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Kamil D, Wojcik KM, Smith L, Zhang J, Wilson OWA, Butera G, Jayasekera J. A Scoping Review of Personalized, Interactive, Web-Based Clinical Decision Tools Available for Breast Cancer Prevention and Screening in the United States. MDM Policy Pract 2024; 9:23814683241236511. [PMID: 38500600 PMCID: PMC10946080 DOI: 10.1177/23814683241236511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/04/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction. Personalized web-based clinical decision tools for breast cancer prevention and screening could address knowledge gaps, enhance patient autonomy in shared decision-making, and promote equitable care. The purpose of this review was to present evidence on the availability, usability, feasibility, acceptability, quality, and uptake of breast cancer prevention and screening tools to support their integration into clinical care. Methods. We used the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews Checklist to conduct this review. We searched 6 databases to identify literature on the development, validation, usability, feasibility, acceptability testing, and uptake of the tools into practice settings. Quality assessment for each tool was conducted using the International Patient Decision Aid Standard instrument, with quality scores ranging from 0 to 63 (lowest-highest). Results. We identified 10 tools for breast cancer prevention and 9 tools for screening. The tools included individual (e.g., age), clinical (e.g., genomic risk factors), and health behavior (e.g., alcohol use) characteristics. Fourteen tools included race/ethnicity, but no tool incorporated contextual factors (e.g., insurance, access) associated with breast cancer. All tools were internally or externally validated. Six tools had undergone usability testing in samples including White (median, 71%; range, 9%-96%), insured (99%; 97%-100%) women, with college education or higher (60%; 27%-100%). All of the tools were developed and tested in academic settings. Seven (37%) tools showed potential evidence of uptake in clinical practice. The tools had an average quality assessment score of 21 (range, 9-39). Conclusions. There is limited evidence on testing and uptake of breast cancer prevention and screening tools in diverse clinical settings. The development, testing, and integration of tools in academic and nonacademic settings could potentially improve uptake and equitable access to these tools. Highlights There were 19 personalized, interactive, Web-based decision tools for breast cancer prevention and screening.Breast cancer outcomes were personalized based on individual clinical characteristics (e.g., age, medical history), genomic risk factors (e.g., BRCA1/2), race and ethnicity, and health behaviors (e.g., smoking). The tools did not include contextual factors (e.g., insurance status, access to screening facilities) that could potentially contribute to breast cancer outcomes.Validation, usability, acceptability, and feasibility testing were conducted mostly among White and/or insured patients with some college education (or higher) in academic settings. There was limited evidence on testing and uptake of the tools in nonacademic clinical settings.
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Affiliation(s)
- Dalya Kamil
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Kaitlyn M. Wojcik
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Laney Smith
- Frederick P. Whiddon College of Medicine, Mobile, AL, USA
| | | | - Oliver W. A. Wilson
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
| | - Gisela Butera
- Office of Research Services, National Institutes of Health Library, Bethesda, MD, USA
| | - Jinani Jayasekera
- Health Equity and Decision Sciences Research Laboratory, Division of Intramural Research, National Institute on Minority Health and Health Disparities, National Institutes of Health, Bethesda, MD, USA
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Adams-Campbell LL, Taylor T, Hicks J, Lu J, Dash C. The Effect of a 6-Month Exercise Intervention Trial on Allostatic Load in Black Women at Increased Risk for Breast Cancer: the FIERCE Study. J Racial Ethn Health Disparities 2022; 9:2063-2069. [PMID: 34580826 PMCID: PMC8957631 DOI: 10.1007/s40615-021-01145-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 09/01/2021] [Accepted: 09/02/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Allostatic load comprises cardiovascular, metabolic, and inflammatory markers, which is characterized by abdominal obesity, high blood glucose levels, impaired glucose tolerance, dyslipidemia, and hypertension and associated with an increased risk in breast cancer. METHODS The study was a 6-month, 3-arm randomized controlled trial of two moderate-intensity exercise interventions (compared with a control group) among obese, physically inactive, postmenopausal Black women aged 45 to 65 years, who were at increased risk for breast cancer based on the CARE model. Two hundred thirteen participants were randomly assigned to (1) supervised, facility-based aerobic exercise intervention (n = 73), (2) home-based exercise intervention (n = 69), or (3) a wait-listed control group (n = 71). The intervention effects of exercise on allostatic load were examined with intent-to-treat analyses using generalized linear models. RESULTS It was revealed that statistically significant decreases in allostatic load over the 6-month period for both exercise intervention groups (i.e., home-based and supervised arms) compared to the controls were observed among the total population, pc-h = 0.023 and pc-s = 0.035, as well as among women with a family history of breast cancer, pc-h = 0.006 and pc-s = 0.012. CONCLUSIONS Short-term aerobic activity improved allostatic load scores in metabolically unhealthy postmenopausal Black women at increased risk for cancer. TRIAL REGISTRATION Clinical trial registration number NCT02103140.
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Affiliation(s)
- Lucile L Adams-Campbell
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA.
