Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population

Evaluating the Harms of Cancer Testing-A Systematic Review of the Adverse Psychological Correlates of Testing for Cancer and the Effectiveness of Interventions to Mitigate These

(1) Background: Several studies have described the psychological harms of testing for cancer. However, most were conducted in asymptomatic subjects and in cancers with a well-established screening programme. We sought to establish cancers in which the literature is deficient, and identify variables associated with psychological morbidity and interventions to mitigate their effect. (2) Methods: Electronic bibliographic databases were searched up to December 2020. We included quantitative studies reporting on variables associated with psychological morbidity associated with cancer testing and primary studies describing interventions to mitigate these. (3) Results: Twenty-six studies described individual, testing-related, and organisational variables. Thirteen randomised controlled trials on interventions were included, and these were categorised into five groups, namely the use of information aids, music therapy, the use of real-time videos, patient navigators and one-stop clinics, and pharmacological or homeopathic therapies. (4) Conclusions: The contribution of some factors to anxiety in cancer testing and their specificity of effect remains inconclusive and warrants further research in homogenous populations and testing contexts. Targeting young, unemployed patients with low levels of educational attainment may offer a means to mitigate anxiety. A limited body of research suggests that one-stop clinics and patient navigators may be beneficial in patients attending for diagnostic cancer testing.

A Comparison of Perceived Lifetime Breast Cancer Risk to Calculated Lifetime Risk Using the Gail Risk Assessment Tool

Background: Understanding the accuracy of a woman's perceived breast cancer risk can enhance shared decision-making about breast cancer screening through provider and patient discussion. We aim to report and compare women's perceived lifetime breast cancer risk to calculated lifetime breast cancer risk. Methods: Women presenting to Mayo Clinic in Arizona and Minnesota in July 2016 completed a survey assessing their perceived breast cancer risk. Lifetime Gail risk scores were calculated from questions pertaining to health history and were then compared with perceived breast cancer risk. Results: A total of 550 predominantly white, married, and well-educated (≥college) women completed surveys. Using lifetime Gail risk scores, 5.6% were classified as high risk (>20% lifetime risk), 7.7% were classified as intermediate risk (15%-20%), and 86.6% were classified as average risk (<15%). Of the 27 women who were classified as high risk, 18 (66.7%) underestimated their risk and of the 37 women who were intermediate risk, 12 (32.4%) underestimated risk. Women more likely to underestimate their risk had a reported history of an abnormal mammogram and at least one or more relative with a history of breast cancer. Surveyed women tended to overestimate risk 4.3 (130/30) times as often as they underestimated risk. Conclusion: In a group of predominantly white, educated, and married cohort of women, there was a large portion of women in the elevated risk groups who underestimated risk. Specific aspects of medical history were associated with underestimation including a history of abnormal mammogram and family history of breast cancer. Overall, in our sample, more women overestimated than underestimated risk.

Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort

BACKGROUND

Dense breast notification (DBN) legislation aims to increase a woman's awareness of her personal breast density and the implications of having dense breasts for breast cancer detection and risk. This information may adversely affect women's breast cancer worry, perceptions of risk, and uncertainty about screening, which may persist over time or vary by sociodemographic factors. We examined short- and long-term psychological responses to DBN and awareness of breast density (BD).

METHODS

In a predominantly Hispanic New York City screening cohort (63% Spanish-speaking), ages 40-60 years, we assessed breast cancer worry, perceived breast cancer risk, and uncertainties about breast cancer risk and screening choices, in short (1-3 months)- and long-term (9-18 months) surveys following the enrollment screening mammogram (between 2016 and 2018). We compared psychological responses by women's dense breast status (as a proxy for DBN receipt) and BD awareness and examined multiplicative interaction by education, health literacy, nativity, and preferred interview language.

RESULTS

In multivariable models using short-term surveys, BD awareness was associated with increased perceived risk (odds ratio (OR) 2.27, 95% confidence interval (CI) 0.99, 5.20 for high, OR 2.19, 95% CI 1.34, 3.58 for moderate, vs. low risk) in the overall sample, and with increased uncertainty about risk (OR 1.97 per 1-unit increase, 95% CI 1.15, 3.39) and uncertainty about screening choices (OR 1.73 per 1-unit increase, 95% CI 1.01, 2.9) in Spanish-speaking women. DBN was associated with decreased perceived risk among women with at least some college education (OR 0.32, 95% CI 0.11, 0.89, for high, OR 0.50, 95% CI 0.29, 0.89, for moderate vs. low risk), while those with a high school education or less experienced an increase (OR 3.01, 95% CI 1.05, 8.67 high vs. low risk). There were no associations observed between DBN or BD awareness and short-term breast cancer worry, nor with any psychological outcomes at long-term surveys.

CONCLUSIONS

Associations of BD awareness and notification with breast cancer-related psychological outcomes were limited to short-term increases in perceived breast cancer risk dependent on educational attainment, and increases in uncertainty around breast cancer risk and screening choices among Spanish-speaking women.

