The role of physician involvement in Latinas' mammography screening adherence

Factors Associated with Screening Mammogram Uptake among Women Attending an Urban University Primary Care Clinic in Malaysia

Screening mammograms have resulted in a reduction in breast cancer mortality, yet the uptake in Malaysia was low. This study aimed to determine the prevalence and factors associated with screening mammogram uptake among women attending a Malaysian primary care clinic. A cross-sectional study was conducted among 200 women aged 40 to 74 attending the clinic. The data was collected using questionnaires assessing sociodemographic, clinical characteristics, knowledge and health beliefs. Multiple logistic regression was used to identify factors associated with mammogram uptake. The prevalence of screening mammograms was 46.0%. About 45.5% of women with high breast cancer risk had never undergone a mammogram. Older participants, aged 50 to 74 (OR = 2.57, 95% CI: 1.05, 6.29, p-value = 0.039) and those who received a physician’s recommendation (OR = 7.61, 95% CI: 3.81, 15.20, p-value < 0.001) were more likely to undergo screening mammography. Significant health beliefs associated with mammogram uptake were perceived barriers (OR = 0.81, 95% CI: 0.67, 0.97, p-value = 0.019) and cues to action (OR = 1.30, 95% CI: 1.06, 1.59, p-value = 0.012). Approximately half of the participants and those in the high-risk group had never undergone a mammogram. Older age, physician recommendation, perceived barriers and cues to action were significantly associated with mammogram uptake. Physicians need to play an active role in promoting breast cancer screening and addressing the barriers.

Influenza and pneumococcal vaccination delivery in older Hispanic populations in the United States

INTRODUCTION

National reports suggest that Hispanic patients may underutilize influenza and pneumococcal vaccination, although studies sometimes conflict on this point. A clearer picture of adult immunization utilization in older Hispanic patients is necessary to ensure equity in adult vaccinations.

METHODS

Using electronic health records from 648 community health centers (CHCs) across 21 states, we compared English-preferring Hispanic patients, Spanish-preferring Hispanic patients, and Non-Hispanic White (NHW) adults aged ≥50 years across five outcomes between 2012-2017: (1) Odds of ever receiving pneumococcal vaccination after age 65, (2) Odds of ever receiving ≥2 pneumococcal vaccinations for those ≥65, (3) odds of vaccination between the ages of 50 and 64 for those with diabetes or heart disease, (4) odds of influenza vaccine, and (5) annual rate of influenza vaccination.

RESULTS

Of our total study sample (N = 143,869), 85,562 were age 50-64 during the entire study period, and 65,977 were ≥65 at some point during the study period. In patients aged 50-64, Spanish-preferring Hispanic patients were more likely to have ever had an influenza vaccination (covariate-adjusted odds ratio [aOR] = 1.33, 95% CI = 1.29-1.37), had higher rates of annual influenza vaccination (covariate-adjusted rate ratio [aRR] = 1.41, 95% CI = 1.38-1.44), and higher odds of pneumococcal vaccination (aOR = 1.87, 95% CI = 1.76-1.98) than NHW patients. These findings were similar in Spanish-preferring Hispanic patients ≥65. English-preferring Hispanics ≥65 were less likely than NHW patients to ever have an influenza vaccination (aOR = 0.91, 95% CI = 0.85-0.98) and to have ever received at least one (aOR = 0.92, 95% CI = 0.86-0.99) or two (aOR = 0.86, 95% CI = 0.77-0.95) pneumococcal vaccine doses.

CONCLUSIONS

In a multistate CHC network, Spanish-preferring Hispanic patients were more likely to receive influenza and pneumococcal vaccinations than NHW patients; older English-preferring Hispanic patients were often less likely than NHW patients to receive these vaccinations. In vaccine initiatives, English-preferring Hispanic patients may be at higher risk of vaccination inequity.

Does mailing unsolicited HPV self-sampling kits to women overdue for cervical cancer screening impact uptake of other preventive health services in a United States integrated delivery system?

