Breast and Cervical Cancer Screening Utilization Among Hispanic Women Living Near the United States-Mexico Border

Breast Cancer Risk Perceptions Among Underserved, Hispanic Women: Implications for Risk-Based Approaches to Screening

BACKGROUND

Understanding factors that shape breast cancer risk perceptions is essential for implementing risk-based approaches to breast cancer detection and prevention. This study aimed to assess multilevel factors, including prior screening behavior, shaping underserved, Hispanic women's perceived risk for breast cancer.

METHODS

Secondary analysis of survey data from Hispanic women (N = 1325, 92% Spanish speaking, 64% < 50) enrolled in a large randomized controlled trial. Analyses were performed in two cohorts to account for the role of age on screening guideline recommendations (< 50 and 50 +). For each cohort, we examined differences in three common measures of perceived risk of breast cancer (percent lifetime, ordinal lifetime, comparative) by participant factors with chi-square or Kruskal-Wallis tests, as appropriate. Multivariate analyses examined the association between mammography history with percent perceived lifetime risk (outcome > 10 vs ≤ 10%).

RESULTS

Overall, 75% reported a lifetime risk between 0 and 10%, 96% rated their ordinal risk as "not high," and 50% rated their comparative risk as "much lower." Women < 50 with a family history of breast cancer reported significantly higher levels of perceived risk across all three measures. Among women 50 + , those reporting lower levels of perceived risk were significantly more likely to be Spanish speaking. No significant association was observed between mammography history and percent lifetime risk of breast cancer.

CONCLUSION

Factors shaping breast cancer risk perceptions differ by age. Prior screening may play less of role in constructing risk perceptions. Research is needed to develop culturally and linguistically appropriate strategies to improve implementation of risk-based screening.

Using the Community Readiness Model to Assess American Indian Communities Readiness to Address Cancer Prevention and Control Programs

Cancer disparities continue among American Indian and Alaska Native (AI/AN) populations while they have decreased among other racial and ethnic groups. No studies were found that utilized the Community Readiness Model (CRM) to ascertain the readiness of Tribal and American Indian organizations to participate in cancer research and cancer prevention and control initiatives. The Partnership for Native American Cancer Prevention conducted an assessment of the status of American Indian communities' readiness to implement activities for prevention, early detection, and treatment to improve AI/AN cancer rates. The assessment was a component of the Community Outreach Core of the grant. Thirty-four key Informants participated in the interview process. The Community Readiness Assessment (CRA) provided a baseline assessment of community partners' readiness to participate in cancer research and programming. Despite years of cancer intervention programs, the communities were classified as being in the early stages of readiness [1-5] of the nine-stage model. Additionally, findings showed low levels of awareness of previous or ongoing cancer research. The findings in prevention and control efforts indicated a need for technical assistance and funding to support community projects in prevention and control. This supported the implementation of a community grants initiative. They also indicated that communities were not ready to conduct research, despite ongoing cancer related research in at least two communities. Communication tools and social media methods and messages were developed to increase awareness of cancer as a health concern and cancer research in the community. The CRM informed these and other engagement activities to meet the appropriate stage of readiness for each Tribe/community, and to build their capacity to participate in cancer research and programming activities.

Breast cancer screening outcomes among Mexican-origin Hispanic women participating in a breast cancer screening program

•

We observed a higher recall rate for diagnostic testing in this population.

•

Breast density distribution was different to both Hispanic and other populations.

•

We did not observe lower biopsy rates compared to other populations.

•

Age, health status, and years in the US were associated with breast density.

Breast cancer is the commonest occurring cancer and the leading cause of cancer death among Hispanic women in the USA. Although their overall breast cancer incidence and mortality is lower, incidence rates are rising faster and mortality declines are lower than other groups. It is expected that the breast cancer burden will rise as this population ages and becomes more acculturated. It is therefore important to better characterize their screening outcomes. This is an observational study of socioeconomically disadvantaged Hispanic women participating in a community-based breast cancer screening program that offered no-cost testing and navigation services in two US-Mexico border counties. Outcomes include results of screening mammograms, diagnostic tests and breast findings. Of 1,966 eligible women, 1,675 (85%) completed a screening mammogram and were included in this analysis. Mean age was 56 years (SD: 6.8 years, range 50 to 75.6 years); 99% were Hispanic and 83.6% had less than high school education. 19.3% of the initial mammogram results were abnormal (BIRADS 0, 3, 4, or 5); a diagnostic mammogram was indicated in 12.2% (n = 205), a diagnostic ultrasound in 26.4% (n = 443), and biopsies in 3.0% (n = 51) of the total. Eleven women (0.66%) had breast cancer diagnosed. Mexican-origin Hispanic women had higher recall rates, but similar biopsy and cancer rates to general screening populations despite their overall lower incidence and mortality in the USA. This suggests that the expected rise in future breast cancer burden among US Hispanics due to aging and acculturation could occur sooner than expected.