The effect of multimedia health education on pain and anxiety in women undergoing mammography in Taiwan

OBJECTIVE

Breast cancer is the most common cancer among women in Taiwan. However, the discomfort of receiving mammograms reduces the willingness to screen.

MATERIALS AND METHODS

This study using a quasi-experimental design and recruited 150 participants in a medical center, Taiwan. In the control group, only provided traditional health education sheets, the experimental group has joined the intervention of multimedia health education. State-Trait Anxiety Inventory and Visual Analogue Scale, respectively, were used to compare the differences in anxiety and pain between the two groups before and after receiving mammography.

RESULTS

After the intervention, the experimental group's state anxiety score was significantly lower than that of the control group (30.63 ± 8.43 vs. 33.77 ± 10.74, p < .05). However, there was no significant difference in pain scores (4.13 ± 2.37 vs. 4.57 ± 2.31; p = .25).

CONCLUSIONS

Younger, prior experience with mammography, and high trait anxiety affect pain and state anxiety of women undergoing mammography. The multimedia health education intervention could reduce anxiety effectively, but it does not significantly relieve the pain undergoing mammography.

Theory-based training to promote breast cancer screening among women with breast cancer worries: randomized controlled trial

BACKGROUND

Breast cancer worries are important determinants in relation to behavior favoring breast cancer screening.

OBJECTIVE

To determine the effect of theory-based training to promote breast cancer screening among women with high and low levels of breast cancer worries.

DESIGN AND SETTING

Randomized controlled trial, conducted in two family health centers.

METHODS

In total, 285 women were recruited. Women with low levels of breast cancer worries were included in the first intervention group (112 women) and the first control group (112 women), while women with high levels of breast cancer worries were included in the second intervention group (37 women) and the second control group (43 women). Theory-based training to promote breast cancer screening was given to intervention groups. The women's willingness to undergo breast cancer screening and breast cancer worry scores were evaluated at 1, 3 and 6 months.

RESULTS

The women in the low cancer-worry intervention group performed breast self-examination more in months 1 and 6 following the training, and the women in the high cancer-worry control group performed breast self-examination more in month 3 (P < 0.05). No difference between the women who had low or high levels of breast cancer worries were observed in relation to breast self-examination, clinical breast examination or mammography (P > 0.05).

CONCLUSION

The level of worry did not affect the success of theory-based training, and the training was partially effective with regard to willingness to undergo breast cancer screening.

"You probably can't feel as safe as normal women": Hispanic women's reactions to breast density notification

BACKGROUND

Patient advocacy has led to state-level legislative mandates for the release of personal mammographic breast density information to women undergoing screening mammography. More research is needed to understand the impact of this information on women's perceptions and mammography screening behavior.

METHODS

Semistructured interviews were conducted in English and Spanish with 24 self-identified Hispanic women who had undergone at least 1 mammogram since breast density notification was enacted in New York State. The women ranged in age from 43 to 63 years. Women were asked about their understanding and perceptions of the communication of New York State-mandated breast density information, and any actions they have taken or would take in response to this information. A content analysis of the qualitative data from the translated and transcribed interviews was conducted.

RESULTS

The majority of participants had no prior knowledge of breast density and expressed confusion and apprehension regarding the meaning of dense breasts when presented with the notification information. Many participants understood having dense breasts to be a serious and abnormal condition, and reported feelings of worry and vulnerability. Participants mostly expressed a strong interest in learning about breast density and obtaining additional and more frequent breast cancer screening tests. These behavioral intentions were consistent with participants' overall favorable view of breast cancer screening and a belief that their faith, as well as regular screening, can help to protect them from breast cancer morbidity and mortality.

CONCLUSIONS

Hispanic women conveyed proactive breast cancer screening intentions in response to breast density notification, despite inadequate comprehension of this information and negative emotional responses.

Childhood body size and midlife mammographic breast density in foreign-born and U.S.-born women in New York City

PURPOSE

We investigated whether childhood body size is associated with midlife mammographic density, a strong risk factor for breast cancer.

METHODS

We collected interview data, including body size at age 10 years using a pictogram, and measured height and weight from 518 women, recruited at the time of screening mammography in New York City (ages 40-64 years, 71% Hispanic, 68% foreign-born). We used linear regression models to examine childhood body size in relation to percent density and areas of dense and nondense tissue, measured using a computer-assisted method from digital mammograms.

RESULTS

In models that adjusted for race/ethnicity, and age and body mass index at mammogram, the heaviest relative to leanest childhood body size was associated with 5.94% lower percent density (95% confidence interval [CI]: -9.20, -2.29), 7.69 cm² smaller dense area (95% CI: -13.94, -0.63), and 26.17 cm² larger nondense area (95% CI: 9.42, 43.58). In stratified analysis by menopausal status and nativity, the observed associations were stronger for postmenopausal and U.S.-born women although these differences did not reach statistical significance.

CONCLUSIONS

Heavy childhood body size is associated with lower mammographic density, consistent with its associations with breast cancer risk. Suggestive findings by nativity require confirmation in larger samples.