| | - Teletia Taylor
- Howard University Cancer Center, Howard University, Washington, DC, USA
| | - Jennifer Hicks
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
| | - Jiachen Lu
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
- University of Texas Health Science Center At Houston, Houston, TX, USA
| | - Chiranjeev Dash
- Office of Minority Health and Health Disparities Research, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 1000 New Jersey Ave SE, Washington, DC, 20003, USA
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3
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Manouchehri E, Taghipour A, Ebadi A, Homaei Shandiz F, Latifnejad Roudsari R. Understanding breast cancer risk factors: is there any mismatch between laywomen perceptions and expert opinions. BMC Cancer 2022; 22:309. [PMID: 35321682 PMCID: PMC8941798 DOI: 10.1186/s12885-022-09372-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/04/2022] [Indexed: 01/21/2023] Open
Abstract
Background Women’s perception and knowledge of breast cancer signs, symptoms, and risk factors could be conducive to breast cancer risk management and interventions. The present study aimed to explore Iranian laywomen perceptions and expert opinions regarding breast cancer risk factors. Methods This qualitative study was conducted from March to November 2019 in Mashhad, northeast of Iran. Through purposive sampling, 24 laywomen (women with and without BC) and 10 experts of different fields including oncology, surgery, gynecology and reproductive health were selected. Data collection was carried out using semi-structured interviews, which was mainly focused on the participants’ understanding and perception of BC risk factors. The data was analyzed utilizing conventional content analysis developed by Graneheim & Lundman. Components of trustworthiness, including credibility, dependability, confirmability, and transferability were considered. Results The main category of risk factors, which emerged from the lay participants’ data analysis, were “unhealthy lifestyle and habits” , “hormonal influences”, “environmental exposures”, “Individual susceptibility “and “belief in supernatural powers”. The experts had similar perspectives for certain risk factors, yet not for all. The category of “Individual history of disease” was emerged only from experts’ interviews. Conclusion In the present study, the lay participants’ perception concerning BC risk factors was found to be a mixture of cultural beliefs and the scientific knowledge dispersed by the media, internet, and health services. Primary prevention approaches, including awareness of breast cancer risk factors, are required for women to make improved health-related choices.
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Affiliation(s)
- E Manouchehri
- Department of Midwifery, Faculty of Nursing and Midwifery, Mashhad Medical Sciences, Islamic Azad University, Mashhad, Iran.,Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Taghipour
- Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.,Department of Epidemiology, School of Public Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - A Ebadi
- Behavioral Sciences Research Center, Life style Institute, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran.,Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, IR, Iran
| | - F Homaei Shandiz
- Cancer Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - R Latifnejad Roudsari
- Department of Midwifery, School of Nursing & Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran. .,Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
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4
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Yelton B, Lead JR, Adams SA, Brandt HM, Kulkarni S, Lewis KR, Fedrick D, Ureda JR, Friedman DB. How Do African-American Community Members' Perceptions About Environmental Risks of Breast Cancer Compare with the Current State of the Science? JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:1193-1200. [PMID: 32314309 PMCID: PMC7572772 DOI: 10.1007/s13187-020-01748-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
African-American (AA) women experience higher mortality from breast cancer than any other racial group. Understanding community-held perceptions of environmental contaminants as risk factors for breast cancer can inform the development of tailored prevention and education efforts for improve health outcomes. Six focus groups were conducted with AA participants in two counties in South Carolina, and themes were identified using open and axial coding. Perceived environmental risks for breast cancer most frequently discussed by participants were compared to findings from published systematic reviews. Frequently discussed environmental risk factors by participants were deodorants containing aluminum, plastics, pesticides, and air and water pollution. While perceptions of aluminum and air pollution as risk factors did not align with the state of the science, perceived risk factors of chemicals in plastics and pesticides were found to be in alignment. There is some congruence between perceived environmental risks for breast cancer within the AA community and the current state of the science; however, there is a need to communicate information that reflects current science regarding commonly held misconceptions. Development of evidence-based, clear, and culturally appropriate messaging that reflects the current state of the science is warranted.
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Affiliation(s)
- Brooks Yelton
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- College of Social Work, University of South Carolina, 1512 Pendleton Street, Columbia, SC, 29208, USA
| | - Jamie R Lead
- Department of Environmental Health Sciences, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC, 29208, USA
- Center for Environmental Nanoscience and Risk, University of South Carolina, Arnold School of Public Health, 921 Assembly St, Columbia, SC, 29208, USA
| | - Swann Arp Adams
- Department of Epidemiology & Biostatistics, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- College of Nursing, University of South Carolina, 1601 Greene Street, Columbia, SC, 29208, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Kaleea R Lewis
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA
| | - Delores Fedrick
- Chester County Literacy Council, 109 Ella Street, Chester, SC, 29706, USA
| | - John R Ureda
- , Insights Consulting, Inc., 2728 Wilmot Ave, Columbia, SC, 29205, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, USA.
- Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA.
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5
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Ismail H, Shibani M, Zahrawi HW, Slitin AF, Alzabibi MA, Mohsen F, Armashi H, Bakr A, Turkmani K, Sawaf B. Knowledge of breast cancer among medical students in Syrian Private University, Syria: a cross-sectional study. BMC MEDICAL EDUCATION 2021; 21:251. [PMID: 33933051 PMCID: PMC8088684 DOI: 10.1186/s12909-021-02673-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 04/15/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Breast cancer is the most common cancer among women and the second leading cause of cancer death globally. Since early diagnosis is crucial to reducing mortality, high levels of knowledge regarding general information, risk factors, and symptoms are required among healthcare professionals to deliver breast cancer care. This study aimed to determine Syrian medical students' knowledge about breast cancer in the fields of general knowledge, common clinical features, and risk factors. METHODS This cross-sectional study was conducted at the Syrian Private University in October 2019 (Breast Cancer Awareness Month), Damascus, during the Syrian war crisis. Data were collected through self-administered surveys and analyzed using the Statistical Package for Social Sciences version 25.0 (SPSS Inc., United States). The chi-square test was applied to assess the relationship between the level of knowledge and gender. One way analysis of variance was performed to assess the overall differences in mean knowledge score by study year, GPA, mother's education, and source of information. Unpaired Student's T-test was used to analyze the differences in mean knowledge scores (continuous variable) based on smoking status and alcohol consumption. RESULTS Of 320 students, 301 completed the questionnaire (response rate = 94.0%), of which 179(59.5%) were males. The study revealed above-average knowledge scores (total mean = 68.4%) regarding breast cancer, general information (71.9%), common clinical features (71.6%), and risk factors (71.6%). Clinical students (4th, 5th, and 6th years) scored higher compared with pre-clinical students (1st, 2nd, and 3rd years). CONCLUSION This study showed above-average knowledge scores regarding breast cancer. More efforts to correct misinformation, through reassessing the university curriculum and promoting awareness about breast cancer are required.