Racial disparities in routine health checkup and adherence to cancer screening guidelines among women in the United States of America

PURPOSE

Routine health checkup and cancer screening rates among women are suboptimal, partially due to the health care disparities by race/ethnicity in the USA. This study examined the previously understudied associations between routine health checkup, cervical cancer screening, and breast cancer screening by race/ethnicity using the national representative sample of women.

METHODS

Data were obtained from three cycles (2017, 2018, and 2019) of the Health Information National Trends Survey (HINTS) (n = 12,227). Survey-weighted logistic regressions were evaluated to assess associations between routine health checkup and cervical and breast cancer screening compliance with the established guidelines with the age criteria and frequency of screening by race/ethnicity (Black, White, Hispanic, and Other).

RESULTS

This study included 6,941 women in the cervical cancer screening and 8,005 women for breast cancer screening, considering the age criteria. Women who had received routine health checkups were more likely to meet the cervical cancer screening guideline (Odds ratio 3.24, p < 0.05) and breast cancer screening guideline (OR 5.86, p < 0.05) compared to women who did not receive routine health checkups. While routine health checkups were associated with both types of cancer screenings in most racial/ethnic groups, analyses stratified by race/ethnicity suggest that Hispanic women and Other women did not benefit from routine health checkup in relation to cervical and breast cancer screening, respectively.

CONCLUSION

Promotion of routine health checkups could promote cancer screening among women across racial/ethnic groups, although specific racial/ethnic groups may require additional support.

Cervical cancer screening in the United States: Challenges and potential solutions for underscreened groups

Cervical cancer screening rates in the United States are generally high, yet certain groups demonstrate disparities in screening and surveillance. Individuals at greatest risk for cervical cancer are often from marginalized or underserved groups who do not participate in regular screening for a variety of reasons. Using the Population-based Research to Optimize the Screening Process (PROSPR) Trans-Organ Conceptual Model, including concepts of individual-, provider-, facility-, system-, or policy-level factors, we provide a commentary to highlight reasons for low screening participation among subgroups in the U.S. These include racial and ethnic minorities, rural residents, sexual and gender minorities, those with limited English proficiency, those with particular religious beliefs, and various health conditions. We describe barriers and offer potential solutions for each group. In addition, we discuss cross-cutting barriers to screening including difficulty interacting with the healthcare system (limited knowledge and health literacy, lack of provider recommendation/contact), financial (cost, lack of insurance), and logistical barriers (e.g., lack of usual source of care, competing demands, scheduling issues). Solutions to address these barriers are needed to improve screening rates across all underscreened groups. Changes at state and national policy levels are needed to address health insurance coverage. Mobile screening, ensuring that interpreters are available for all visits, and targeted in reach at non-gynecological visits can further overcome barriers. Employing community outreach workers can increase community demand for screening, and patient navigators can improve adherence to both screening and follow-up diagnostic evaluation. HPV self-sampling can address multiple barriers to cervical cancer screening.

Cervical cancer, human papillomavirus (HPV), and HPV vaccination: exploring gendered perspectives, knowledge, attitudes, and cultural taboos among Mexican American adults

Background: Gendered perspectives may be particularly important in shaping norms and values around HPV and HPV vaccination, as previous research suggests that sexuality taboos (e.g. promiscuity) may contribute to low perceived risk among adolescent and young adult Hispanic females. However, research to date focuses primarily on Hispanic mothers, adolescent females, and women of HPV vaccine-eligible age. Hispanic father's perspectives are relatively unknown despite father's important role in shaping norms for their female children. Objective: To close this gap, this study examines gendered perspectives in knowledge, beliefs, and attitudes about HPV and HPV vaccination from Hispanic parents (mothers and fathers), women of vaccine-eligible age (18-26 years old), and women eligible for Pap Test screening (>26 years old) living in two counties along the Texas-Mexico border. Design: We conducted eight focus groups. Research staff transcribed audio recordings verbatim and uploaded them into Atlas(ti) 5.0 for analysis. The research team analyzed the data for content, meaning, patterns and themes using the constant comparison approach. Results: Perspectives were highly gendered. Women's (all groups combined) beliefs focused on misconceptions around how the HPV virus is contracted (e.g. toilet surfaces). Women also linked HPV-related sexual risk to adultery and indiscretion of male partners. Fathers (men) were more likely to link risk to female promiscuity. Fathers also worried that HPV vaccination might increase promiscuity. All groups believe that HPV vaccination is a way to protect Hispanic females in the face of beliefs around sexual behavior and risk of contracting HPV. Conclusion: Results suggest gendered differences in risk beliefs concerning HPV among Hispanics living along the Texas-Mexico border. Researchers can use these findings to address barriers to HPV vaccination, as well as to create culturally appropriate prevention messages that may help reduce disparities in HPV among Hispanic women.