Women overdue for cervical cancer screening often have other preventive care gaps. We examined whether mailing unsolicited human papillomavirus (HPV) self-sampling kits to increase cervical cancer screening impacted receipt of other preventive services women were due for: mammography, colorectal cancer (CRC) screening, influenza vaccination, depression screening, and diabetic HbA1c monitoring. From 2014 to 2016, 16,590 underscreened women were randomized to receive a mailed kit or usual care Pap reminders within Kaiser Permanente Washington. We used logistic regression to estimate odds ratios (ORs) of preventive services receipt within 12-months between the intervention vs. control arms, and within the intervention arm (comparing those returning a kit vs. attending Pap vs. nothing), adjusting models for demographic variables. There were no significant between-arm differences in uptake of any of the preventive services: intervention vs. control: mammography OR = 1.01 (95% confidence interval:0.88-1.17), CRC screening OR = 0.98 (0.86-1.13), influenza vaccination OR = 0.99 (0.92-1.06), depression screening OR = 1.07 (0.99-1.16), HbA1c OR = 0.84 (0.62-1.13). Within the intervention arm, preventive services uptake was higher in women who completed cervical cancer screening vs. did not, with stronger effects for women who attended Pap: Pap vs. nothing: mammography OR = 11.81 (8.11-17.19), CRC screening OR = 7.31 (5.57-9.58), influenza vaccination OR = 2.06 (1.82-2.32), depression screening OR = 1.79 (1.57-2.05), HbA1c OR = 3.35 (1.49-7.52); kit vs. nothing: mammography OR = 2.26 (1.56-3.26), CRC screening OR = 5.05 (3.57-7.14), influenza vaccination OR = 1.67 (1.41-1.98), depression screening OR = 1.09 (0.89-1.33), HbA1c OR = 1.23 (0.57-2.65). Mailing HPV self-sampling kits to underscreened women did not negatively impact uptake of other preventive services. However, overall preventive service uptake was the highest among women who attended in-clinic cervical cancer screening.

Contextual factors associated with cancer screening uptake: A systematic review of observational studies

We conducted a systematic review of a wide range of contextual factors related to cancer screening uptake that have been studied so far. Studies were identified through PubMed and Web of Science databases. An operational definition of context was proposed, considering as contextual factors: social relations directly aimed at cancer screening, health care provider and facility characteristics, geographical/accessibility measures and aggregated measures at supra-individual level. We included 70 publications on breast, cervical and/or colorectal cancer screening from 42 countries, covering a data period of 24 years. A wide diversity of factors has been investigated in the literature so far. While several of them, as well as many interactions, were robustly associated with screening uptake (family, friends or provider recommendation, provider sex and experience, area-based socio-economic status…), others showed less consistency (ethnicity, urbanicity, travel time, healthcare density …). Screening inequities were not fully explained through adjustment for individual and contextual factors. Context, in its diversity, influences individual screening uptake and lots of contextual inequities in screening are commonly shared worldwide. However, there is a lack of frameworks, standards and definitions that are needed to better understand what context is, how it could modify individual behaviour and the ways of measuring and modifying it.

Breast cancer screening behavior and its associated factors in female employees in South Khorasan

BACKGROUND

Breast cancer is a preventable disease, using three secondary preventive methods of mammography, clinical breast examination (CBE), and breast self-examination (BSE) that can lead to early detection of breast cancer. This study was designed to assess breast cancer screening behavior and its associated factors in females employed in South Khorasan.

MATERIALS AND METHODS

In this analytic-descriptive study, 2256 female personnel of governmental organizations were investigated in Birjand city in 2016-2017. The data collection tool was a three-part questionnaire: sociodemographic characteristics, knowledge about breast cancer screening methods plus women's performance, and stage of change regarding screening behaviors of mammography, CBE, and BSE. The data were analyzed by SPSS 16 and one-way analysis variance, Tukey's post hoc, and multiple logistic regression model statistical tests.

RESULTS

The mean ± standard deviation score of knowledge of the women was 3.45 ± 1.5. There was a significant difference of the mean score of knowledge between the single and married (P = 0.03) and age group (P = 0.04). The stage action of mammography, CBE, and BSE was 6.8%, 12.3%, and 16.8%, respectively. Logistic regression model showed that variables such as age and family history of breast cancer were highly significant related to mammography and also CBE. Knowledge was also highly significant in mammography, CBE, and BSE. Education level in CBE, marital status in BSE and mammography, and job in BSE were also significant (P < 0.001).

CONCLUSIONS

This study reveals insufficient knowledge of female workers about breast cancer and the negative influence of low knowledge on the practice of breast cancer screening behavior. Therefore, the establishment and maintenance of regular educational courses for female employees is essential.

The association between social media use for health related information and compliance with breast and cervical cancer screenings

There is a need to investigate the impact of social media use on patient compliance with important health screenings due to the inconsistency of research findings on the effect of using social media on cervical cancer screenings. This study assessed associations between social media use and adherence in women at risk for breast and cervical cancer to mammograms and Pap smear screenings. A total of 6695 respondents from the Health Information National Trends Survey (HINTS) 5 Cycle 1 and 2 datasets were used for data analysis. Chi-square tests were used to explore social network activities and cancer screening compliance, and multivariate logistic regressions were used to identify factors associated with cancer screening compliance. Among respondents, 68% of women and 84% of women complied with mammograms and Pap smears, respectively. Women who used the Internet during last 12 months to visit a social networking site, participate in a forum support group for medical issue, or watch a health-related video on YouTube complied with Pap smears more significantly than women who did not use the Internet (p <.05, p <.0001, and p <.001, respectively). Variables associated with mammogram and Pap smear screening compliance were age, health insurance, regular provider, marital status, and internet use. There was no significant association between social network activities and compliance with mammogram screenings. It is critical to use the same and up-to-date guidelines when reporting cancer screening rates to effectively promote adherence to cancer prevention programs and make valid and reliable comparisons across studies.

