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Castaneda-Avila MA, Baek J, Epstein MM, Forrester SN, Ortiz AP, Lapane KL. Association Between Body Mass Index and Cancer Screening Adherence Among Latinas in the United States and Puerto Rico. WOMEN'S HEALTH REPORTS 2022; 3:552-562. [PMID: 37096019 PMCID: PMC10122236 DOI: 10.1089/whr.2021.0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/19/2022] [Indexed: 11/12/2022]
Abstract
Background Research on the role of body size on cancer screening is mixed with few studies among Latinas in the United States. We evaluated the association between body size and cancer screening adherence among Latinas living in Puerto Rico and the rest of the United States. Methods We conducted a cross-sectional study using 2012-2018 Behavioral Risk Factor Surveillance System data among Latinas 50-64 years of age (n = 16,410). Breast, cervical, and colorectal cancer screening (guideline adherent: yes/no), height and weight were self-reported. Prevalence ratios (PRs) derived from Poisson models were estimated for each cancer screening utilization for Puerto Rico versus rest of the United States by body mass index (BMI) category. Results Nearly a quarter of women lacked adherence with breast and cervical cancer screening and 43.6% were nonadherent to colorectal cancer screening. Latinas with BMI ≥40.0 kg/m2 in both groups were more likely to lack adherence to cervical cancer screening than women with BMI 18.5-24.9 kg/m2. For those with BMI ≥40.0 kg/m2, Latinas in Puerto Rico were more likely to lack adherence to colorectal cancer screening recommendations than Latinas living in the rest of the United States (adjusted PR: 1.38; 95% confidence interval = 1.12-1.70). Conclusions The role of body size in cancer screening utilization among Latinas differs in women living in Puerto Rico versus in the rest of the United States and varies by cancer type. Understanding Latinas' experience can inform culturally adapted interventions to promote cancer screening.
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Affiliation(s)
- Maira A. Castaneda-Avila
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Jonggyu Baek
- Division of Biostatistics and Health Services Research, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Mara M. Epstein
- Meyers Health Care Institute, a Joint Endeavor of the University of Massachusetts Chan Medical School, Fallon Health, and Reliant Medical Group, Worcester, Massachusetts, USA
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Sarah N. Forrester
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
| | - Ana P. Ortiz
- University of Puerto Rico, Comprehensive Cancer Center, San Juan, Puerto Rico
- Graduate School of Public Health, Medical Sciences Campus, University of Puerto Rico, San Juan, Puerto Rico
| | - Kate L. Lapane
- Division of Epidemiology, Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
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Pape R, Spuur KM, Wilkinson JM, Zuhukepe A. A review of mammographic image quality in Papua New Guinea. J Med Radiat Sci 2021; 69:24-29. [PMID: 34418330 PMCID: PMC8892422 DOI: 10.1002/jmrs.538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction To report for the first time the image quality of mammograms performed in Papua New Guinea (PNG) using the Perfect, Good, Moderate, Inadequate (PGMI) image evaluation system (IES); and to benchmark the image quality against BreastScreen Australia (BSA) National Accreditation Standards (NAS). Methods A retrospective image quality analysis of the de‐identified mammograms of 102 women imaged at the Port Moresby General Hospital (PMGH) was undertaken using the PGMI IES. Each craniocaudal (CC) and mediolateral oblique (MLO) image was assigned a grade and the reasons for the grade recorded. Age was recorded in years. Simple frequency analysis was undertaken and comparison with BSA NAS 2.4 was made. Results Women were aged between 25 and 74 years. There were 111 CC views and 109 MLO views. The most frequent individual grade for the CC view was G (83.8%) and for the MLO view M (72.48%); and for a routine series (four images), P and G combined (14.8%). Non‐visualisation of the IMA (28%), nipple not in profile (26%) and short length of pectoral muscle (12%) were the most cited reasons for assigning an M grade. Conclusion The reported image quality is not commensurate with that required by BSA (P and G > 50%) and while common positioning errors can be rectified through education and training, it is also important to recognise the complex challenges faced by PNG radiographers in obtaining mammographic images that extend beyond education and training and reflect the emerging nature of the modality as well as wider health, economic and other issues. This work raises the need for national standards, dedicated equipment, and radiographer education to best serve the women of PNG.