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Affiliation(s)
- Hlma Ismail
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Mosa Shibani
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Hanaa Wael Zahrawi
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Ali Fouad Slitin
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Mhd Amin Alzabibi
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic.
| | - Fatema Mohsen
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Humam Armashi
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
| | - Aliaa Bakr
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
- Department of Internal Medicine, Oncology Medicine, Damascus University, Damascus, Syria
| | - Khaled Turkmani
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
- AL Kalamoon General Hospital, Ministry of Health, Damascus, Syria
| | - Bisher Sawaf
- Faculty of Medicine, Syrian Private University, Mazzeh Street, P.O. Box 36822, Damascus, Syrian Arab Republic
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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6
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Yelton B, Brandt HM, Adams SA, Ureda JR, Lead JR, Fedrick D, Lewis K, Kulkarni S, Friedman DB. "Talk About Cancer and Build Healthy Communities": How Visuals Are Starting the Conversation About Breast Cancer Within African-American Communities. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2021; 41:267-274. [PMID: 32660340 PMCID: PMC7854839 DOI: 10.1177/0272684x20942076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
African-American (AA) women are at higher risk of breast cancer mortality than women of other races. Factors influencing breast cancer risk, including exogenous environmental exposures, and debate around timing of exposure and dose-response relationship, can cause misunderstanding. Collaboration with priority populations encourages culturally relevant health messaging that imparts source reliability, influences message adoption, and improves understanding. Through six focus groups with AA individuals in rural and urban counties in the southeastern United States, this study used a community-engaged participatory approach to design an innovative visual tool for disseminating breast cancer information. Results demonstrated that participants were generally aware of environmental breast cancer risks and were willing to share new knowledge with families and community members. Recommended communication channels included pastors, healthcare providers, social media, and the Internet. Participants agreed that a collaboratively designed visual tool serves as a tangible, focused "conversation starter" to promote community prevention and education efforts.
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Affiliation(s)
- Brooks Yelton
- College of Social Work, University of South Carolina
- South Carolina Cancer Prevention and Control Research Network, University of South Carolina
| | - Heather M. Brandt
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina
- The Graduate School, University of South Carolina
| | - Swann Arp Adams
- Statewide Cancer Prevention and Control Program, University of South Carolina
- Department of Epidemiology and Biostatistics, College of Nursing, University of South Carolina
| | | | - Jamie R. Lead
- Department of Environmental Health Sciences, Center for Environmental Nanoscience and Risk, University of South Carolina
| | | | - Kaleea Lewis
- Department of Health Sciences, University of Missouri
| | - Shibani Kulkarni
- Department of Health Promotion, Education, and Behavior, University of South Carolina
| | - Daniela B. Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina
- Statewide Cancer Prevention and Control Program, University of South Carolina
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7
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Bojanic K, Vukadin S, Grgic K, Malenica L, Sarcevic F, Smolic R, Kralik K, Včev A, Wu GY, Smolic M. The accuracy of breast cancer risk self-assessment does not correlate with knowledge about breast cancer and knowledge and attitudes towards primary chemoprevention. Prev Med Rep 2020; 20:101229. [PMID: 33145151 PMCID: PMC7593623 DOI: 10.1016/j.pmedr.2020.101229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 10/11/2020] [Accepted: 10/13/2020] [Indexed: 01/02/2023] Open
Abstract
The increase of breast cancer (BC) incidence has drawn attention to BC risk as means of reducing mortality and morbidity of the disease. The aim of this study was to determine the accuracy of BC risk perception, evaluate factors that affect risk perception and assess the correlation between BC risk perception and attitudes towards BC chemoprevention. A cross-sectional study included total of 258 women with average and high-risk for BC according to the Breast Cancer Risk Assessment Tool (BCRAT). All data were collected by face-to-face interview by three trained 6th year medical school students using a 54-item questionnaire. Each participant's actual BC risk was compared to a perceived risk and the accuracy of the BC risk self-assessment was determined. 72% of high-risk women underestimated their BC risk (p < 0.001). One third of subjects with a family history of BC have also underestimated their own risk (p = 0.002). Women who responded to screening mammography were more informed about BC risk factors (p = 0.001). General knowledge about BC chemoprevention was surprisingly low, regardless of the accuracy of BC risk self-assessment. High-risk women appear to be unrealistically optimistic, since there was a significant difference between the accuracy of self-perceived risk and the objective BC risk.