The Patient Perspective on Lung Cancer Screening and Health Disparities

Lung cancer screening is just starting to be implemented across the United States. Challenges to screening include access to care, awareness of the option for screening, stigma and implicit bias that are due to stigmatization of smoking, stigma of race, nihilism with lung cancer diagnosis viewed as a "death sentence," shared decision making, and underestimation of lung cancer risk. African Americans (AA) have the highest lung cancer mortality rate in the United States despite similar smoking rates as whites. AAs are diagnosed at a later stage, and there is a greater likelihood they will refuse treatment options when diagnosed. Additionally, fewer AAs were found to meet lung cancer screening eligibility criteria compared with whites because of lower tobacco exposure and younger age at time of diagnosis. Outreach and access for lung cancer screening in the AA community and other subpopulations at risk are critical to avoid further increasing disparities in lung cancer morbidity and mortality as lung cancer screening is implemented across the United States. The path forward requires implementing outreach programs and providing lung cancer screening in underserved communities at high risk for lung cancer; consideration of using National Comprehensive Cancer Network guidelines for screening selection criteria, including risk model screening selection; and developing interventions to address stigma, clinician implicit bias, and nihilism.

A 10-Year Evaluation of New Jersey's National Breast and Cervical Cancer Early Detection Program: Comparison of Stage at Diagnosis in Enrollees and Nonenrollees

Purpose: The New Jersey Cancer Education and Early Detection (NJCEED) program provides breast cancer screening to low income, uninsured, and underinsured women. The purpose of this study was to evaluate the effectiveness of the NJCEED program by considering stage at diagnosis for women enrolled in NJCEED compared to women diagnosed in the state of New Jersey who were not enrollees. Materials and Methods: The sample included 47,162 women diagnosed with breast cancer; of those, 1,364 women were NJCEED enrollees. Enrollees were significantly different from nonenrollees in age, race, ethnicity, education, and poverty level. Results: In the logistic regression, NJCEED enrollees had 88.3% higher odds of being diagnosed at a late stage compared with nonenrollees (odds ratio [OR]: 1.883, confidential interval [CI]: 1.678-2.109). African American women had 54.9% higher odds of being diagnosed at a later stage (OR: 1.549, CI: 1.457-1.646). The likelihood of a late stage diagnosis increased as poverty level increased. Conclusion: These results were consistent with other National Breast and Cervical Cancer Early Detection Program state evaluations, and with evaluations of the national program. Providing a free screening service is not in itself adequate to encourage screening in low-income uninsured women.

Examining Mammography Use by Breast Cancer Risk, Race, Nativity, and Socioeconomic Status

Minority and foreign-born women report lower rates of mammograms compared to non-Hispanic white, U.S.-born women, even though they have increased risk for developing breast cancer. We examine disparities in mammography across breast cancer risk groups and determine whether disparities are explained by socioeconomic factors. Propensity score methodology was used to classify individuals from the 2000, 2005, and 2010 National Health Interview Survey according to their risk for developing breast cancer. Logistic regression models were used to predict the likelihood of mammography. Compared to non-Hispanic white women, Mexicans, Asians and "other" racial/ethnic origins were less likely to have undergone a mammogram. After controlling for breast cancer risk, socioeconomic status and health care resources, Mexican, Cuban, Dominican, Central American, Black, and foreign-born women had an increased likelihood of receiving a mammogram. Using propensity scores makes an important contribution to the literature on sub-population differences in the use of mammography by addressing the confounding risk of breast cancer. While other factors related to ethnicity or culture may account for lower breast cancer screening rates in Asian and Mexican women, these findings highlight the need to consider risk, in addition to socioeconomic factors, that may pose barriers to screening in determining mammography disparities.

Healthcare Factors for Obtaining a Mammogram in Latinas With a Variable Mammography History

PURPOSE/OBJECTIVES

To understand the relationship between mammography history and current thoughts about obtaining a mammogram among Latinas and examine the mediation effects of several healthcare factors.
.

DESIGN

Cross-sectional survey.
.

SETTING

Federally qualified health centers (Sea Mar Community Health Centers) in western Washington.
.

SAMPLE

641 Latinas nonadherent and adherent with screening mammography.
.

METHODS

Baseline survey data from Latinas with a mammography history of never, not recent (more than two years), or recent (less than two years) were analyzed. Preacher and Hayes methods were used to estimate the mediation effect of healthcare factors.
.

