium database in Minnesota, North Dakota, and South Dakota. MEASUREMENTS Relative risks (RRs) of death were computed for patients with mammographically detected tumors, stratified by age and comorbidity. Survival analysis was performed, stratified by level of comorbidity and method of tumor detection. RESULTS Patients with mammographically detected tumors and no comorbidity experienced significantly lower RRs of death in every age group (range P <.001 to P =.039). Women with mammographically detected tumors and mild to moderate comorbidity had RRs of death as follows: age 65 to 69 (RR = 0.32, 95% confidence interval (CI) = 0.15-0.69), age 70 to 74, (RR = 0.45, 95% CI = 0.22-0.91); age 75 to 79 (RR = 0.47, 95% CI = 0.25-0.88), age 80 and older (RR = 0.52, 95% CI = 0.33-0.80). Women with severe or multiple comorbidities experienced no improvement in survival with mammographically detected tumors. CONCLUSIONS Mammographic detection of breast cancer may be associated with a significantly decreased risk of death for older women of all ages, even for women with mild to moderate levels of comorbidity, but for older women with severe or multiple comorbidities, mammography is not associated with improvement in overall survival.
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Affiliation(s)
- Carol P McPherson
- Oncology Research Program, Park Nicollet Institute, 3800 Park Nicollet Boulevard, 2-South, Minneapolis, MN 55416, USA. mcphec@parknicollet .com
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Delivering Preventive Health Services for Breast Cancer Control: A Longitudinal View of a Randomized Controlled Trial. Health Serv Res 2002. [DOI: 10.1111/1475-6773.99158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Abstract
OBJECTIVE The potential benefits and harms of screening mammography in frail older women are unknown. Therefore, we studied the outcomes of a screening mammography policy that was instituted in a population of community-living nursing home-eligible women as a result of requirements of state auditors. We focused on the potential burdens that may be experienced. METHODS Between January 1995 and December 1997, we identified 216 consecutive women who underwent screening mammography after enrolling in a program designed to provide comprehensive care to nursing home-eligible patients who wished to stay at home. Mammograms were performed at 4 radiology centers. From computerized medical records, we tracked each woman through September 1999 for performance and results of mammography, additional breast imaging and biopsies, documentation of psychological reactions to screening, as well as vital status. Mean follow-up was 2.6 years. RESULTS The mean age of the 216 women was 81 years. Sixty-three percent were Asian, 91% were dependent in at least 1 activity of daily living, 49% had cognitive impairment, and 11% died within 2 years. Thirty-eight women (18%) had abnormal mammograms requiring further work-up. Of these women, 6 refused work-up, 28 were found to have false-positive mammograms after further evaluation, 1 was diagnosed with ductal carcinoma in situ (DCIS), and 3 were diagnosed with local breast cancer. The woman diagnosed with DCIS and 1 woman diagnosed with breast cancer were classified as not having benefited, because screening identified clinically insignificant disease that would not have caused symptoms in the women's lifetimes, since these women died of unrelated causes within 2 years of diagnosis. Therefore, 36 women (17%; 95% confidence interval [CI], 12 to 22) experienced burden from screening mammography (28 underwent work-up for false-positive mammograms, 6 refused further work-up of an abnormal mammogram, and 2 had clinically insignificant cancers identified and treated). Forty-two percent of these women had chart-documented pain or psychological distress as a result of screening. Two women (0.9%; 95% CI, 0 to 2) may have received benefit from screening mammography. CONCLUSION We conclude that screening mammography in frail older women frequently necessitates work-up that does not result in benefit, raising questions about policies that use the rate of screening mammograms as an indicator of the quality of care in this population. Encouraging individualized decisions may be more appropriate and may allow screening to be targeted to older women for whom the potential benefit outweighs the potential burdens.
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Affiliation(s)
- L C Walter
- Division of Geriatrics, San Francisco VA Medical Center and the University of California-San Francisco 94121, USA.