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Affiliation(s)
- Kristina Bojanic
- Department of Biophysics and Radiology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Biophysics and Radiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Radiology, Health Center Osijek, Osijek 31000, Croatia
| | - Sonja Vukadin
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Kaja Grgic
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Luka Malenica
- Department of Patophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Filip Sarcevic
- Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Robert Smolic
- Department of Patophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Patophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Internal Medicine, University Hospital Osijek, Osijek 31000, Croatia
| | - Kristina Kralik
- Department of Medical Statistics and Medical Informatics, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
| | - Aleksandar Včev
- Department of Patophysiology, Physiology and Immunology, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Patophysiology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Internal Medicine, University Hospital Osijek, Osijek 31000, Croatia
| | - George Y Wu
- Department of Internal Medicine, Division of Gastrenterology/Hepatology, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06032, USA
| | - Martina Smolic
- Department of Pharmacology and Biochemistry, Faculty of Dental Medicine and Health Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia.,Department of Pharmacology, Faculty of Medicine Osijek, J. J. Strossmayer University of Osijek, Osijek 31000, Croatia
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8
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Pegington M, Evans DG, Howell A, Donnelly LS, Wiseman J, Cuzick JM, Harvie MN. Lifestyle behaviours and health measures of women at increased risk of breast cancer taking chemoprevention. Eur J Cancer Prev 2020; 28:500-506. [PMID: 30444752 DOI: 10.1097/cej.0000000000000493] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Women at increased breast cancer (BC) risk are eligible for chemoprevention. Healthy lifestyles are potentially important for these women to improve efficacy and minimise side effects of chemoprevention and reduce the risk of BC and other lifestyle-related conditions. We investigated whether women taking chemoprevention adhere to healthy lifestyle recommendations, how their lifestyle risk factors and health measures compare to women in the general population, and whether these change whilst taking chemoprevention. Lifestyle risk factors and health measures in 136 premenopausal women taking tamoxifen for prevention of BC (Tam-Prev study) were compared to both national recommendations and an age-matched female population from the Health Survey for England 2012. The Tam-Prev population had high rates of overweight and obesity (59.2%) and low adherence to physical activity recommendations (30.6%) which were comparable to the general population (55.2 and 35.1%, respectively). Fewer Tam-Prev participants were current smokers (10.5 vs. 18.2%, P = 0.032), but more exceeded alcohol recommendations (45.0 vs. 18.7%, P < 0.001). Tam-Prev participants had suboptimal diets; proportions not meeting fibre, saturated fat and non-milk extrinsic sugar recommendations were 87.8, 64.9 and 21.4% respectively. Many Tam-Prev participants had markers of cardiovascular disease risk and the metabolic syndrome. Health behaviours did not change during the first year on tamoxifen. Women taking chemoprevention had a high prevalence of unhealthy lifestyle behaviours and health measures, similar to an age-matched English cohort. Improving these measures in women at increased BC risk could significantly decrease rates of BC and other noncommunicable diseases.
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Affiliation(s)
- Mary Pegington
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health.,Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital
| | - D Gareth Evans
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester.,Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital.,Genomic Medicine, Division of Evolution and Genomic Sciences, The University of Manchester, St Mary's Hospital, Manchester University NHS Foundation Trust
| | - Anthony Howell
- Division of Cancer Sciences, Faculty of Biology, Medicine and Health.,Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester.,Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital.,Department of Medical Oncology, The Christie NHS Foundation Trust, Manchester
| | - Louise S Donnelly
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital
| | - Julia Wiseman
- Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital
| | - Jack M Cuzick
- Wolfson Institute of Preventative Medicine, Barts and The London School of Medicine and Dentistry, London, UK
| | - Michelle N Harvie
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester.,Prevent Breast Cancer Research Unit, The Nightingale Centre, Wythenshawe Hospital
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9
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Khushalani JS, Qin J, Ekwueme DU, White A. Awareness of breast cancer risk related to a positive family history and alcohol consumption among women aged 15-44 years in United States. Prev Med Rep 2020; 17:101029. [PMID: 31890475 PMCID: PMC6926360 DOI: 10.1016/j.pmedr.2019.101029] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 09/24/2019] [Accepted: 12/01/2019] [Indexed: 11/20/2022] Open
Abstract
Awareness of the link between breast cancer and risk factors such as family history of breast cancer and alcohol consumption may help modify health behaviors. To reduce risk factors for breast cancer among young women, it is important to understand overall levels of risk awareness and socioeconomic differences in awareness. Data from the National Survey of Family Growth 2011-2015 were used to examine awareness of two risk factors for breast cancer, positive family history and alcohol consumption, among women aged 15-44 years (n = 10,940) in the United States by presence of risk factors and by socioeconomic characteristics. Prevalence of positive family history, non-binge, and binge drinking was 30%, 29%, and 31%, respectively among women aged 15-44. Awareness of positive family history of breast cancer as a risk factor for breast cancer was 88%, whereas for alcohol consumption it was 25%. Awareness of family history as a risk factor was higher among women with positive family history of breast cancer compared to those without. Current drinkers were more likely to believe that alcohol was not a risk factor for breast cancer compared to those who did not drink. Racial/ethnic minority women and those with lower education and income had lower awareness of family history as a risk factor. Awareness of alcohol consumption as a risk factor for breast cancer was low across all socioeconomic groups. Evidence-based interventions to increase risk awareness and decrease excessive alcohol use among young women are needed to reduce the risk of developing breast cancer.
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Affiliation(s)
- Jaya S. Khushalani
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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10
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Ozanne E, Karliner LS, Tice JA, Haas JS, Livaudais-Toman J, Pasick RJ, Kaplan CP. An Intervention Tool to Increase Patient-Physician Discussion of Lifestyle Risk Factors for Breast Cancer. J Womens Health (Larchmt) 2019; 28:1468-1475. [PMID: 30222505 PMCID: PMC7207052 DOI: 10.1089/jwh.2018.7026] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: Risk assessment and discussion of lifestyle in primary care are crucial elements of breast cancer prevention and risk reduction. Our objective was to evaluate the impact of a breast cancer risk assessment and education tool on patient-physician discussion of behaviors and breast cancer risk. Materials and Methods: We conducted a randomized controlled trial with an ethnically and linguistically diverse sample of women, ages 40-74, from two primary care practices. Intervention participants completed a tablet computer-based Breast Cancer Risk Assessment and Education (BreastCARE) intervention in the waiting room before a scheduled visit. Both patients and physicians received an individualized risk report to discuss during the visit. Control patients underwent usual care. Telephone surveys assessed patient-physician discussion of weight, exercise, and alcohol use 1 week following the visit. Results: Among the 1235 participants, 27.7% (161/580) intervention and 22.3% (146/655) usual-care patients were high risk for breast cancer. Adjusting for clustering by physician, the intervention increased discussions of regular exercise (odds ratios [OR] = 1.94, 1.50-2.51) and weight (OR = 1.56, 1.23-1.96). There was no effect of the intervention on discussion of alcohol. Women with some college education were more likely to discuss their weight than those with high school education or less (OR = 1.75, 1.03-2.96). Similarly, non-English speakers were more likely to discuss their weight compared with English speakers (OR = 2.33, 1.04-5.22). Conclusions: BreastCARE is a feasible risk assessment tool that can successfully promote discussions about modifiable breast cancer risk factors between patients and primary care physicians.