Knowledge and perceptions regarding triage among human papillomavirus-tested women: A qualitative study of perspectives of low-income women in Argentina

Objectives:

Among cancer prevention studies, little is known about knowledge, attitudes, and beliefs toward triage adherence in the context of the human papillomavirus self-collection test. This formative research aims to identify knowledge, attitudes, and beliefs related to human papillomavirus and cervical cancer prevention specifically about adherence to Pap triage among women residing in a low-income province in Argentina.

Methods:

We conducted six focus groups, stratified by residence and age. All participants were aged 30 or older and had performed human papillomavirus self-collection. Data collection and thematic analysis were carried out using constructs from the Health Belief Model.

Results:

Misinformation regarding human papillomavirus and cervical cancer was common and was a source of distress. Women could not distinguish Pap screening from triage; human papillomavirus risk perception was limited but cervical cancer was perceived as a threatening disease. Women were willing to follow-up after receiving an abnormal screening result. Negative views about clinician-collected screening/triage were common, defined as painful and shameful, and comes with an economic cost (transport/time). Lack of help from family/friends was an obstacle to adhering to triage. Health issues in the family’s records and a physician’s recommendation were a cue to adhere to triage.

Conclusion:

Lack of knowledge or misinformation of the causes of cervical cancer, human papillomavirus, and the multi-step screening and triage process are barriers to follow-up adherence. Interventions to improve communication between women and health providers about screening results and follow-up are needed. Also, health services should be organized to respond to women’s needs and reduce access barriers to follow-up.

Association of depression with adherence to breast cancer screening among women aged 50 to 74 years in the United States

RATIONALE, AIMS, AND OBJECTIVES

Previous research has shown inconsistent results regarding the association of depression and screening mammography use behaviours. This study aimed to assess the relationship between women's depression and mammography adherence.

METHODS

This cross-sectional study used data from the 2016 Behavioural Risk Factor Surveillance System and employed the Health Belief Model (HBM). The primary independent variable was the presence of depression. The dependent variable was adherence to biennial screening mammography based on the US Preventive Services Task Force guidelines. Demographic characteristics and HBM constructs were included as covariates. Univariate and multivariate logistic regressions were used.

RESULTS

A total of 139 550 women were included (weighted n = 48 712 531). Among them, 23.1% reported the presence of depression (n = 32 247). The unadjusted odds ratio (OR) for mammography use in women with depression was 0.85 (95% confidence interval [CI], 0.80-0.91, P < .001) compared with women without depression, and the probability of mammography use was significantly lower in women with depression (76.3%; 95% CI, 75.4-77.3) compared with women without depression (79.1%; 95% CI, 78.5-79.6). However, the adjusted OR was not statistically significant when controlling for demographic and HBM characteristics (1.02; 95% CI, 0.93-1.11, P = .698), and the probabilities of mammography use were similar between women with depression (80.1%; 95% CI, 79.0-81.3) and without depression (79.9%; 95% CI, 79.2-80.6).

CONCLUSIONS

Depression itself was related to nonadherence with mammography screening guidelines. However, after controlling for demographic and HBM characteristics, depression was not associated with adherence with mammography screening guidelines.

Differences in Breast and Cervical Cancer Screening Among U.S. Women by Nativity and Family History

INTRODUCTION

System-level factors such as poor access to health services can help explain differential uptake in breast and cervical cancer screening between U.S.- and foreign-born women. However, few studies have explored the roles of family history and perceived risk of these cancers on screening rates. To address these gaps, this study investigates whether a family history of cancer, perceived risk, and system-level factors independently and additively predict differential screening rates of breast and cervical cancer between U.S.-born and foreign-born women living in the U.S.