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Clemow L, Costanza ME, Haddad WP, Luckmann R, White MJ, Klaus D, Stoddard AM. Underutilizers of mammography screening today: characteristics of women planning, undecided about, and not planning a mammogram. Ann Behav Med 2001; 22:80-8. [PMID: 10892532 DOI: 10.1007/bf02895171] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
Using concepts from the Precaution Adoption Process Model, we identified behavioral factors, sociodemographic and psychosocial variables, and beliefs about breast cancer that discriminated among women at different stages with regard to their intention to obtain mammography screening. An independent survey company conducted telephone interviews with 2,507 women aged 50 to 80 who were identified as underutilizers of mammography screening. Each underutilizer was assigned to one of three stages with regard to intention to get a mammogram: (a) definitely planning, (b) thinking about, and (c) not planning. Estimated actual risk of breast cancer, perceived risk to breast cancer, worry about breast cancer, and fear of learning from a mammogram that one has breast cancer were variables found to be significantly associated with intention to obtain a mammogram for several subgroups of underutilizing women. There are significant behavioral and psychosocial variables, beliefs and feelings about breast cancer, and demographic characteristics that distinguish underutilizing women at various stages with regard to intention to obtain mammography screening. Our findings provide new information that could help the health care professional motivate women who are not planning to utilize this preventive health measure to become regular utilizers.
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Affiliation(s)
- L Clemow
- University of Massachusetts Medical School, USA
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Abstract
INTRODUCTION Age is the major risk factor for the majority of patients with cancer. More than 50% of cancers occurs after the age of 60. Cancer in the elderly is therefore a public health issue at stake. However, in daily clinical practice the elderly presenting cancer are not listened to with great interest and treatment is often not proper or suboptimal. CURRENT KNOWLEDGE AND KEY POINTS Diagnosis in the elderly is established at a more advanced stage of cancer than in younger people; diagnostic workup is reduced and suboptimal treatments are implemented. Therefore, barriers exist that prevent the elderly from accessing the healthcare system as easily as their younger counterpart. Misconceptions about cancer also lead them to delay their first visit. As well, although treatment with curative intent and without major side-effect is feasible, physicians have misconceptions regarding therapeutic possibilities. Due to the heterogeneity of the so-called "ageing population", difficulties are related to patients' selection. FUTURE PROSPECTS AND PROJECTS Decision in oncology for the elderly must walk a fine line in attempting to deliver the best treatment under the best conditions. Age per se must not be the only criterion for medical decision. Providing accurate information adapted to the elderly, with large circulation among healthcare professionals, should lead to the same quality of care as that in young people. Comprehensive multimodal geriatric assessments should help to further differentiate patients who may benefit from curative treatment from those for whom only palliative treatment is necessary.
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Affiliation(s)
- T Pignon
- Service de radiothérapie oncologie, hôpital de la Timone, Marseille, France
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Burack RC, George J, Gurney JG. Mammography use among women as a function of age and patient involvement in decision-making. J Am Geriatr Soc 2000; 48:817-21. [PMID: 10894323 DOI: 10.1111/j.1532-5415.2000.tb04759.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To assess the extent to which self-reported patient involvement in decision-making for initiation of mammography differs with age. DESIGN Data from the 1992 National Health Interview Survey (NHIS) Cancer Control Supplement were evaluated. Prevalences were weighted and variances were adjusted using SUDAAN software to account for the complex, multistage sampling probability design of the NHIS. Logistic regression was used to evaluate the relative likelihood of self-reported involvement in the decision to have a mammogram within the preceding year as a function of age and other covariates. PARTICIPANTS Mammography use was assessed among 3,863 NHIS female respondents 40 years of age or older. The analysis of decision-making was restricted to the subgroup of 1,064 women who reported a screening mammogram within the preceding year and who provided information on the other relevant variables. MEASUREMENTS AND MAIN RESULTS The probability of reported mammography use within the preceding year declines among older groups of interviewees. Among women with a mammogram in the preceding year, the weighted percentage of women reporting active involvement in the decision (patient decision or decided jointly with a physician) declines from 51% among women 40 to 45 years of age to 19% among those aged 75 years or older. The adjusted odds ratio comparing the likelihood of participating in the decision to have a mammogram for the oldest women, compared with the youngest, was 0.31 (95% confidence interval 0.15 to 0.61). CONCLUSIONS Older women are substantially less likely than younger women to report active involvement in the mammography decision-making process. Increased use of screening mammography among older women will require greater promotion by physicians. Other interventions, such as directed educational efforts, may also be needed to increase mammography demand among older women.