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Affiliation(s)
- Elissa Ozanne
- Division of Health System Innovation and Research, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Leah S. Karliner
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Multi-Ethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Jeffrey A. Tice
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Jennifer S. Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jennifer Livaudais-Toman
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
| | - Rena J. Pasick
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Celia P. Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
- Multi-Ethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
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11
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Keating NL, Pace LE. A Promising Tool to Increase Individualized Discussions About Lifestyle Risk Factors for Breast Cancer. J Womens Health (Larchmt) 2019; 28:1454-1455. [DOI: 10.1089/jwh.2018.7421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Nancy L. Keating
- Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Lydia E. Pace
- Division of General Internal Medicine, Brigham and Women's Hospital, Boston, Massachusetts
- Division of Women's Health, Brigham and Women's Hospital, Boston, Massachusetts
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12
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Mehta SS, Arroyave WD, Lunn RM, Park YMM, Boyd WA, Sandler DP. A Prospective Analysis of Red and Processed Meat Consumption and Risk of Colorectal Cancer in Women. Cancer Epidemiol Biomarkers Prev 2019; 29:141-150. [PMID: 31575555 DOI: 10.1158/1055-9965.epi-19-0459] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/13/2019] [Accepted: 09/27/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Red and processed meats have been implicated as risk factors in the development of colorectal cancer in U.S. women, but associations with cooking practices are less well established. METHODS Data are from the Sister Study, a cohort of women ages 35 to 74 years from the United States and Puerto Rico who have a sister diagnosed with breast cancer. Red and processed meat consumption, meat cooking practices, and intake of common meat products were collected at baseline using self-administered questionnaires (N = 48,704). Multivariable HRs (HRadj) and 95% confidence intervals (95% CI) were estimated. RESULTS During a median 8.7 years' follow-up (range <1-12.7 years), 216 colorectal cancer cases were diagnosed. In categorical analyses, an increased risk of colorectal cancer was seen in the highest quartile of processed meat consumption compared with the lowest [HRadj = 1.52 (95% CI, 1.01-2.30); P trend = 0.02], and for specific meat products, including breakfast sausages [HRadj = 1.85 (95% CI, 1.30-2.64)] and bacon [HRadj = 1.46 (95% CI, 1.01-2.11)]. The HRadj for the highest quartile of red meat consumption was 1.04 (95% CI, 0.68-1.60), and little evidence of association was observed for cooking practices or doneness of red meat. We observed positive associations with specific red meat products when cooking methods were considered, for example, grilled/barbequed steaks [HRadj = 2.23 (95% CI, 1.20-4.14)] and hamburgers [HRadj = 1.98 (95% CI, 1.00-3.91)]. CONCLUSIONS Higher reported daily intake of processed meats and consumption of barbecued/grilled red meat products were associated with increased risk of colorectal cancer in women. IMPACT Variability in colorectal risk risk by meat type and cooking method should be considered when evaluating meat consumption.
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Affiliation(s)
- Suril S Mehta
- Office of the Report on Carcinogens, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina.
| | | | - Ruth M Lunn
- Office of the Report on Carcinogens, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Yong-Moon Mark Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Windy A Boyd
- Office of Health Assessment and Translation, Division of the National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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13
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Wiseman KP, Klein WMP. Evaluating Correlates of Awareness of the Association between Drinking Too Much Alcohol and Cancer Risk in the United States. Cancer Epidemiol Biomarkers Prev 2019; 28:1195-1201. [PMID: 31043419 DOI: 10.1158/1055-9965.epi-18-1010] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/15/2018] [Accepted: 04/23/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Awareness that alcohol consumption is associated with cancer is low in the United States, and predictors of awareness are not well understood. METHODS Data from the 2017 Health Information National Trends Survey (HINTS 5 Cycle 1) were used to describe knowledge of the association between drinking too much alcohol and cancer ("Yes," aware of the association; "No"; or "Don't know") among 3,009 adults. Weighted multinomial multivariable logistic regression determined personal characteristics (e.g., demographic characteristics, health-related self-efficacy, cancer beliefs, and information seeking) associated with reporting "Yes" or "Don't know" compared with "No." RESULTS Thirty-eight percent of the U.S. population believed there was an association (38.36%), 36.17% were uncertain, and 25.47% believed there was no association. People believing that everything causes cancer and people who had ever looked up information about cancer had 1.61 and 1.80 higher odds of reporting "Yes" [95% confidence intervals (CI), 1.08-2.42 and 1.27-2.57, respectively]. Compared with people who were completely confident in their ability to take care of their health, people only somewhat confident had 2.32 higher odds of reporting "Don't know" (95% CI, 1.30-4.14). Younger age was negatively associated with reporting "Don't know." CONCLUSIONS Awareness of the association between alcohol and cancer is low in the United States. Personal characteristics associated with awareness differed between reporting "Yes" and "Don't know," and there were few associations between demographic characteristics and awareness. IMPACT A significant knowledge gap exists in the population. Broad reaching public health media campaigns, particularly those that increase information seeking, are needed to increase awareness.