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Affiliation(s)
- Ruth Pape
- School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea
| | - Kelly Maree Spuur
- School of Dentistry and Medical Sciences, Charles Sturt University, Wagga Wagga, New South Wales, Australia
| | | | - Aileen Zuhukepe
- Radiology Department, Port Moresby General Hospital, Port Moresby, Papua New Guinea
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Miles RC, Lehman CD, Mercaldo SF, Tamimi RM, Dontchos BN, Narayan AK. Obesity and breast cancer screening: Cross-sectional survey results from the behavioral risk factor surveillance system. Cancer 2019; 125:4158-4163. [PMID: 31393609 DOI: 10.1002/cncr.32430] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Revised: 06/17/2019] [Accepted: 07/07/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Postmenopausal obese women demonstrate an elevated breast cancer risk and experience increased breast cancer morbidity and mortality compared with women with a normal body mass index (BMI). However, to the authors' knowledge, prior studies have yielded inconclusive results regarding the effects of obesity on mammography screening adherence. Using national cross-sectional survey data, the objective of the current study was to assess the current association between increasing BMI and use of mammography screening. METHODS Cross-sectional survey data from the 2016 Behavioral Risk Factor Surveillance System, a state-based national telephone survey of noninstitutionalized adults in the United States, was used to identify the association between mammography screening use and increasing incremental BMI categories, including normal (18.5-24.9 kg/m2 ), overweight (25-29.9 kg/m2 ), obese class I (30-34.9 kg/m2 ), obese class II (35-39.9 kg/m2 ), and obese class III (>40 kg/m2 ), with adjustments for potential confounders. A multivariable logistic regression model was used to evaluate the effect of each BMI category on self-reported mammography use, using unadjusted and adjusted odds ratios. Effect modification by race/ethnicity was determined by testing interaction terms using Wald tests. RESULTS Of 116,343 survey respondents, 33.5% (38,984 respondents) had a normal BMI, 32.6% (37,969 respondents) were overweight, 19.3% (22,416 respondents) were classified as obese class I, 8.4% (9791 respondents) were classified as obese class II, and 6.2% (7183 respondents) were classified as obese class III. There was no statistically significant difference (P < .05) observed with regard to mammography use between women with a normal BMI and obese women from each obese class (classes I-III) when compared individually. There also was no evidence of effect modification by race (P = .53). CONCLUSIONS In contrast to prior reports, the results of the current study demonstrated no association between obesity and adherence to screening mammography. These findings may relate to the increasing social acceptance of obesity among women from all racial/ethnic groups and the removal of weight-related facility-level barriers over time.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Rulla M Tamimi
- Channing Institute, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
| | - Brian N Dontchos
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Njor SH, von Euler-Chelpin M, Tjønneland A, Vejborg I, Lynge E. Body weight and sensitivity of screening mammography. Eur J Cancer 2016; 60:93-100. [PMID: 27085424 DOI: 10.1016/j.ejca.2016.02.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 02/24/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
AIM Obese women tend to participate less in breast cancer screening than normal weight women. However, obese women have fattier breast than normal weight women, and screening mammography works better in fatty than in dense breasts. One might, therefore, hypothesise that obese women would actually benefit more from screening than other women. METHODS We combined data from the Danish Diet, Cancer and Health study and the organised population-based screening mammography programme in Copenhagen, Denmark. Women were categorised according to body mass index (BMI) (<20; 20 to <25; 25 to <30; 30 to <35, and 35+). We measured recall rate, sensitivity and specificity for subsequent screens with a 2-year follow-up period. RESULTS The study included 6787 women. The recall rate varied from 1.4% for women with BMI <20 to 1.9% for women with BMI 35+, test for trend p = 0.86. Sensitivity varied from 42% (95% confidence interval [CI] 20-64%) for women with BMI <20 to 100% (95% CI 69-100%) for women with BMI 35+, test for trend p = 0.015. Specificity was fairly constant across BMI levels, being on average 98.8%, test for trend p = 0.79. CONCLUSION This study showed that obese women were the ones with the highest sensitivity of screening mammography, while the specificity of screening remained stable across weight groups. Screening programmes should be organized to encourage these women to overcome obstacles for participation.
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Affiliation(s)
- Sisse H Njor
- Department of Public Health, University of Copenhagen, Denmark
| | | | | | - Ilse Vejborg
- Center of Diagnostic Imaging, Copenhagen University Hospital, Denmark
| | - Elsebeth Lynge
- Department of Public Health, University of Copenhagen, Denmark.
