The influence of previous breast cancer upon mammography utilization

Use of Breast Imaging After Treatment for Locoregional Breast Cancer (AFT-01)

BACKGROUND

Annual mammography is recommended after breast cancer treatment. However, studies suggest its under-utilization for Medicare patients. Utilization in the broader population is unknown, as is the role of breast magnetic resonance imaging (MRI). Understanding factors associated with imaging use is critical to improvement of adherence to recommendations.

METHODS

A random sample of 9835 eligible patients receiving surgery for stages 2 and 3 breast cancer from 2006 to 2007 was selected from the National Cancer Database for primary data collection. Imaging and recurrence data were abstracted from patients 90 days after surgery to 5 years after diagnosis. Factors associated with lack of imaging were assessed using multivariable repeated measures logistic regression with generalized estimating equations. Patients were censored for death, bilateral mastectomy, new cancer, and recurrence.

RESULTS

Of 9835 patients, 9622, 8702, 8021, and 7457 patients were eligible for imaging at surveillance years 1 through 4 respectively. Annual receipt of breast imaging declined from year 1 (69.5%) to year 4 (61.0%), and breast MRI rates decreased from 12.5 to 5.8%. Lack of imaging was associated with age 80 years or older and age younger than 50 years, black race, public or no insurance versus private insurance, greater comorbidity, larger node-positive hormone receptor-negative tumor, excision alone or mastectomy, and no chemotherapy (p < 0.005). Receipt of breast MRI was associated with age younger than 50 years, white race, higher education, private insurance, mastectomy, chemotherapy, care at a teaching/research facility, and MRI 12 months before diagnosis (p < 0.05).

CONCLUSION

Under-utilization of mammography after breast cancer treatment is associated with sociodemographic and clinical factors, not institutional characteristics. Effective interventions are needed to increase surveillance mammography for at-risk populations. ClinicalTrials.gov Identifier: NCT02171078.

Practice of breast self-examination among women in Malaysia

OBJECTIVES

The objective of this study was to examine the practice and associated factors of breast self- examination (BSE) among Malaysian women.

METHODS

For this cross-sectional study 250 women were selected by a simple random sampling technique. The questionnaire was consisted of three parts: socio-demographic characteristics, knowledge about BSE, and practice of BSE. Obtained data was analyzed using SPSS version 13. T-test and ANOVA test were used to explore the relation between socio-demographic characteristics and the practice of BSE.

RESULTS

About 32% of the participants reported that they have had family history of cancer and about 20% of the participants reported that they have had family history of breast cancer. The majority of the participants (88.8%) have heard about breast cancer and 78.4% of the participants have heard about BSE. Race, marital status, residency, regular exercise, awareness about breast cancer, belief that breast cancer can be detected early, belief that early detection improves the chance of survival, family history of cancer, family history of breast cancer, awareness about BSE, and belief that BSE is necessary, significantly influenced the practice of BSE among women. Practice of BSE on monthly basis was found to be 47.2% among the study participants.

CONCLUSION

The socio-demographic characteristics significantly influence the practice of BSA among women in Malaysia. The findings of this study might not only influence the planning of specific screening interventions and strategies in Malaysia but might also be important for the relevant international communities, interested in the peculiarities of BSE incidence in different countries.

Prospective study of factors predicting adherence to surveillance mammography in women treated for breast cancer

PURPOSE

This prospective study examined the factors that predicted sustained adherence to surveillance mammography in women treated for breast cancer.

METHODS

Breast cancer survivors (N = 204) who were undergoing surveillance mammography completed questionnaires assessing mammography-related anticipatory anxiety, persistent breast pain, mammography pain, and catastrophic thoughts about mammography pain. Adherence to mammography in the following year was assessed.

RESULTS

In the year after study entry, 84.8% of women (n = 173) returned for a subsequent mammogram. Unadjusted associations showed that younger age, shorter period of time since surgery, and having upper extremity lymphedema were associated with lower mammography adherence. Forty percent of women reported moderate to high levels of mammography pain (score of ≥ 5 on a 0 to 10 scale). Although mammography pain was not associated with adherence, higher levels of mammography-related anxiety and pain catastrophizing were associated with not returning for a mammogram (P < .05). The impact of anxiety on mammography use was mediated by pain catastrophizing (indirect effect, P < .05).

CONCLUSION

Findings suggest that women who are younger, closer to the time of surgery, or have upper extremity lymphedema may be less likely to undergo repeated mammograms. It may be important for health professionals to remind selected patients directly that some women avoid repeat mammography and to re-emphasize the value of mammography for women with a history of breast cancer. Teaching women behavioral techniques (eg, redirecting attention) or providing medication for reducing anxiety could be considered for women with high levels of anxiety or catastrophic thoughts related to mammography.