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Affiliation(s)
- Kara P Wiseman
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
| | - William M P Klein
- Behavioral Research Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
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14
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Bertoni N, de Souza MC, Crocamo S, Szklo M, de Almeida LM. Is a Family History of the Breast Cancer Related to Women's Cancer Prevention Behaviors? Int J Behav Med 2019; 26:85-90. [PMID: 30088188 DOI: 10.1007/s12529-018-9737-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Families share behavioral risk factors that can increase the risk of cancer development. We examined whether having a positive family breast cancer history is associated with health behaviors/screening practices. Analyses were based on a cross-sectional sample of 545 Brazilian National Cancer Institute Hospital patients with newly diagnosed breast cancer in 2013/2014. Women were categorized according to their breast cancer family history. Age-adjusted Poisson regressions with robust variance were performed to estimate the association between breast cancer family history and selected health-related behaviors and screening practices. About one fourth of women reported a positive family history of breast cancer. Contrary to expectation, we found that women with a family history of breast cancer did not report healthier behaviors more often than those without a family history. However, those with a family history were more likely to report a mammographic exam prior to the mammographic diagnosis. Our study suggests that having a family history of cancer is not sufficient to change women's behaviors about physical activity, weight control and diet, smoking, and drinking, but it seems to influence their breast cancer screening behavior. Our results suggest the need to increase women's information and/or understanding that healthier lifestyles contribute to cancer prevention.
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Affiliation(s)
- Neilane Bertoni
- Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rua Marquês de Pombal 125/7° andar, Centro, Rio de Janeiro, 20230-240, Brazil.
| | - Mirian Carvalho de Souza
- Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rua Marquês de Pombal 125/7° andar, Centro, Rio de Janeiro, 20230-240, Brazil
| | - Susanne Crocamo
- Division of Clinical Research, Brazilian National Cancer Institute (INCA), Rio de Janeiro, Brazil
| | - Moyses Szklo
- Division of Epidemiology, Johns Hopkins Bloomberg School of Public Health (JHU), Baltimore, MD, USA
| | - Liz Maria de Almeida
- Division of Epidemiology, Brazilian National Cancer Institute (INCA), Rua Marquês de Pombal 125/7° andar, Centro, Rio de Janeiro, 20230-240, Brazil
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15
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Conley CC, Agnese DM, Vadaparampil ST, Andersen BL. Factors associated with intentions for breast cancer risk management: Does risk group matter? Psychooncology 2019; 28:1119-1126. [PMID: 30889627 DOI: 10.1002/pon.5066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 03/05/2019] [Accepted: 03/12/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE National guidelines provide breast cancer (BC) risk management recommendations based on estimated lifetime risk. Despite this specificity, it is unclear if women's risk management intentions are or are not guideline concordant. To address this knowledge gap, women at varying risk levels reported intentions for risk-reducing behaviors. Factors associated with intentions, informed by the Health Beliefs Model, were also studied. METHODS Women with elevated BC risk (N = 103) were studied and categorized by risk level: moderate (15%-20%), high (greater than or equal to 20%), or very high (BRCA1/2 positive). Participants self-reported BC susceptibility, self-efficacy, and benefits, barriers, and intentions for risk-reducing mastectomy (RRM), risk-reducing salpingo-oophorectomy (RRSO), chemoprevention, improving diet or physical activity, and reducing alcohol use. RESULTS Groups significantly differed in RRSO intentions (P < .01); BRCA1/2 positive women had greater intentions for RRSO. Groups did not differ in intentions for RRM, chemoprevention, or lifestyle changes (Ps > .28). In hierarchical linear regression models examining Health Belief Model (HBM) factors, perceived susceptibility was associated with intentions for RRM (β = .169, P = .08). Perceived benefits was associated with intentions for RRM (β = .237, P = .02) and chemoprevention (β = .388, P < .01). Self-efficacy was associated with intentions for physical activity (β = .286, P < .01). CONCLUSIONS Consistent with guidelines, BRCA1/2 positive women reported greater intentions for RRSO, and risk groups did not differ in intentions for lifestyle changes. Notably, women's intentions for RRM and chemoprevention were guideline discordant; groups did not differ in intentions for these behaviors. Accounting for the effects of risk group, modifiable health beliefs were also associated with risk management intentions; these may represent targets for decision support interventions.
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Affiliation(s)
- Claire C Conley
- Department of Psychology, The Ohio State University, Columbus, Ohio.,Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Doreen M Agnese
- Department of Surgical Oncology, The Ohio State University, Columbus, Ohio
| | - Susan T Vadaparampil
- Health Outcomes and Behavior Program, H. Lee Moffitt Cancer Center, Tampa, Florida
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16
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Lagarde JBB, Laurino MY, San Juan MD, Cauyan JML, Tumulak MAJR, Ventura ER. Risk perception and screening behavior of Filipino women at risk for breast cancer: implications for cancer genetic counseling. J Community Genet 2019; 10:281-289. [PMID: 30259342 PMCID: PMC6435779 DOI: 10.1007/s12687-018-0391-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 09/17/2018] [Indexed: 12/11/2022] Open
Abstract
The burden and experiences that come with a breast cancer diagnosis in a family impact how women perceive personal cancer risk and pursue preventive strategies and/or early detection screening. Hence, this study sought to understand how Filipino women incorporate their experiences living with a sister diagnosed with early-onset breast cancer to their personal perceived risk and screening behavior. Guided by phenomenological approach of inquiry, a face-to-face, semi-structured interview was conducted with 12 purposively sampled women with a female sibling diagnosed with breast cancer before age 50. Transcripts were analyzed using thematic analysis. Results revealed that the respondents tend to compare themselves with their sister when constructing views of personal cancer vulnerability. The subjective risk is also shaped by their beliefs regarding cancer causation such as personalistic causes, personal theory of inheritance, and locus of control. Their sisters' cancer diagnoses serve as a motivation for them to perform breast self-examination. However, clinical breast examination and screening mammography are underutilized due to perceived barriers such as difficulty allotting time to medical consultation, fear, and lack of finances. Overall, cancer risk perception and screening behavior are important factors that must be addressed during cancer genetic counseling consultations. Better understanding of these factors will aid in the formulation of an effective management plan for at-risk women.