MAIN RESEARCH VARIABLES

The survey assessed mammography history, sociodemographic and healthcare factors, and current thoughts about obtaining a mammogram.
.

FINDINGS

Latinas' thoughts about obtaining a mammogram were associated with mammography history. Having had a clinical breast examination mediated 70% of differences between Latinas with a never and recent mammography history. Receipt of a provider recommendation mediated 54% of differences between Latinas with and without a recent mammography history.
.

CONCLUSIONS

These findings emphasize the importance of the patient-provider relationship during a clinic visit and help inform how nurses may be incorporated into subsequent screening mammography interventions tailored to Latinas.
.

IMPLICATIONS FOR NURSING

As providers, health educators, and researchers, nurses have critical roles in encouraging adherence to screening mammography guidelines among Latinas.

Risk Factors for Late Screening Mammography

BACKGROUND

Breast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population.

MATERIALS AND METHODS

This study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening.

RESULTS

Of the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (P = 0.001), white race/ethnicity (P = 0.03), self-reported lack of financial means or health insurance (P = 0.005), lack of satisfaction with a previous mammogram experience (P = 0.001), inadequate mammography education by a physician (P = 0.001), and lack of awareness/comprehension of screening mammography guidelines (P = 0.002).

CONCLUSION

Many factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients.

Conversations about Abnormal Mammograms on Distress and Timely Follow-up Across Ethnicity

Communication with healthcare providers, family, and friends is associated with increased mammography use. Less is known about the abnormal mammogram experience, especially in terms of the interval between screening and follow-up appointments (time to follow-up) and psychological distress. The impact of communication may vary across ethnicity, depending on cultural emphases placed on interpersonal relationships. The current study's objectives were to (a) explore the role of family/friend and provider communication with regard to time to follow-up and distress and (b) examine if family/friend and provider communication moderates associations between ethnicity and these outcomes. A convenience-based sample of 41 Latina and 41 non-Latina White (NLW) women who had received an abnormal mammogram result was recruited from Washington State. Women who discussed results with providers had a shorter time to follow-up, although this was not significant when including health insurance. A significant interaction between conversations with family/friends and ethnicity was found: Latinas who did not have conversations with family/friends had particularly elevated psychological distress relative to NLW women and slightly more than other Latinas. This exploratory study suggests health communication with providers and family/friends is important for timely receipt of follow-up care and reduced distress among women who receive an abnormal mammogram result, which has implications for cancer education intervention development and adaptation. Larger, population-based research is necessary to confirm these findings.

The Relationship Between the Supply of Primary Care Physicians and Measures of Breast Health Service Use

BACKGROUND

To investigate whether women are more likely to report receipt of a mammography recommendation from a doctor or mammography use if they reside in primary care service areas (PCSAs) having a greater number of clinically active primary care physicians.

MATERIALS AND METHODS

The analysis used a nationally representative sample of women, aged 40 years and above (n = 10,706 unweighted respondents), extracted from the 2005 National Health Interview Survey. The restricted geocoded addresses of the respondents were linked to PCSA data on physician density at a secure research data center. Multivariable logistic regression was used to determine whether, after adjustment, specific measures of primary care providers (e.g., the number of obstetricians and gynecologists [Ob-GyNs] per 10,000 population) were associated with either recommendation receipt or mammography use.

RESULTS

After adjusting for other factors, a one-unit increase in the PCSA number of Ob-GyNs per 10,000 population increased the odds of mammography recommendation receipt by 9% and the odds of mammography use by 9%. The ratio of international medical graduate Ob-GyNs to US-trained Ob-GyNs in a PCSA was negatively associated with mammography use.

CONCLUSION

The results from this nationwide study underscore the importance of using physician density measures estimated from within bounded medical markets, where women reside and actually seek preventive breast health services. Results support the hypothesis that PCSA physician supply is independently associated with both mammography recommendation receipt and mammography utilization.

Multilevel Intervention Raises Latina Participation in Mammography Screening: Findings from ¡Fortaleza Latina!

BACKGROUND

Breast cancer is the most commonly diagnosed cancer in women in the United States, and Latinas have relatively low rates of screening participation. The Multilevel Intervention to Increase Latina Participation in Mammography Screening study (¡Fortaleza Latina!) sought to assess the efficacy of a clinic- and patient-level program to increase breast cancer screening among Latinas in Western Washington who seek care at a safety net health center.

METHODS

The study enrolled 536 Latinas ages 42 to 74 who had a primary care clinic visit in the previous 5 years and had not obtained a mammogram in the previous 2 years. Participants were block-randomized within clinic to either (i) a control arm (usual care) or (ii) a promotora-led, motivational interviewing intervention that included a home visit and telephone follow-up. At the clinic level, two of four participating clinics were provided additional mammography services delivered by a mobile mammography unit.