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Affiliation(s)
- R C Burack
- Department of Internal Medicine, Wayne State University, Detroit, Michigan, USA
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Messecar DC. Mammography screening for older women with and without cognitive impairment. J Gerontol Nurs 2000; 26:14-24; quiz 52-3. [PMID: 11272962 DOI: 10.3928/0098-9134-20000401-05] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
No upper age limit exists for Medicare benefits for mammography screening, but benefits for women older than age 75 remain unclear. From a clinical perspective, it would be useful to know if there is an upper age limit for women beyond which screening for breast cancer will not extend life. Using a decision-analysis model, the author examined the utility of screening using cohorts of women age 75 to 79, 80 to 84, and 85 and older, with and without cognitive impairment. The analysis evaluated different scenarios of the benefit of biennial screening versus no screening for women who had no prior screening and women who had participated in a regular screening program. Screening increased Quality Adjusted Life Years (QALYs) at all ages. Marginal savings in life expectancy adjusted for quality of life for women with no prior screening ranged from 43.5 days for healthy 75 to 79-year-old women to 25.9 days for women older than age 85. Among cognitively impaired women who were never screened, savings ranged from 20 to 5.5 days for the three age cohorts. Biennial screening among women who had been screened continuously resulted in substantially smaller life expectancy savings, from 3.3 days for healthy individuals age 75 to 79 to less than 1 day for women older than age 85. Cost effectiveness analysis indicated the reduction in costs associated with managing recurrent disease gained by early diagnosis with mammography was greatest among the population with no prior screening. Although the increase in QALYs was consistently lower for cognitively impaired women than for their healthy counterparts, the presence of cognitive impairment did not alter the finding that screening increased QALYs.
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Affiliation(s)
- D C Messecar
- Oregon Health Sciences University School of Nursing, SN-4N, 3181 SW Sam Jackson Park Road, Portland, OR 97201-3098, USA
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Vercelli M, Quaglia A, Casella C, Parodi S, Capocaccia R, Martinez Garcia C. Relative survival in elderly cancer patients in Europe. EUROCARE Working Group. Eur J Cancer 1998; 34:2264-70. [PMID: 10070297 DOI: 10.1016/s0959-8049(98)00325-6] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
In this paper different patterns of survival by age and gender are presented for 17 European countries which participated in the EUROCARE II programme. Survival data were available for 701,521 patients aged between 65 and 99 years from 44 population-based cancer registries. Age-standardised relative survival rates at 1 and 5 years from diagnosis were computed. Relative risks (RRs) of death for those aged between 65 and 99 years compared with those aged between 55 and 64 years were estimated by gender and country. In general, the elderly had a large survival disadvantage, particularly 1 year after diagnosis and in women. Poorer survival rates in the elderly were observed for patients from Eastern European countries for almost all sites. However, relative survival of the elderly with respect to younger patients was similar in the different geographic areas. The results are in agreement with other population-based studies, confirming a worse prognosis for the elderly in both sexes. This may be explained by changes in biology and the natural history of the tumour and the occurrence of severe comorbidities, potentially affecting preventive, diagnostic and therapeutic strategies. The lack of equality in providing adequate treatment to elderly cancer patients should be addressed as a matter of urgency by health-care providers.