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Affiliation(s)
- John Benedict B Lagarde
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
| | - Mercy Y Laurino
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Cancer Prevention Programs, Seattle Cancer Care Alliance, Seattle, WA, USA
| | - Michael D San Juan
- Section of Medical Oncology, Department of Medicine, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Jaclyn Marie L Cauyan
- College of Education, University of the Philippines Diliman, Quezon City, Philippines
| | - Ma-Am Joy R Tumulak
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
- Institute of Human Genetics, National Institutes of Health, University of the Philippines Manila, Manila, Philippines
| | - Elizabeth R Ventura
- College of Social Sciences and Philosophy, University of the Philippines Diliman, Quezon City, Philippines
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17
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Developing community-based health education strategies with family history: Assessing the association between community resident family history and interest in health education. Soc Sci Med 2019; 271:112160. [PMID: 30862375 DOI: 10.1016/j.socscimed.2019.02.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 02/01/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Family history (FH) is an underutilized genetically informative tool that can influence disease prevention and treatment. It is unclear how FH fits into the development of community-based health education. This study examines the role that FH plays in perceived threat and health education related to mental and chronic physical conditions in the context of the health belief model. METHODS Data were collected from 1,048 adult participants aged 18-90 years. Approximately 76% of participants indicated African-American race/ethnicity and 35% had less than high school level education. Self-report data were collected on FH of four disorders: anxiety, depression, diabetes, and high blood pressure. Interest in receiving information regarding prevention as well as future testing efforts was assessed broadly. A series of logistic regressions examined the association between FH for each of the disorders and interest in receiving information on (1) prevention of diseases in general and (2) testing for diseases in general. These associations were also analyzed after accounting for the influence of perceived threat of conditions. RESULTS Interest in receiving general health education was significantly associated with FH of depression (OR = 2.72, 95% CI = 1.74-4.25), anxiety (OR = 2.26, 95% CI = 1.45-3.22), and high blood pressure (OR = 2.54, 95% CI = 1.05-6.12). After adjustment for perceived threat, the magnitude of these associations was reduced substantially. The associations between perceived threat and either interest in receiving information on disease testing or receiving general health education were strong and significant across all conditions (OR = 2.11-3.74). DISCUSSION These results provide evidence that perceived threat mediates the association between FH and engagement with health education. Currently available health education programs may benefit from considering the role of FH in an individual's motivation for participation in health education activities alongside other factors.
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18
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Niehoff NM, Nichols HB, Zhao S, White AJ, Sandler DP. Adult Physical Activity and Breast Cancer Risk in Women with a Family History of Breast Cancer. Cancer Epidemiol Biomarkers Prev 2018; 28:51-58. [PMID: 30333218 DOI: 10.1158/1055-9965.epi-18-0674] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/14/2018] [Accepted: 10/11/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Recreational physical activity has been consistently associated with reduced breast cancer risk. Less is known about how family history of breast cancer affects the association and whether it varies by menopausal status. METHODS The Sister Study is a cohort of 50,884 women who had a sister with breast cancer but no prior breast cancer themselves at enrollment. Women reported all recreational sport/exercise activities they participated in over the past 12 months. Hours/week and MET-hours/week of physical activity were considered in association with breast cancer risk. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated with Cox regression. Extent of family history, examined as a modifier, was characterized by a Bayesian score incorporating characteristics of the family structure. RESULTS During follow-up (average 8.4 years), 3,023 cases were diagnosed. Higher hours/week (HR≥7vs<1 = 0.77; 95% CI, 0.66-0.90) and MET-hours/week (HRquartile4vs1 = 0.75; 95% CI, 0.67-0.85) of physical activity were associated with reduced postmenopausal breast cancer risk. Hours/week and MET-hours/week were associated with suggestively increased premenopausal breast cancer risk (MET-hours/week HRquartile4vs1 = 1.25; 95% CI, 0.98-1.60). Associations did not vary with extent of family history. However, the increased risk in premenopausal women may be limited to those with stronger family history. CONCLUSIONS In women with a family history of breast cancer, physical activity was associated with reduced postmenopausal, but not premenopausal, breast cancer risk and was not modified by extent of family history. IMPACT This was the first study to examine the association between physical activity and breast cancer risk in a large population with a family history of breast cancer.
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Affiliation(s)
- Nicole M Niehoff
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina.
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina
| | - Shanshan Zhao
- Biostatistics and Computational Biology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina
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19
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Rainey L, van der Waal D, Wengström Y, Jervaeus A, Broeders MJ. Women's perceptions of the adoption of personalised risk-based breast cancer screening and primary prevention: a systematic review. Acta Oncol 2018; 57:1275-1283. [PMID: 29882455 DOI: 10.1080/0284186x.2018.1481291] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Increased knowledge of breast cancer risk factors may enable a paradigm shift from the current age-based mammographic screening programmes to a personalised risk-based approach. This would warrant a significant change in practice, yet the acceptability from a woman's perspective has never been systematically explored. In this systematic review, we inventoried and appraised studies of women's perceptions of risk-based breast cancer screening and prevention to identify factors associated with adopting this new paradigm. METHODS We searched Medline, Embase and PsycInfo to identify original articles in English containing perceptions of risk-based breast cancer screening and/or primary prevention of women with an average to above average risk of developing breast cancer. Qualitative data were systematically extracted and referenced against four theoretical models of preventative health behaviour adoption. RESULTS When considering the adoption of this novel screening and prevention programme, women carefully review their perceived susceptibility to breast cancer. Their decisions are based on a cost-benefit analysis of adopting lifestyle changes, chemoprevention, or prophylactic surgery, taking into account their perceived competence, individual autonomy, relatedness to others, and personal preference. The role of intent is limited when considering behavioural change. CONCLUSIONS Implementing risk-based breast cancer screening and prevention will require a multifactorial approach. The transition from theory to practice can be supported by developing evidence-based shared decision aids and family-oriented (genetic) counselling programmes.