RESULTS

Rates of screening mammography 1 year post-randomization were 19.6% in the intervention group and 11.0% in the usual care group (P < 0.01), based on medical record data. No significant differences in participants' mammography screening were observed in clinics randomized to additional mammography services versus usual care (15.8% vs. 14.4%; P = 0.68).

CONCLUSION

This multilevel intervention of promotora-delivered motivational interviewing and free mammography services modestly raised rates of participation in breast cancer screening among Latinas.

IMPACT

Our findings can inform future efforts to boost mammography participation in safety net practices. Cancer Epidemiol Biomarkers Prev; 25(4); 584-92. ©2016 AACR SEE ALL ARTICLES IN THIS CEBP FOCUS SECTION, "MULTILEVEL APPROACHES TO ADDRESSING CANCER HEALTH DISPARITIES".

Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy

PURPOSE

Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening.

METHODS

We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ(2) tests.

RESULTS

A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age.

CONCLUSION

This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.

Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature

Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.

The impact of level of education on adherence to breast and cervical cancer screening: Evidence from a systematic review and meta-analysis

OBJECTIVE

To assess the inequalities in adherence to breast and cervical cancer screening according to educational level.

METHODS

A systematic review was carried out between 2000 and 2013 by querying an electronic database using specific keywords. Studies published in English reporting an estimation of the association between level of education and adherence to breast and/or cervical cancer screening were included in the study. Two different meta-analyses were carried out for adherence to breast and cervical cancer screening, respectively: women with the highest level of education and women with the lowest level of education were compared. The level of heterogeneity was investigated and subgroup analyses were carried out.

RESULTS

Of 1231 identified articles, 10 cross-sectional studies were included in the analysis. The meta-analyses showed that women with the highest level of education were more likely to have both screenings with an overall OR=1.61 (95% CI 1.36-1.91; I(2)=71%) for mammography and OR=1.96 (95% CI 1.79-2.16; I(2)=0%) for Pap test, respectively. Stratified meta-analysis for breast cancer screening included only studies that reported guidelines with target age of population ≥50 years and showed a reduction in the level of heterogeneity and an increase of 36% in the adherence (95% CI 1.19-1.55; I(2)=0%).

CONCLUSIONS

This study confirms and reinforces evidence of inequalities in breast and cervical cancer screening adherence according to educational level.

Family/friend recommendations and mammography intentions: the roles of perceived mammography norms and support

Identifying factors that increase mammography use among Latinas is an important public health priority. Latinas are more likely to report mammography intentions and use, if a family member or friend recommends that they get a mammogram. Little is known about the mechanisms underlying the relationship between social interactions and mammography intentions. Theory suggests that family/friend recommendations increase perceived mammography norms (others believe a woman should obtain a mammogram) and support (others will help her obtain a mammogram), which in turn increase mammography intentions and use. We tested these hypotheses with data from the ¡Fortaleza Latina! study, a randomized controlled trial including 539 Latinas in Washington State. Women whose family/friend recommended they get a mammogram within the last year were more likely to report mammography intentions, norms and support. Perceived mammography norms mediated the relationship between family/friend recommendations and intentions, Mediated Effect = 0.38, 95%CI [0.20, 0.61], but not support, Mediated Effect = 0.002, 95%CI [-0.07, 0.07]. Our findings suggest perceived mammography norms are a potential mechanism underlying the effect of family/friend recommendations on mammography use among Latinas. Our findings make an important contribution to theory about the associations of social interactions, perceptions and health behaviors.

Socioecological determinants of mammography screening in Mexican rural areas

Purpose

– The purpose of this paper is to determine which socioecological factors encourage rural women to participate in mammographies rather than avoiding taking the test.

Design/methodology/approach

– The study mainly uses data from the 2007 Rural Households Evaluation Survey (ENCEL-2007). These crossover data are analyzed using the framework proposed in the Spatial-Interaction Model of Mammography Use (SIMMU), through a three-level logistic regression model to examine the likelihood that a woman will choose to participate in a mammography.

Findings

– At the woman-household level, the completion of the Pap smear and the asset index is the strongest determinant of mammography participation. Obtaining preventive medicine services or being enrolled in the Popular Insurance System prevent women from undergoing screening. At the interpersonal level, the probability of screening use decreases with lower social coverage. At the intermediate level, availability of health centers is negatively related to the use of screening.

Research limitations/implications

– The study fails to take into account the fact that women’s propensity to have a mammography may vary over time relatively to life changes. Moreover, findings were restricted to women ages from 40 to 49 and limited due to the lack of published data or data quality issues.