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Affiliation(s)
- M Vercelli
- Department of Clinical and Experimental Oncology, University of Genoa, Italy
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Gulitz E, Bustillo-Hernandez M, Kent EB. Missed cancer screening opportunities among older women: A provider survey. CANCER PRACTICE 1998; 6:325-32. [PMID: 9824423 DOI: 10.1046/j.1523-5394.1998.006006325.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE Lack of physician recommendation is a major predictor of underutilization of breast and cervical cancer screening. The authors conducted a comprehensive two-part study of Florida primary care providers to determine which providers were not screening their older patients and why. This article reports on the study's quantitative survey component. DESCRIPTION OF STUDY After an initial mailing of surveys to 2052 randomly sampled, licensed medical and osteopathic physicians, nurse practitioners, and certified nurse midwives, a follow-up mailing and phone calls resulted in 496 usable surveys. Outcome variables were whether or not primary care providers performed screening tests for their asymptomatic, women patients older than 50 years of age. Predictor variables included: age, race, gender, training, specialty, practice size, and location of the providers, and the percentage of older patients that they served. RESULTS The best predictors of primary care providers not screening their asymptomatic women patients who were older than 50 years of age were providers also being older than 50, specializing in geriatrics or adult health, and working in a small or rural practice. An analysis of providers' responses to structured survey items related to their own and their patients' attitudes about screening indicated that providers often miss the opportunity to screen due to a combination of patient, provider, practice, and access barriers. CLINICAL IMPLICATIONS The authors recommend that public health and primary care practitioners collaborate in developing strategies that address areas of potential change for overcoming these four barriers, while also considering the essential public health services of assessment, policy development, and assurance. These strategies should be designed to facilitate the breast and cervical cancer screening process for both providers and patients, so that providers feel more comfortable performing and recommending these important tests, particularly for underserved groups of older women.
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Affiliation(s)
- E Gulitz
- College of Public Health, University of South Florida, Tampa, USA
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Gulitz E, Hernandez MB, Kent EB. Missed cancer screening opportunities among older women: a review. CANCER PRACTICE 1998; 6:289-95. [PMID: 9767349 DOI: 10.1046/j.1523-5394.1998.00024.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The authors present an analysis of the literature and findings from a qualitative research study as a framework for discussion of potential strategies to increase utilization of breast and cervical cancer screening among older women. The qualitative findings are one component of a comprehensive two-part study investigating why providers miss the opportunity to screen older women for cancer. OVERVIEW Qualitative analysis of in-depth interviews with experts in cancer control (academicians, clinicians, and cancer center administrators) and a survey of primary care providers revealed four emergent themes of patient, provider, office, and access barriers that contribute to underutilization of screening. Patient and provider barriers represent human factors or reasons why both groups may be reluctant to participate in screening. Office and access barriers exemplify systems factors that impede the screening process for both groups. Primary care providers may miss the opportunity to perform or recommend screening for underserved groups of older women because of their perceptions of these human and systems factors. CLINICAL IMPLICATIONS In light of the critical importance of primary care providers' recommendations, health professionals and community leaders should collaborate in developing multifaceted programs to help providers feel more comfortable about promoting screening to their patients. Such comprehensive, coordinated initiatives, which adapt successfully proven strategies to community needs and resources, may be essential to increase utilization of screening among underserved groups of older American women.
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Affiliation(s)
- E Gulitz
- College of Public Health, University of South Florida, Tampa, USA
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Abstract
OBJECTIVE To assess the extent to which an age-associated reduction in mammography use can be explained by declining self-reported health status. DESIGN We analyzed data from the 1992 National Health Interview Survey (NHIS) and Cancer Control Supplement. Logistic regression analysis was used to evaluate the association between age, health status (self-reported health and limitations in major activity), and other variables potentially related to mammography use within the past 1 year (recent mammography). PARTICIPANTS Of 12,035 NHIS respondents we restricted our analysis to the 1,772 women aged 50 years or older who reported one or more lifetime mammograms. We excluded women without a mammogram (n = 937) because we were interested in factors related to recent use versus past use of mammography. MEASUREMENTS AND MAIN RESULTS The percentage of women with a recent mammogram declined with increasing age, and the age association was independent of other factors including health status (adjusted odds ratio [OR] comparing women aged 75 years or older with those aged 50 to 64 years was 0.54; 95% confidence interval [CI] 0.41, 0.70). This age effect persisted in an analysis restricted to women reporting good or better health (adjusted OR was 0.60, 95% CI 0.44, 0.80). CONCLUSION The observed decline in recent mammography use with advancing age was not explained by variation in health status. Because healthy elderly women may live long enough to realize the potential benefit of screening mammography, factors responsible for its reduced use should be identified. Doing so will allow for the selective promotion of screening mammography among those older women most likely to benefit.