METHODS

Data were analyzed in 2019 from the 2015 National Health Interview Survey. Descriptive and multivariable logistic regression modeling was performed to test whether there were differences in breast and cervical cancer screening within and between the 2 groups and whether family history of cancer and perceived risk of breast cancer were predictors of uptake.

RESULTS

The sample comprised women aged 21-74 years (n=14,047). The mean age of the sample was 45.5 (SD=14.8 years). The majority of the women were U.S.-born (77.5%). U.S.- and foreign-born women had more mammograms and Pap tests with a usual source of care (p<0.001) and insurance (p<0.001). Healthcare access and utilization factors were also predictive for both groups of women. Data analyses were conducted in 2019.

CONCLUSIONS

These findings are consistent with previous work. Access and healthcare utilization were associated with screening uptake. However, differences in risk perception, family history of breast and cervical cancers, and screening uptake were found between U.S.- and foreign-born women.

Hereditary Breast Cancer Risk Analysis in Uninsured Mexican-Origin Women Living in the U.S.–Mexico Border Region

Purpose:

This article describes the risk of hereditary breast cancer (HBC) in low-income Hispanic women living on the U.S.–Mexico border using the Pedigree Assessment Tool (PAT).

Method:

The PAT was administered as part of the El Paso and Hudspeth County Breast Cancer Education, Screening and NavigaTion program (BEST). Baseline data ( n = 1,966) from this program was used to analyze risk factors for HBC. Analysis was conducted to determine significant covariates associated with the presence of any PAT risk factors.

Results:

The PAT identified 17% (95% CI [15%, 19%]) of the women in the study as having some risk of HBC. Having had a mammogram within 3 years was significantly associated with having any PAT risk factors (odds ratio [OR] = 1.79, p = .006). Women who immigrated to the United States during childbearing age (OR = 0.610, p = .009) or during peri/menopause (OR = 0.637, p = .024) were significantly less likely to have any PAT risk factors.

Discussion:

The PAT instrument detected a substantial pool of women who may be at risk for HBC. A significant proportion of these women were not up to date mammogram.

Conclusions:

The PAT is an effective tool to identify women at risk for HBC and encourage regular screening.

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.

Qualitative Study of Latino Cancer Patient Perspectives on Care Access and Continuity in a Rural, U.S.-Mexico Border Region

Access to quality cancer care for cancer patients living in the rural U.S.-Mexico border region is complex due to common binational health care-seeking behaviors and regional socio-economic and cultural characteristics. But little is known about the challenges border dwelling residents face when navigating their cancer care systems. In-depth interviews were conducted with 22 cancer patients in Southern California. Thematic analysis was applied to identify patterns of meaning in the data. Emerging themes were: (1) delays in cancer care coordination: (a) poor coordination of cancer care (b) U.S. and cross-border discordance in cancer diagnosis; (2) regional shortage of cancer specialists; and (3) financial hardship. Findings revealed that care needs distinctly involved care coordination in/outside of the patient's community and bi-national care coordination. In addition to local solutions to improve cancer coordination through community-based partnerships, efforts to bridge care in a two-nation context are also imperative.

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.

Health Care Access, Utilization, and Cancer Screening Among Low-Income Latina Women

INTRODUCTION

Cancer screening reduces mortality rates for breast, cervical, and colon cancer. Yet cancer screening rates for Latina women are lower than for non-Latino Whites, and below Healthy People 2020 goals. Additionally, Latinos face many health care access barriers. This study examined health care access and utilization in relation to cancer screening among low-income Latina women recruited from a high-risk area and enrolled in a navigation-plus-education intervention.

METHODS

Latina women considered rarely or never screened for breast, cervical, or colorectal cancer were recruited from community-based organizations and events (N = 691). We gathered self-reported survey data on insurance status, usual source of care, health care utilization, and cancer screening behavior. We conducted multivariable logistic regression models to estimate odds ratios of receipt of at least one cancer screening test.

RESULTS

Overall, 28% of women received at least one cancer screening test. Results indicated that women without insurance (odds ratio [OR] = 2.08; confidence interval [CI] = 1.09, 3.98) and without a doctor's visit in the past year (OR = 2.02; CI = 1.28, 3.18), compared with their counterparts, had greater odds of receiving at least one screening test.

CONCLUSION

Findings highlight the continued need to explore ways to support uninsured individuals' screening efforts and further investigate barriers among insured women who are not up-to-date with screenings.