Determinants of breast self-examination performance among Iranian women: an application of the health belief model

Breast cancer is one of the most common cancers among women. Screening behavior rates are low in the world. Therefore, the purpose of the current study was to investigate breast self-examination (BSE) rate and the relationships of Health Belief Model (HBM) constructs for predicting BSE. Path analysis was used to examine both one-way direct and indirect effects of HBM factors on BSE in this population (N = 382). Data were collected by a part of Champion's HBM Scale (CHBMS) and a self-administered questionnaire. The results showed that 7.6% of the participants reported performing BSE regularly. The final model provided a good fit to the data, with 13 variables explaining 62% of the variance in BSE. Perceived self-efficacy was intermediate construct between modifying factors and HBM constructs. Also, perceived self-efficacy and perceived benefits were the most highly related to BSE. The results suggest that HBM is a useful framework for identifying factors influencing the use of BSE in Iranian women.

Socioeconomic factors, immigration status, and cancer screening among Mexican American women aged 75 and older

To explore the association between socioeconomic factors and acculturation with cancer screening methods, we analyzed data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, on 1,272 women aged 75 and older residing in the United States in 2004-2005. We found that lower Pap smear or mammography uses were associated with older age, lower education, and having public health insurance compared with private. Other factors associated with mammography use were depressive symptoms, cognition, and functional limitations. In sum, socioeconomic factors and health insurance coverage, but not acculturation, determine cancer screening utilization in very old Mexican American women.

Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities

BACKGROUND

The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance.

METHODS

A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status.

RESULTS

Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance.

CONCLUSIONS

In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.

Factors associated with breast cancer screening behaviours in a sample of Turkish women: a questionnaire survey

The purpose of this descriptive correlational study was to identify breast self-examination (BSE) and mammography rates and to examine variables related to the breast cancer screening behaviours in a sample of Turkish women. Data were collected from a convenience sample of 656 women, attending three health centres and two maternal and health centres, using an adapted version of Champion's revised Health Belief Model Scale. Results showed that 17% of the women reported performing BSE on a regular basis. Women, over the age of 40, 25% reported at least one mammography. Higher susceptibility to breast cancer, higher confidence for BSE, lower barriers to BSE, and having heard/read about breast cancer and BSE were significantly associated with performing BSE. Higher seriousness of breast cancer, higher benefits of having mammography, having heard/read about mammography, and having a gynaecologist as a regular physician were significantly associated with having mammography.

Health maintenance and screening in breast cancer survivors in the United States

BACKGROUND

The general health maintenance and follow-up of breast cancer survivors has not been well-studied. In a population-based sample we sought to investigate the health practices of breast cancer survivors and to compare rates of screening to women with no history of breast cancer.

METHODS

Subjects were participants of the medical expenditure survey in the years 1996 and 1998, years for which information on screening were available. We used a matched cohort design. Breast cancer survivors aged 40 and older were matched (on age and race/ethnicity) to women with no breast cancer history. We performed logistic regression to estimate the odds of receiving appropriate health care services in breast cancer survivors versus women with no breast cancer history. In addition, we examined demographic and socioeconomic differences between breast cancer survivors who reported appropriate screening and survivors who had inadequate screening.

RESULTS

A small minority of breast cancer survivors report inadequate mammography (18%) and clinical breast exam (12%) follow-up. A significant portion of breast cancer survivors report inadequate screening for Pap smear (40%), general physical exam (GPE) (30%) and flu shot (33%). The odds of receiving appropriate screening were higher in survivors versus matched women for mammography, clinical breast and cholesterol screening. There were no differences for other screening. Across all health maintenance and screening practices, breast cancer survivors who did not receive appropriate screening were less likely to have private insurance, to be married and to be above the mean income level, though these differences were non-significant.

CONCLUSIONS

Although survivors report high levels of screening, a small minority of women report inadequate mammography and clinical breast exam follow-up which is concerning given their risk of recurrence and second primary breast cancer. Additionally, a significant portion of survivors report inadequate screening for general health maintenance issues. Demographic and socioeconomic factors were associated with lower screening rates. However, the deficits in screening among breast cancer survivors appears to be smaller compared to women in the general population.

Cancer screening among Latino subgroups in the United States

BACKGROUND

Relying upon the Health Belief Model and a behavioral model of health care utilization, the purpose of this study was to examine current adherence to cancer screening among Latino subgroups.

METHODS

Using data from the 2000 National Health Interview Survey, 5377 Latinos were surveyed for their use of Pap smear, mammogram, breast self-examination and the clinical breast exam among women, prostate specific antigen test among men, and the fecal occult blood test, sigmoidoscopy, colonoscopy, and proctoscopy among both men and women. Using sampling weights, multivariate logistic regression models were used to assess screening use.