Practical implications

– The results of this research can give health planners, policymakers and social marketers a platform for how to approach social change and promote the cancer screening health behavior through the marketing mix (price, place, promotion and product) in the design of their programs.

Originality/value

– In addition to be informative and persuasive with people to change their behavior, this paper also seeks to provide a direction for using commercial marketing tools through social marketing to “sell” the health behavior. Due to target population variation, this paper addresses the health behavior change strategy by audience segmentation, regarded as essential to successful health communication campaigns.

Breast Cancer Screening Among Dominican Latinas: A Closer Look at Fatalism and Other Social and Cultural Factors

With the marked increase of the Latino population in the United States during the past 20 years, there has been growing interest in the social, cultural, and structural factors that may impede breast cancer screening among Latino women, especially among those subgroups that have been understudied. Acculturation and fatalism are central cultural constructs in these growing fields of research. However, there is great debate on the extent to which acculturation and fatalism affect breast cancer screening among Latinas relative to other social or structural factors or logistical barriers. Moreover, little theoretical work specifies or tests pathways between social, structural, and cultural determinants of screening. This study tests a theoretical model of social and structural (socioeconomic status and access to health care) and cultural factors (acculturation and fatalism) as correlates of mammography screening among Dominican Latinas, a group that has been understudied. The study expands prior work by examining other factors identified as potential impediments to mammography screening, specifically psychosocial (e.g., embarrassment, pain) and logistical (e.g., not knowing how to get a mammogram, cost) barriers. Interview-administered surveys were conducted with 318 Latinas from the Dominican Republic aged 40 years or older. Fatalistic beliefs were not associated with mammogram screening. Greater acculturation assessed as language use was associated with decreased screening. The strongest predictor of decreased screening was perceived barriers. Results highlight the importance of assessing various self-reported psychosocial and logistical barriers to screening. Possible avenues for screening interventions include intensifying public health campaigns and use of personalized messages to address barriers to screening. Results add to a limited body of research on Dominicans, who constitute the fifth largest Latino group in the United States.

Breast cancer screening programmes: challenging the coexistence with opportunistic mammography

OBJECTIVE

This study investigated predictive factors of women's participation in organized mammography screening (OrgMS) and/or opportunistic mammography screening (OppMS) when the two screening modes coexist.

METHODS

Questionnaires were sent to 6,000 women aged 51-74 years old invited to attend an OrgMS session between 2010 and 2011 in France. Data collected concerned the women's healthcare behaviour and their socioeconomic characteristics. Women without a personal or family history of breast cancer that could explain their participation in OppMS were retained in the generalized logits analysis.

RESULTS

The data of 1,202 women were analysed. Of these, 555 (46.2%) had attended OrgMS only, 105 (8.7%) OppMS only and 542 (45.1%) had performed both OrgMS and OppMS. Multivariable analyses showed that women who had regular gynaecological check-ups were more likely to perform OppMS only or both OrgMS and OppMS, OR 95% CI were 2.1 [1.1-3.9], 1.9 [1.4-2.6], respectively. Being employed also increased participation in OppMS only [OR: 2.1 (1.2-3.7)] or both OrgMS and OppMS [OR: 1.5 (1.1-2.05)].

CONCLUSION AND PRACTICE IMPLICATIONS

In countries where OrgMS and OppMS coexist, strategies involving gynaecologists, referring doctors or company doctors and the organization of healthcare services to promote adequate screening round may help to reduce the overuse of mammography.

Physician and Family Recommendations to Obtain a Mammogram and Mammography Intentions: The Moderating Effects of Perceived Seriousness and Risk of Breast Cancer

A growing body of literature has demonstrated psychosocial factors enable mammography intentions and usage among Latinas. Although these factors (e.g., family recommendations, breast cancer perceptions) likely influence one another, little research has examined interactive effects. The current study assessed the moderating effect of perceived breast cancer seriousness and risk on associations between recommendations to obtain mammography and mammography intentions. This sample included 97 Latinas in rural Eastern Washington State. After adjusting for age, two significant interactions emerged: perceived seriousness × physician recommendation and perceived risk × family recommendation. This exploratory study provides important directions for future communication research and planning to improve screening disparities.

European transnational ecological deprivation index and participation in population-based breast cancer screening programmes in France

BACKGROUND

We investigated factors explaining low breast cancer screening programme (BCSP) attendance taking into account a European transnational ecological Deprivation Index.

PATIENTS AND METHODS

Data of 13,565 women aged 51-74years old invited to attend an organised mammography screening session between 2010 and 2011 in thirteen French departments were randomly selected. Information on the women's participation in BCSP, their individual characteristics and the characteristics of their area of residence were recorded and analysed in a multilevel model.