Latina Women and Cervical Cancer Screening: Decisional Balance and Self-Efficacy

BACKGROUND

Latina women in the United States have greater cervical cancer mortality rates than non-Latina women because of their low rates of Papanicolau (Pap) smear screening.

OBJECTIVES

The purpose of this article is to assess differences in perceived benefits, perceived barriers, and self-efficacy among Latina women to obtain Pap smears using the framework of the Transtheoretical Model.

METHODS

A descriptive design with a snowball sample was used. The researchers assessed demographics, three perceived benefits, 12 barriers, and seven self-efficacy measures for 121 Latina women in northern Nevada.

FINDINGS

Participants in precontemplation and relapse perceived greater barriers than those in action and maintenance for three items.

Cultural and emotional determinants of cervical cancer screening among older Hispanic women

Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.

Utilization of Cervical Cancer Screening Among Hispanic Immigrant Women in Coastal South Carolina

OBJECTIVES

This study aims to examine prevalence and correlates of cervical cancer screening utilization and adherence among a growing population of Hispanic immigrant women in coastal South Carolina.

METHODS

We conducted a cross-sectional survey of 196 women to assess recency of screening and hypothesized study predictors (health status, beliefs, self-efficacy, having a regular provider, barriers to screening, and trust in providers). Multiple ordinal logistic regressions identified final covariates which would predict recency of screening.

RESULTS

Approximately 84% of women were up-to-date with their Pap tests and 47% had received a Pap test in the previous year. In the adjusted analyses, having a regular provider and having a chronic medical condition were significantly associated with recency of Pap test.

CONCLUSIONS

Differences in cervical cancer screening for participants were partially explained by psychosocial factors, health status, and individual and structural barriers to healthcare.

Psychosocial correlates of cervical cancer screening among older Hispanic women

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

Predictors of Human Papillomavirus Vaccine Initiation and Completion Among Latino Mothers of 11- to 17-Year-Old Daughters Living Along the Texas-Mexico Border

Few Texas Latino girls initiate and complete the human papillomavirus (HPV) vaccine series, but few studies have examined predictors of initiation and completion in this group. Mothers are crucial to vaccine uptake. Using self-reported data from mothers of unvaccinated girls (n = 317), we examined the association between predictors (HPV and HPV vaccine knowledge, vaccine self-efficacy) and outcomes (initiation and completion). Despite an increase in HPV and HPV vaccine knowledge from baseline to follow-up (n = 195), we found no association between the predictors and the outcomes. Findings showed that health insurance status and study group participation (Entre Madre e Hija program or brochure only) were associated with initiation and completion.

Breast health beliefs, behaviors, and barriers among latina permanent resident and migratory farm workers

There is a dearth of research on the breast health behaviors of migratory farm workers. This research used focus group methodology to compare the breast cancer beliefs and barriers of Latina women working as migratory farmers (n = 33) and permanent residents (n = 31). In comparison to their permanent resident counterparts, migrant farmers had low knowledge about the causes of breast cancer, and experienced significant barriers to care. Many barriers were cultural-specific, including culturally-based gender roles. These findings have significant implications for designing culturally-relevant interventions to improve access to care among this population.

Women's Attitudes Toward Cervicovaginal Self-Sampling for High-Risk HPV Infection on the US-Mexico Border

OBJECTIVE

The purpose of this study was to assess the acceptability and intention to use cervicovaginal self-sampling for high-risk human papillomavirus infection after receiving an educational intervention among the predominantly Hispanic population residing along the US-Mexico border.

METHODS

Women received an educational intervention about cervical cancer prevention through screening with conventional cytology and with self-sampling for high-risk human papillomavirus. After the educational intervention, women performed the self-sampling test. Women's attitudes toward the self-sampling test and cervical cytology were assessed and compared.

RESULTS

A total of 110 women aged 30 to 65 years completed the study. The mean (SD) age of the population was 48 (9.3) years. Most (87%) self-identified as being Hispanic and half were born in Mexico; 16% had not had cervical cytology done in 3 years. Self-sampling was more acceptable than cervical cytology; mean (SD) acceptability scores were 25.0 (2.9) and 22.7 (3.0), respectively, with the maximum possible score being 28 (p < .001). A large proportion (42.7%) of women preferred both tests equally. We found high intention to use and recommend self-sampling. Contrary to previous studies, there were no differences between cervical cytology and self-sampling regarding women's concerns about performing the test well and the accuracy of the test, which we attribute to the educational intervention.