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Affiliation(s)
- R C Burack
- Department of Internal Medicine, Wayne State University, Detroit, Mich, USA
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Kim K, Yu ES, Chen EH, Kim J, Brintnall RA. Colorectal cancer screening. Knowledge and practices among Korean Americans. CANCER PRACTICE 1998; 6:167-75. [PMID: 9652248 DOI: 10.1046/j.1523-5394.1998.006003167.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
PURPOSE The purpose of this study was to examine knowledge and practices of colorectal cancer screening among Korean Americans. DESCRIPTION OF STUDY The sample consisted of 104 Korean American men and 159 women, 40 to 69 years of age, living in the Chicago area. The National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire, prepared by the National Center for Health Statistics, was used to collect data regarding colorectal cancer screening knowledge and practices. The NHIS questionnaire was translated into Korean with minor modification. RESULTS The percentage of male respondents ever having had a digital rectal exam (DRE) and fecal occult blood test (FOBT) were 13.5% and 10.6%, respectively. Only 11.3% of women reported DRE and 8.8% FOBT. Multiple logistic regression analysis results indicate that gender, education, knowledge of the seven cancer warning signals, and length of residence in the United States were significantly related to having heard of DRE. For those having had DRE, knowledge of the seven cancer warning signals, and length of residence in the United States were the only significant variables. Gender and education were significantly related to having heard of FOBT. None of the variables were found to be significantly related to having had FOBT. The findings indicate that a majority of respondents were unaware of these cancer screening examinations and forego these tests due to an underestimation of their importance. CLINICAL IMPLICATIONS The findings of this study underscore the importance of cancer education and further research addressing the cancer screening needs of Korean Americans. Currently, Korean Americans do not see healthcare providers or health brochures as valuable sources of health information. Therefore, healthcare professionals need to target this population by 1) coordinating their efforts with church and other community leaders and 2) developing health brochures that are in the Korean language and sensitive to the Korean culture.
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Affiliation(s)
- K Kim
- Grand Valley State University, Allendale, MI 49401, USA
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Skaer TL, Robison LM, Sclar DA, Harding GH. Financial incentive and the use of mammography among Hispanic migrants to the United States. Health Care Women Int 1996; 17:281-91. [PMID: 8850763 DOI: 10.1080/07399339609516245] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Researchers in migrant health clinics in Washington state found cost to be the single most commonly reported reason given by foreign-born Hispanic women for never having had a mammogram. The true significance of this finding beyond self-report was unknown. A randomized intervention trial designed to test the effect of fully subsidized mammograms on utilization was conducted within this population. Women in the intervention group received standard clinic instruction plus a voucher for a free mammogram. Controls received standard clinic instruction alone. Eighty-seven percent of women receiving vouchers obtained a mammogram within 30 days, compared with 17.5% of controls. Logistic regression analysis revealed that women receiving vouchers were 47 times more likely to obtain a mammogram than controls. This confirms women's self-report that cost is a major barrier to accessing screening mammograms in this low-income migrant population, and that women are more likely to utilize this service when financial barriers are removed.
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Daly MB, Lerman CL, Ross E, Schwartz MD, Sands CB, Masny A. Gail model breast cancer risk components are poor predictors of risk perception and screening behavior. Breast Cancer Res Treat 1996; 41:59-70. [PMID: 8932877 DOI: 10.1007/bf01807037] [Citation(s) in RCA: 60] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Gail model is being used increasingly to determine individual breast cancer risk and to tailor preventive health recommendations accordingly. Although widely known to the medical and biostatistical communities, the risk factors included in the model may not be salient to the women to whom the model is being applied. This study explored the relationship of the individual Gail model risk factors to perceived risk of breast cancer and prior breast cancer screening among women with a family history of breast cancer. Data from baseline interviews with 969 women found a striking disparity between the objective risk factors included in the model and the accuracy of perceived risk and screening behaviors of this population, particularly among women over the age of 50 years. Risk perception accuracy was unrelated to all of the Gail model risk factors for all age groups. Reported mammography adherence was only associated with having had a breast biopsy in both age groups. Breast self examination (BSE) practice was independent of all measured factors for both age groups. These findings support the need for further research to identify additional determinants of risk perception and motivators of screening behavior.
