Inequalities in the use of mammography in Spain: effect of caring for disabled family

A Systematic Review to Evaluate the Barriers to Breast Cancer Screening in Women with Disability

Background: Breast cancer (BC) is one of the leading causes of mortality worldwide. There are observed disparities in patients with disability as compared to those without disability, which leads to poor BC screening attendance, thereby worsening disease management. Aim: The aim of this systematic review is to investigate if there are disparities in screening rates in women with disability as compared to those without disability, as well as the different factors that pose barriers to patients with disability for enrolment in BC screening programs. Method: Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we systematically reviewed published articles between 2008 and 2023, which assessed different factors that contributed to poor attendance in BC screening programs held across different countries. Detailed study characteristics were obtained, and methodological quality assessment was performed on the individual studies included in this review. Result: A total of fifty-three articles were identified as eligible studies based on the pre-defined inclusion and exclusion criteria. These included 7,252,913 patients diagnosed with BC (913,902 patients with disability/6,339,011 patients without disability). The results revealed there are demographic, clinical, financial, and service-related barriers that contributed to lower screening rates in disabled patients as compared to non-disabled. Patient age is the most common factor, with the highest effect observed for 80 years (vs. 30-44 years) [odds ratio (OR) = 13.93 (95% confidence interval (CI) = 8.27-23.47), p < 0.0001], followed by race/ethnicity for Hispanic (vs. non-Hispanic white) [OR = 9.5 (95%CI = 1.0-91.9), p < 0.05]. Additionally, patients with multiple disabilities had the highest rate of dropouts [OR = 27.4 (95%CI = 21.5-33.3)]. Other factors like education, income, marital status, and insurance coverage were essential barriers in screening programs. Conclusions: This study presents a holistic view of all barriers to poor BC screening attendance in disabled patients, thereby exacerbating health inequalities. A standardized approach to overcome the identified barriers and the need for a tailored guideline, especially for disability groups, is inevitable.

Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence

PURPOSE

The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe.

METHODS

Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken.

RESULTS

Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation.

CONCLUSIONS

The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.

Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain

BACKGROUND

It is necessary to raise a positive attitude towards cancer information to improve disease prevention and control.

OBJECTIVE

To identify social factors, health characteristics and cancer-related perceptions and knowledge associated with a positive attitude towards cancer information.

DESIGN

We ran multivariate logistic regression models to analyse population-based data from OncoBarómetro-2010, a Spanish representative survey on perceptions and knowledge, related to cancer, conducted among 7938 people aged 18 years or more.

MEASUREMENT

Attitudes towards cancer information. A positive attitude includes feeling motivated to keep informed, to have screening tests or to change lifestyle. A negative attitude includes feeling indifference, concern, frustration or fear.

RESULTS

38.3% of the studied population reported having received information related to cancer (within the last 6 months). Among those, 31.5% expressed a negative attitude towards cancer information. People more likely to have a positive attitude towards cancer information (reference category: negative attitude) were people aged 35-74 (ref: aged 18-34) (P < 0.001) and cancer survivors (ref: those who had not had cancer) (OR: 3.05; 95% CI: 1.73-5.38). The likelihood of a positive attitude increased with the level of education (P < 0.001). The variables negatively associated with a positive attitude towards cancer information were poor self-rated health status (ref: fair) (OR: 0.63; 95% CI: 0.42-0.95) and high self-perceived risk of developing cancer (ref: low) (OR: 0.75; 95% CI: 0.60-0.92).

CONCLUSIONS

These findings have potential to inform programmes designed to promote cancer prevention behaviours. Policies should target population groups with low socio-economic groups, those with poor self-rated health and individuals with high self-perceived risk of cancer. Further, in order to increase knowledge of cancer symptoms, we need to focus on individuals with unhealthy lifestyles.