CONCLUSION

The high acceptability of self-sampling after participants received education about the test and the reported intention to use it if made available add to the evidence on the feasibility of integrating self-testing within cervical cancer screening guidelines.

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".

Barriers for Compliance to Breast, Colorectal, and Cervical Screening Cancer Tests among Hispanic Patients

Hispanics are less likely to undergo screening tests for colorectal cancer and cervical cancer than non-Hispanic whites. Compliance with mammography, fecal occult blood testing (FOBT), colonoscopy, and cervical smears (PAP) and barriers for compliance were studied. A descriptive study was performed with 194 ambulatory patients while they attended routine medical visits. Women are more likely than men to undergo a colonoscopy. Conversely, FOBT was most likely reported by men. Reasons for compliance with FOBT differed by gender. Men were most likely to avoid FOBT due to lack of knowledge whereas women reported that physicians do not recommend the procedure. Both men and women reported that lack of physician's recommendation was their primary reason for not undergoing a colonoscopy. Men tend to report lack of knowledge about colonoscopy procedure. A higher mammogram utilization rate was reported by women older than 40 years. PAP smears were reported by 74% of women older than 21 years. The major reasons for avoiding mammography and PAP tests were having a busy schedule, fear, and feeling uncomfortable during the procedure. In a multivariate regression analysis, occupational status was found to be a predictor for compliance with FOBT and colonoscopy.

Increasing Cervical Cancer Screening Among US Hispanics/Latinas: A Qualitative Systematic Review

Hispanic/Latina women experience the highest cervical cancer incidence rates of any racial/ethnic group in the USA and tend to present with more severe cases and experience higher mortality compared to most other populations. The goals of this qualitative systematic review were to explore existing interventions to increase cervical cancer screening among US Hispanics/Latinas and to identify characteristics of effective interventions and research gaps. Six online databases were searched from their inception through June 30, 2013, using designated search terms and keywords. Peer-reviewed articles that documented an intervention designed to improve screening for cervical cancer among Hispanics/Latinas ages 18 years and older living in the USA were reviewed. Data were abstracted using a standardized form to document intervention characteristics and results. Forty-five articles, describing 32 unique interventions, met inclusion criteria. Identified interventions consisted primarily of educational programs and/or provision of screening. Interventions used lay health advisors (LHAs), clinic-based outreach/delivery strategies, partnerships with churches, and mass media campaigns. Twelve interventions resulted in significant increases in cervical cancer screening rates. Interventions developed utilizing theory, applying community-based participatory research approaches, and using LHAs were identified as having the greatest potential for improving cervical cancer screening among Hispanics/Latinas. There continues to be a need for the development of interventions in geographic areas with new and emerging Hispanic/Latino populations and that are comprehensive, follow participants for longer periods of time, and broaden the roles and build the capacities of LHAs.

Academic-Community Partnership to Develop a Patient-Centered Breast Cancer Risk Reduction Program for Latina Primary Care Patients

This collaborative study sought to address Latina breast cancer (BC) disparities by increasing health literacy (HL) in a community health center situated on the US-Mexico border region of San Diego County. An academic-community partnership conducted formative research to develop a culturally tailored promotora-based intervention with 109 individuals. The Spanish language program, entitled Nuestra Cocina: Mesa Buena, Vida Sana (Our Kitchen: Good Table, Healthy Life), included six sessions targeting HL, women's health, BC risk reduction, and patient-provider communication; sessions include cooking demonstrations of recipes with cancer-risk-reducing ingredients. A pilot study with 47 community health center Latina patients was conducted to examine the program's acceptability, feasibility, and ability to impact knowledge and skills. Pre- and post-analyses demonstrated that participants improved their self-reported cancer screening, BC knowledge, daily fruit and vegetable intake, and ability to read a nutrition label (p < 0.05). Results of the pilot study demonstrate the importance of utilizing patient-centered culturally appropriate noninvasive means to educate and empower Latina patients.

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.

Factors associated with the uptake of cervical cancer screening among women in portland, Jamaica

BACKGROUND

Cervical cancer is the second most common cancer among women worldwide and is the leading cause of deaths in developing countries. Despite the strong evidence that cervical cancer screening results in decreased mortality from this disease, the uptake for cervical screening among Jamaican women remains low.

AIMS

This study was carried out to identify factors associated with Jamaican women's decisions to screen for cervical cancer.