RESULTS

Between 2010 and 2012, 7121 (52.5%) women of the studied population had their mammography examination after they received the invitation. Women living in the most deprived neighbourhood were less likely than those living in the most affluent neighbourhood to participate in BCSP (OR 95%CI=0.84[0.78-0.92]) as were those living in rural areas compared with those living in urban areas (OR 95%CI=0.87[0.80-0.95]). Being self-employed (p<0.0001) or living more than 15min away from an accredited screening centre (p=0.02) was also a barrier to participation in BCSP.

CONCLUSION

Despite the classless delivery of BCSP, inequalities in uptake remain. To take advantage of prevention and to avoid exacerbating disparities in cancer mortality, BCSP should be adapted to women's personal and contextual characteristics.

A systematic review of barriers and facilitators to mammography in Hispanic women

PURPOSE

A systematic review of the research on barriers and facilitators to mammography in Latinas was conducted to determine if the challenges faced by these women are unique to this population.

METHOD

Medline and CINAHL database searches for the years 2005-2013 were included. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to guide this review.

RESULTS

Of the 174 articles identified, 18 articles met inclusion criteria. The most consistent findings were that income and education were associated with screening.

CONCLUSIONS

Financial barriers and social characteristics were significant predictors of mammography in these studies, which were composed almost exclusively of low-income Latinas. These findings are similar to those found in other populations of low-income women and therefore are not likely unique to Latinas.

IMPLICATIONS FOR PRACTICE

It is likely that there is little difference between poor Latinas and other populations of poor, non-English-speaking women in barriers and facilitators to mammography.

Applying the Fuzzy Delphi Method for determining socio-ecological factors that influence adherence to mammography screening in rural areas of Mexico

In Mexico, regular participation in mammography screening is low, despite higher survival rates. The objective of our research is to highlight healthcare procedures to be optimized and target areas to encourage investment and to raise awareness about the benefits of early diagnosis. Those socio-ecological factors (community, interpersonal and individual) were collected through a review of literature and based on the spatial interaction model of mammography use developed by Mobley et al. The opinion of diverse groups of experts on the importance of those factors was collected by survey. The Fuzzy Delphi Method helped to solve the inherent uncertainty of the survey process. Our findings suggest that population health behaviors, proximity-density to facilities/ physicians and predisposing factors are needed to increase the screening rate. Variations in expert group size could affect the accuracy of the conclusions. However, the application of the enhanced aggregation method provided a group consensus that is less susceptible to misinterpretation and that weighs the opinion of each expert according to their clinical experience in mammography research.

Inequalities associated with lack of mammography in Teresina-Piauí-Brazil, 2010-2011

INTRODUCTION

Randomized studies have shown that screening for breast cancer with mammography reduces the breast cancer mortality. However there are signs of a great inequality in access to mammography in Brazil.

OBJECTIVES

To analyze the percentage of women who did not undergo mammography according to socioeconomic and demographic variables in women aged from 40 to 69 years in Teresina, Piauí State, Brazil.

METHODS

This was a cross-sectional population-based study in women aged 40-69 years in Teresina-Piauí in 2010/2011. The sampling was randomly conducted in five stages. The data were processed by SPSS 19.0 and it was performed univariate and multivariate analysis.

RESULTS

Among 433 women who answered the questionnaire, 75,3% had a mammography and 17,2% of these women had not a mammography over the last two years. The lack of breast cancer screening was associated with non-white skin color (p = 0,030), never being married (p = 0,041), low levels of education (p = 0,010), low family income (p < 0,001), smoking (p = 0,006), having no private health insurance (p < 0,001). The Unified National Health System (SUS) performed 56,3% of reported mammograms.

CONCLUSION

About 24.7% of women in the sample never had a mammography. According to the findings, the lack of breast cancer screening is associated with social and racial inequalities.

Plans to obtain a mammogram among Chilean women: the roles of recommendations and self-efficacy

Social factors may heavily influence cancer screening decisions and practices among Latinas, given the importance their culture places on close, interpersonal relationships. Recommendations by healthcare providers, family and friends have been associated with early detection strategies among US-based Latina populations, but little is known about other Latin American populations. Furthermore, less is known about mechanisms underlying this relationship. In this study, we sought to (i) understand if different types of recommendations were associated with subsequent plans to obtain a mammogram and (ii) assess the potential mediating roles of perceived importance of these recommendations and self-efficacy. Our sample included 250 women residing in a low-income, urban area of Santiago, Chile, and who had participated in a 6-month intervention to increase mammography screening, but remained non-compliant. Women who received family recommendations were more likely to indicate they planned to receive a mammogram in the next 6 months. Perceived self-efficacy mediated this relationship, such that women who received a family recommendation appeared to be more likely to plan to get a mammogram because of increased perceived capabilities to do so. Future research should consider the cultural context of family and self-efficacy in the development of screening interventions for Latinas.