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Madeley CR, Kessell MA, Madeley CJD, Taylor DB, Wylie EJ. Radiographer technique: Does it contribute to the question of clip migration? J Med Imaging Radiat Oncol 2015; 59:564-70. [PMID: 26108860 DOI: 10.1111/1754-9485.12327] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 04/19/2015] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Marker clips are commonly deployed at the site of a percutaneous breast biopsy. Studies have shown that displacement of the clip from the site of deployment is not uncommon. The objective of this study was to determine how much 'migration' could be seen with fixed structures within the breast tissue across three consecutive annual screening examinations, and therefore attempt to quantify how much of the reported clip migration could be due to radiographer technique. METHODS Large, easily identified benign calcifications were measured by two investigators across three consecutive cycles of screening mammography. The position of the calcifications on the two standard mammographic views was measured in two planes. Other variables recorded included breast size and density, compression force used, and location of the benign calcifications within the breast. RESULTS In 38% of cases, benign breast calcifications showed a mimicked movement of >15 mm in at least one plane. This was greatest in large breasts, those where fibroglandular tissue occupied less than 50% of the breast volume, and in the upper outer quadrant of the breast where mimicked movement >10 mm was noted in up to 90% of the larger breasts. CONCLUSION Fixed immobile objects in the breast can appear to move a distance of >15 mm in up to 30% of cases. Clinically, some of what has previously been called marker 'migration' may be spurious and accounted for by differences in radiographic positioning techniques.
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Affiliation(s)
- Carolyn R Madeley
- Imaging Services Department, Royal Perth Hospital, Perth, Western Australia, Australia
| | | | | | - Donna Blanche Taylor
- Imaging Services Department, Royal Perth Hospital, Perth, Western Australia, Australia.,University of Western Australia, Perth, Western Australia, Australia
| | - Elizabeth Jane Wylie
- Imaging Services Department, Royal Perth Hospital, Perth, Western Australia, Australia
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Eichholzer M, Huang DJ, Modlasiak A, Schmid SM, Schötzau A, Rohrmann S, Güth U. Impact of body mass index on prognostically relevant breast cancer tumor characteristics. ACTA ACUST UNITED AC 2014; 8:192-8. [PMID: 24415969 DOI: 10.1159/000350002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND This study analyzes the association of body mass index (BMI) and prognostically relevant breast cancer (BC) characteristics in a country that has been rather spared of the global obesity epidemic. PATIENTS AND METHODS Based on 20-year data (1999-2009, n = 1,414) of the prospective relational BC database of the University Hospital Basel, Switzerland, the associations between BMI, tumor size and stage, histological subtype, grading, hormonal receptor status, HER2 status and 'triple-negative' status were evaluated. Multivariate analysis considered BMI and patient's age. RESULTS The association between increasing BMI and the above-mentioned variables were as follows (results described in each case: Beta-coefficient or odds ratio, 95% confidence interval, p value): tumor size, (1) entire cohort: 0.03 (0.01-0.05), p < 0.001, (2) tumor found by self-palpation: 0.05 (0.03-0.07), p < 0.001, (3) tumor found by radiological examination: 0.03 (0-0.07), p = 0.044; advanced TNM stage: 1.16 (1.02-1.31), p = 0.022; histological subtype: 1.04 (0.89-1.22), p = 0.602; unfavorable grading: 1.11 (1.00-1.25), p = 0.057; positive estrogen receptor status: 0.95 (0.83-1.09), p = 0.459; positive HER2 status: 0.92 (0.74-1.15), p = 0.467; presence of a 'triple-negative' carcinoma: 1.19 (0.93-1.52), p = 0.165. Consideration of only postmenopausal BC patients (n = 1,063) did attenuate the results, but did not change the direction of the associations with BMI. CONCLUSION BMI was positively associated with TNM stage, grading and tumor size for tumors that were found by self-detection, as well as for those lesions detected by radiological breast examinations.
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Affiliation(s)
- Monika Eichholzer
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Basel, Switzerland
| | - Dorothy J Huang
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland
| | - Alexandra Modlasiak
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland
| | - Seraina M Schmid
- Department of Gynecology and Obstetrics, Breast center, Hospital Grabs, Basel, Switzerland
| | - Andreas Schötzau
- Schötzau and Simmen Institute for Biomathematics, Basel, Switzerland
| | - Sabine Rohrmann
- Division of Cancer Epidemiology and Prevention, Institute of Social and Preventive Medicine, University of Zurich, Basel, Switzerland
| | - Uwe Güth
- Department of Obstetrics and Gynecology, Breast center, Hospital Grabs, Basel, Switzerland ; Breast Center, University Hospital Basel, Breast center, Hospital Grabs, Basel, Switzerland ; Department of Gynecology and Obstetrics, Breast center, Cantonal Hospital Winterthur, Switzerland
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