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Affiliation(s)
- M B Daly
- Fox Chase Cancer Center, Cheltenham, PA 19012, USA
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Affiliation(s)
- S M Moss
- Cancer Screening Evaluation Unit, Institute of Cancer Research, Royal Cancer Hospital, Sutton, Surry, United Kingdom
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Ford MB, Martin RD. Longitudinal evaluation of a breast cancer training module. Preliminary results. Cancer 1995; 76:2125-32. [PMID: 8635011 DOI: 10.1002/1097-0142(19951115)76:10+<2125::aid-cncr2820761336>3.0.co;2-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In 1993, the University of Texas M.D. Anderson Cancer Center's Department of Clinical Cancer Prevention began a longitudinal evaluation of its efforts to improve early detection and prevention of breast cancer by training health care professionals in special assessment skills, including how to determine risk and how to teach patients to detect breast cancer early. METHODS Sixty-three nurses enrolled in the 1-week training module were studied in this descriptive analysis. Their evaluation incorporated not only pretests and post-tests of knowledge and clinical performance but also an employer survey, pretraining and posttraining patient logs, and an assessment of clinical skills in each participant's practice setting. RESULTS Students made statistically significant gains in measures of general knowledge, clinical knowledge and performance, and routine practice of risk assessment, risk counseling, and history taking and physical examination of old (i.e., familiar) patients. Furthermore, the number of patients screened, patients referred, and cancer diagnoses made increased significantly over time, not only between pretraining and posttraining at 6 and 12 months, but also between 6 and 12 months' posttraining. CONCLUSIONS After learning and practicing new skills, participants successfully incorporated and maintained them and increased referrals and cancers detected, thereby improving the effectiveness of cancer screening.
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Affiliation(s)
- M B Ford
- Department of Clinical Cancer Prevention, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA
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Montella M, Biondi E, De Marco M, Botti G, Tatangelo F, Capasso I, Marone A. Sociodemographic factors associated with the diagnostic staging of breast cancer in southern Italy. Cancer 1995; 76:1585-90. [PMID: 8635062 DOI: 10.1002/1097-0142(19951101)76:9<1585::aid-cncr2820760914>3.0.co;2-o] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND There are marked regional differences in breast cancer mortality rates in Italy, probably linked to factors such as diagnostic delay, therapeutic strategies, and biologic and sociodemographic differences. To investigate a possible link between sociodemographic factors (e.g. age, education, and residence) and delay in the diagnosis of breast cancer, data were evaluated from all such patients from our Institute living in the Campania Region of Southern Italy for 1991-1993. METHODS Patients were grouped into Tis-T1/N0-N+ versus T2-4/N0-N+ and the variables examined were age (< 40, 41-50, 51-60, > 60 years), education (< or = 5 vs. > 5 school years) and residence (urban vs. rural). An analysis was made using the Pearson's Chi-square test and the multiple logistic regression. RESULTS Statistically significant differences were found for both residence (P = 0.04) and education level (P = 0.03) in the older than 60 years age group, but only for residence (P = 0.03) in the 51-60 years age group. The risks according to Mantel-Haenszel were 1.28 for education (P = 0.08) and 1.32 for residence in rural municipalities (P = 0.05). The odds ratio for residence in rural municipalities, adjusted by education and by the education-residence interaction, was 2.26 (95% confidence interval [CI], 1.12-4.54) in the 51-60 years age group and 1.74 (95% CI, 1.01-3.00) in the older than 60 years age group. CONCLUSIONS These data clearly indicate that residents of rural municipalities, as well as poorly educated subjects, are more likely than their respective counter-parts to have a delayed diagnosis of breast cancer.
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Affiliation(s)
- M Montella
- Fondazione Pascale, National Cancer Institute, Department of Epidemiology, Naples, Italy
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