MATERIALS AND METHODS

Cross-sectional descriptive study of 403 women aged 19 years and older from Portland, Jamaica. An interviewer-administered questionnaire assessed the women's cervical cancer screening history, as well as their knowledge, attitudes, and practices regarding the disease and screening.

RESULTS

Of the 403 women interviewed, 66% had a Papanicolaou (Pap) smear and only 16% had a Pap test within the past year. Significant predicators of uptake of screening were being married, age, parity, discussing cancer with health provider, perception of consequences of not having a Pap smear, and knowing a person with cervical cancer. Women who did not know where to go for a Pap smear were 85% less likely to have been screened (prevalence odds ratio (POR): 0.15, 95% confidence interval (CI): 0.04, 0.52).

CONCLUSIONS

This study showed suboptimal uptake of cervical cancer screening among Jamaican women. Multipronged approaches are needed to address barriers to screening, as well as identify and support conditions that encourage women's use of reproductive health services, thereby reducing incidence and mortality rates from cervical cancer.

The relationship between psychosocial factors and breast cancer screening behaviors of older Hispanic women

Guided by the theory of planned behavior, this study utilized data from the 2008 wave of the Health and Retirement Study to investigate psychosocial factors associated with older Hispanic women's participation in breast cancer screening services. Hierarchical logistic regression models were used to assess the odds of breast cancer screening participation. Findings indicate that satisfaction with aging and constraints were associated with a reduced likelihood of participating in breast cancer screening. These findings suggest the continued importance to assess older women's attitudes when discussing preventive services.

Cancer screening at a federally qualified health center: a qualitative study on organizational challenges in the era of the patient-centered medical home

Federally Qualified Health Centers (FQHCs) serve uninsured and minority populations, who have low cancer screening rates. The patient-centered medical home (PCMH) model aims to provide comprehensive preventive services, including cancer screening, to these populations. Little is known about organizational factors influencing the delivery of cancer screening in this context. We conducted 18 semi-structured interviews with clinic personnel at four FQHC clinics in Washington State. All interviews were recorded and transcribed verbatim and analyzed by two bilingual coders to identify salient themes. We found that screening on-site, scheduling separate visits for preventive care, and having non-provider staff recommend and schedule screening services facilitated the delivery of cancer screening. We found work overload to be a barrier to screening. To successfully implement screening strategies within the PCMH model, FQHCs must enhance facilitators and address organizational gaps in their cancer screening processes.

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.

Prevalence and correlates of breast and cervical cancer screening among a Midwest community sample of low-acculturated Latinas

BACKGROUND

Low adherence to cervical and breast cancer (CBC) screening recommendations contributes to high CBC mortality among Latinas.

PURPOSE

To estimate the prevalence of, and factors associated with, last 12-month Pap smear and mammogram receipt among a Midwest community sample of low-acculturated Latinas.

METHODS

We conducted a cross-sectional study with 278 Latina immigrants in Dane County, Wisconsin. Participants completed a self-administered questionnaire. We estimated multivariate logistic regression models to identify factors associated with CBC screening receipt.

RESULTS

Rates of last 12-month Pap smear and mammogram receipt were 56.8% and 39.4%, respectively. Age, knowledge of screening recommendations, and having a regular health care provider were independently associated with both Pap smear and mammogram receipt. Having ever used Planned Parenthood and fear of cancer were uniquely correlated with Pap smear and mammogram receipt, respectively.

CONCLUSIONS

Modifiable individual, structural, and cultural factors contribute to suboptimal rates of CBC screening among low-acculturated Latino immigrants.

Cancer statistics for Hispanics/Latinos, 2012

Hispanics/Latinos are the largest and fastest growing major demographic group in the United States, accounting for 16.3% (50.5 million/310 million) of the US population in 2010. In this article, the American Cancer Society updates a previous report on cancer statistics for Hispanics using incidence data from the National Cancer Institute, the Centers for Disease Control and Prevention, and the North American Association of Central Cancer Registries and mortality data from the National Center for Health Statistics. In 2012, an estimated 112,800 new cases of cancer will be diagnosed and 33,200 cancer deaths will occur among Hispanics. In 2009, the most recent year for which actual data are available, cancer surpassed heart disease as the leading cause of death among Hispanics. Among US Hispanics during the past 10 years of available data (2000-2009), cancer incidence rates declined by 1.7% per year among men and 0.3% per year among women, while cancer death rates declined by 2.3% per year in men and 1.4% per year in women. Hispanics have lower incidence and death rates than non-Hispanic whites for all cancers combined and for the 4 most common cancers (breast, prostate, lung and bronchus, and colorectum). However, Hispanics have higher incidence and mortality rates for cancers of the stomach, liver, uterine cervix, and gallbladder, reflecting greater exposure to cancer-causing infectious agents, lower rates of screening for cervical cancer, differences in lifestyle and dietary patterns, and possibly genetic factors. Strategies for reducing cancer risk among Hispanics include increasing utilization of screening and available vaccines, as well as implementing effective interventions to reduce obesity, alcohol consumption, and tobacco use.