Ductal carcinoma in situ (DCIS): posttreatment follow-up care among Latina and non-Latina White women

BACKGROUND

There is a lack of information about posttreatment care among patients with ductal carcinoma in situ (DCIS). This study compares posttreatment care by ethnicity-language and physician specialty among Latina and White women with DCIS.

METHODS

Latina and White women diagnosed with DCIS between 2002 and 2005 identified through the California Cancer Registry completed a telephone survey in 2006. Main outcomes were breast surveillance, lifestyle counseling, and follow-up physician specialty.

KEY RESULTS

Of 742 women (396 White, 349 Latinas), most (90 %) had at least one clinical breast exam (CBE). Among women treated with breast-conserving surgery (BCS; N = 503), 76 % had received at least two mammograms. While 92 % of all women had follow-up with a breast specialist, Spanish-speaking Latinas had the lowest specialist follow-up rates (84 %) of all groups. Lifestyle counseling was low with only 53 % discussing exercise, 43 % weight, and 31 % alcohol in relation to their DCIS. In multivariable analysis, Spanish-speaking Latinas with BCS had lower odds of receiving the recommended mammography screening in the year following treatment compared to Whites (OR 0.5; 95 % CI, 0.2-0.9). Regardless of ethnicity-language, seeing both a specialist and primary care physician increased the odds of mammography screening and CBE (OR 1.6; 95 % CI, 1.2-2.3 and OR 1.9; 95 % CI, 1.3-2.8), as well as having discussions about exercise, weight, and alcohol use, compared to seeing a specialist only.

CONCLUSIONS

Most women reported appropriate surveillance after DCIS treatment. However, our results suggest less adequate follow-up for Spanish-speaking Latinas, possibly due to language barriers or insurance access.

IMPLICATIONS FOR CANCER SURVIVORS

Follow-up with a primary care provider in addition to a breast specialist increases receipt of appropriate follow-up for all women.

Determinants of breast, cervical and colorectal cancer screening adherence in Mexican-American women

Despite the effectiveness of cancer screening procedures, its utilization among Latinas remains low. Guided, in part, by the Behavioral Model for Vulnerable Populations, this study examined the associations between predisposing, enabling, and need factors with self-reported breast, cervical, and colorectal cancer screening adherence. Participants were 319 Mexican-American women, from a range of socioeconomic backgrounds, living near the United States-Mexico border. Women were adherent with breast cancer (BC) screening (≥42 years) if they had received at least one mammogram within the last 2 years, with cervical cancer (CC) screening (≥40 years) if they had received at least one Pap exam in the last 3 years, and with colorectal cancer (CRC) screening (≥52 years) if they had undergone one or more of the following: Fecal Occult Blood Test within the last year, or sigmoidoscopy in the last 5 years, or colonoscopy within the last 10 years. BC and CC screenings were higher in the current sample compared to national and state figures: 82% with mammography and 86% adherent with Pap exam screening. However, only 43% were adherent with CRC screening recommendations. Characteristics associated with mammography adherence included CC adherence and usual source of care. BC adherence was associated to CC adherence. Characteristics associated with CRC adherence included BC adherence, being premenopausal, and insurance coverage. A key correlate of cancer screening adherence was adherence to other preventive services. Results underscore the need for continued efforts to ensure that Latinas of all SES levels obtain regular and timely cancer screenings.

Influence of primary care physician availability and socioeconomic deprivation on breast cancer from 1988 to 2008: a spatio-temporal analysis

Background

Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States. It is unclear how county-level primary care physician (PCP) availability and socioeconomic deprivation affect the spatial and temporal variation of breast cancer incidence and mortality.

Methods

We used the 1988–2008 public-use county-based data from nine Surveillance, Epidemiology, and End Results (SEER) programs to analyze the temporal and spatial disparity of PCP availability and socioeconomic deprivation on early-stage incidence, advanced-stage incidence and breast cancer mortality. The spatio-temporal analysis was implemented by a novel structural additive modeling approach.

Results

Greater PCP availability was significantly associated with higher early-stage incidence, advanced-stage incidence and mortality during the entire study period while socioeconomic deprivation was significantly negatively associated with early-stage incidence, advanced-stage incidence, and mortality up to 1992. However, the observed influence of PCP availability and socioeconomic deprivation varied by county.

Conclusions

We showed important associations of PCP availability and socioeconomic deprivation with the three breast cancer indicators. However, the effect of these associations varied over time and across counties. The association of PCP availability and socioeconomic deprivation was stronger in selected counties.

Mammography adherence: a qualitative study

BACKGROUND

Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened.

METHODS

We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis.

RESULTS

All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography.

CONCLUSIONS

Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.