RESULTS

Dominican women had 2.4 times greater likelihood of having had mammography than other Latinos. In addition, Latinas aged 50-69, who had more years of education, a personal history of cancer, who were not current smokers, had health insurance, had visited a primary care provider over the past 12 months, and had at least one other screening test had greater use of mammography. Younger age, marriage, greater acculturation, visits to a primary care provider, health insurance, and the use of other cancer screening tests predicted the uptake of the Pap smear. Latinas were more likely to use a CBE if they were younger, had a Bachelor's degree, a personal history of cancer, were more acculturated, had visits to a primary care provider over the past 12 months, and used other cancer screening tests. Puerto Ricans, Central or South Americans had half the likelihood of having colorectal cancer screening than other groups. Ages between 50 and 69, male sex, marriage, history of visiting a health care provider, and use of other screening tests predicted use of the FOBT. Older age, greater education, male sex, history of visiting a health care provider in the previous year, use of other screening tests, and better health status influenced the uptake of endoscopy for colorectal cancer screening. Cuban males had fivefold greater utilization of PSA testing. Additionally, PSA use among Latinos was predicted by older age, history of visiting a primary care provider in the past 12 months, and use of other screening tests.

CONCLUSIONS

Cancer screening programs must take into account differences among Latinos in age, gender, educational levels, marital status, cancer history, risk behaviors, insurance, health status and health services utilization.

What’s the message? Interpretation of an uninformative BRCA1/2 test result for women at risk of familial breast cancer

PURPOSE

To test the "false-reassurance hypothesis," which suggests that women who receive an uninformative BRCA1/2 test result may incorrectly conclude that they no longer have an elevated risk, with possible harmful consequences for adherence to breast surveillance guidelines.

METHODS

A prospective questionnaire design was used to compare 183 women with an uninformative BRCA test result (94 affected and 89 unaffected) with 41 proven BRCA mutation-carriers and 49 true negatives before and after BRCA1/2 test disclosure.

RESULTS

After DNA-test disclosure, test applicants differed from each other with regard to their perception of the likelihood of carrying a deleterious gene (P < 0.0001). The BRCA mutation carriers reported the highest perceived likelihood and the true negatives reported the lowest. Compared to the predisclosure measures, women who received an uninformative DNA test result reported a lower perceived risk after disclosure (P < 0.0001), suggesting a relatively high level of reassurance because of the test result. However, after DNA-test disclosure, only 12 women concluded that the risk of carrying a mutation was nonexistent, and perceived likelihood was significantly associated with the pedigree-based risk assessment (P = 0.0001). Moreover, despite the significant decrease in perceived likelihood for uninformative women, intention to obtain mammograms did not change (P = 0.71); it remained at the same almost optimal level as for BRCA mutation carriers.

CONCLUSION

No support was found for the suggestion that the nature of uninformative test results is often misunderstood. Moreover, an uninformative test result did not affect the positive mammography intentions of both affected and unaffected women.

Empowering factors in repeat mammography: insights from the stories of underserved women

Screening mammography can reduce breast cancer mortality. Although a significant percentage of underserved women obtain low income, minority mammograms regularly women underutilize mammography and rates of regular screening are also very low in the general population. By structuring focus groups around constructs from the Precede-Proceed Model, our study explored how these underserved women overcame barriers to be screened on a regular basis. Twenty-eight items were categorized as personal factors that helped them overcome the barriers: awareness and knowledge of risk factors (age and family history); knowledge and trust in early detection and treatment processes; personal responsibility about own health and well-being; and pride in self and satisfaction with one's own actions.

Reliability and validity of the breast cancer screening belief scale among Turkish women

Breast cancer is the second leading cause of cancer deaths in Turkish women, and the use of breast self-examination (BSE) and mammography remains low in Turkey. Therefore, we need to identify the beliefs, influencing BSE and mammography, and a valid and reliable tool to measure constructs. The Champion's health belief model scale (CHBMS) is a valid and reliable tool to measure beliefs about breast cancer, BSE, and mammography in an English culture. The purpose of this study was to assess the psychometric characteristics of a Turkish version of the CHBMS related to breast cancer, BSE, and mammography. A convenience sample of 656 women was recruited from 3 health centers and 2 maternal and child health centers in Istanbul. The CHBMS was translated to Turkish, validated by professional judges, back translated, and tested. Factor analysis yielded 7 factors for BSE: confidence, seriousness, barriers-BSE, health motivation 1 and 2, susceptibility, and benefits-BSE. For mammography scale, 6 factors were identified: seriousness, benefits-mammography, barriers-mammography, health motivation 1 and 2, and susceptibility. All items on each factor were from the same construct. Cronbach alpha reliability coefficients ranged from.75 to.87 for the subscales. The Turkish version of the CHBMS showed adequate reliability and validity for use in Turkish women. It could easily be used to evaluate the health beliefs about breast cancer, BSE, and mammography. Further refinement is required to study Turkish women's health beliefs and breast cancer screening behaviors in various settings.