Prevention of invasive cervical cancer in the United States: past, present, and future

Over the past several decades, invasive cervical cancer (ICC) incidence in the United States has declined dramatically. Much of this decline has been attributed to widespread use of cytology screening followed by treatment of precancerous lesions. Despite available technologies to prevent ICC and screening programs targeting high-risk women, certain populations in the United States experience disproportionately high rates of ICC (e.g., racial/ethnic minorities and rural women). Limited access to and use of screening/follow-up services underlie this disparity. The licensure of the human papillomavirus (HPV) vaccine in 2006 introduced an additional method of ICC prevention. Unfortunately, dissemination of the vaccine to age-eligible females has been lower than expected (32% have received all 3 recommended doses). Decreasing the burden of HPV infection and HPV-related diseases in the United States will require greater dissemination of the HPV vaccine to adolescents and young adults, along with successful implementation of revised ICC screening guidelines that incorporate HPV and cytology cotesting. While a future without ICC is possible, we will need a comprehensive national health care program and innovative approaches to reduce ICC burden and disparities.

Influence of demographic factors, knowledge, and beliefs on Jordanian women's intention to undergo mammography screening

PURPOSE

The purpose of this study was to determine the influence of demographic characteristics, breast cancer knowledge, fatalistic beliefs, health beliefs, and subjective norms on Jordanian women's intention to participate in mammography screening.

DESIGN

A cross-sectional survey was used to collect data at 14 comprehensive healthcare centers in Amman and Zarqa, Jordan. A convenience sample of 142 Jordanian women 40 years of age or older with no history of breast cancer and able to read and write in Arabic participated.

METHODS

Self-report surveys included a combination of researcher-designed and existing instruments to measure the study variables. Data were analyzed using descriptive statistics, Pearson's correlation, t tests, and multiple logistic regression.

FINDINGS

Jordanian women surveyed lacked knowledge about breast cancer. Social norms and self-efficacy highly influenced these women's intention to engage in mammography screening. Younger women were more willing to indicate intention to engage in mammographic screening.

CONCLUSIONS

Self-efficacy and the social connectedness of Jordanian society, but not religious beliefs or perceived barriers to screening, influence Jordanian women's intention to undergo mammography. Future research should examine cultural influences, rather than religious beliefs, and investigate Jordanian women's potentially unique perspectives on barriers to actual mammography screening behavior.

CLINICAL RELEVANCE

The prevalence of mammography screening may be enhanced by focusing interventions on Jordanian women's support systems and empowering women by providing knowledge and skills needed to engage in the procedure.

A Promotora-administered group education intervention to promote breast and cervical cancer screening in a rural community along the U.S.-Mexico border: a randomized controlled trial

BACKGROUND

Breast cancer is the most common neoplasm among Hispanic women. Cervical cancer has a higher incidence and mortality among Hispanic women compared with non-Hispanic White women.

OBJECTIVE

To assess the effectiveness of a promotora-administered educational intervention to promote breast and cervical cancer screening among post-reproductive age, medically underserved Hispanic women residing along the U.S.-Mexico border.

METHODS

Women age 50 or older were eligible to participate in this intervention study. A total of 381 subjects agreed to participate. Women were randomly assigned into one of two groups, educational intervention or usual care. The primary outcomes were self-reported mammogram and Pap smear screening. Logistic regression analysis was used to compute odds ratios for comparisons between intervention and control groups.

RESULTS

Women in the intervention group were 2.0 times more likely to report having had a mammogram within the last year when compared with the usual care group (95% CI = 1.3-3.1). Likewise, women in the intervention group were 1.5 times more likely to report having a Pap smear within the last year when compared with the usual care group, although this was not statistically significant (95% CI = 0.9-2.6). In a secondary analysis, the intervention suggests a stronger effect on those that had not had a mammogram or Pap smear within the past year at baseline.

CONCLUSIONS

A promotora-based educational intervention can be used to increase breast and cervical cancer screening utilization among Hispanic women.