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Affiliation(s)
- Linda Rainey
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Daniëlle van der Waal
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Yvonne Wengström
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Cancer, Karolinska University Hospital, Huddinge, Sweden
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
| | - Mireille J.M. Broeders
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Center for Screening, Nijmegen, The Netherlands
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20
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Sá A, Peleteiro B. The effect of chronic disease family history on the adoption of healthier lifestyles. Int J Health Plann Manage 2018; 33:e906-e917. [PMID: 29968422 DOI: 10.1002/hpm.2561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
AIM To determine the influence of family history (FH) and personal history (PH) of chronic disease (CD) in the adoption of healthy lifestyles. METHODS This cross-sectional study was based on the EPIPorto cohort (n = 1588). Participants were grouped taking into account FH and PH of CD, such as diabetes, myocardial infarction, stroke, asthma, and cancer, and if at least one of the first-degree relatives had died from the CD. Age-, sex-, and education-adjusted odds ratios and corresponding 95% confidence intervals were computed using multinomial logistic regression. RESULTS Subjects with PH and FH of CD were more likely to follow recommendations regarding salt intake but less likely regarding obesity measures. Overall, similar results were observed when repeating the analyses according to the type of CD, particularly in those with diabetes. CONCLUSIONS Recommendations towards healthier lifestyles are not followed by individuals with history of CD, at least in what concerns obesity measures. Our study suggests reducing obesity as a major target for interventions in these groups of individuals.
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Affiliation(s)
- Alexandre Sá
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina Universidade do Porto, Porto, Portugal
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21
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Wu Y, Dijkstra A, Dalley SE, Roerink FS. An experimental test to reveal negative side-effects of high treatability information on preventative health behaviour. Psychol Health 2018; 33:1028-1048. [PMID: 29616825 DOI: 10.1080/08870446.2018.1456290] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVES When the course of a disease can be positively changed by health professionals the disease can be indicated as 'highly treatable'. This 'high treatability information' (HTI) may have negative side-effects on people's preventative motivation. This study examined the effects of HTI regarding skin cancer on preventative motivation. DESIGN This study employed a 2 (high treatability (HTI) versus low treatability (LTI)) × 2 (high versus low susceptibility)-experiment with a hanging control group. (family) History and self-efficacy were assessed as moderators. Participants (N = 309) were randomly assigned to one of the five conditions. MAIN OUTCOME MEASURES The main outcome was intention to engage in preventative actions regarding skin cancer. RESULTS HTI significantly lowered the intention compared to LTI, under the condition of high susceptibility in people with low self-efficacy. In addition, in people with a (family) history of skin cancer, HTI significantly lowered the intention compared to the no-information group. CONCLUSION HTI regarding skin cancer can cause a drop in the preventative motivation. The effects can be conceptualised as negative side-effects of HTI. As substantial proportions of the general population have a (family) history of skin cancer or low self-efficacy, the side-effects may be widespread, possibly increasing the incidence of skin cancer.
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Affiliation(s)
- Yingqiu Wu
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Arie Dijkstra
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Simon E Dalley
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
| | - Florentine S Roerink
- a Department of Social Psychology , University of Groningen , Groningen , the Netherlands
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22
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Scheideler JK, Klein WM. Awareness of the Link between Alcohol Consumption and Cancer across the World: A Review. Cancer Epidemiol Biomarkers Prev 2018; 27:429-437. [DOI: 10.1158/1055-9965.epi-17-0645] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/13/2017] [Accepted: 01/09/2018] [Indexed: 11/16/2022] Open
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Pasi H, Md Isa Z, Azhar Shah S. Perceived Risk of Developing Cancer in a Suburban Community
in Malaysia. Asian Pac J Cancer Prev 2018; 19:395-400. [PMID: 29479988 PMCID: PMC5980925 DOI: 10.22034/apjcp.2018.19.2.395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Objective: To determine the perceived risk of developing cancer in a suburban community in Malaysia. Methods: A cross sectional study using a simple random sampling was conducted among residents aged 18 years old and above (n=520) who had never been diagnosed with cancer, in selected households in a suburban area of Pahang state in Malaysia. The study instruments were a validated questionnaire on risk perception, an automatic blood pressure monitor, a weighing scale and a measuring tape. Data were analyzed using IBM SPSS Statistics for Windows, Version 20.0 and the p value was taken at p <0.05 as significant. Result: This study revealed that only 5.0 percent individuals perceived they were at risk cancer, whilst the perceived severity was 41.3 percent. Multivariable analysis showed a significant association only for a family history of cancer (adjusted OR of 4.80; 95% CI = 1.45-15.82) (p=0.010) among this population. Conclusion: The perceived risk of developing cancer in the selected suburban community of Pahang state in Malaysia is low as compared to that for other non-communicable diseases in this country, whilst the perceived severity was higher than for other diseases. Thus, considering the importance of correct perceptions for behavioral changes, more health education and promotion is needed to make the community better aware of the actual threat of cancer.
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Affiliation(s)
- Hafizah Pasi
- Department of Community Medicine, International Islamic University Malaysia, Malaysia.
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Lee KL, Janz NK, Zikmund-Fisher BJ, Jagsi R, Wallner LP, Kurian AW, Katz SJ, Abrahamse P, Hawley ST. What Factors Influence Women's Perceptions of their Systemic Recurrence Risk after Breast Cancer Treatment? Med Decis Making 2018; 38:95-106. [PMID: 28814131 PMCID: PMC5764769 DOI: 10.1177/0272989x17724441] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Breast cancer patients' misunderstanding of their systemic cancer recurrence risk has consequences on decision-making and quality of life. Little is known about how women derive their risk estimates. METHODS Using Los Angeles and Georgia's SEER registries (2014-2015), a random sample of early-stage breast cancer patients was sent surveys about 2 to 3 months after surgery ( N = 3930; RR, 68%). We conducted an inductive thematic analysis of open-ended responses about why women chose their risk estimates in a uniquely large sub-sample ( N = 1,754). Clinician estimates of systemic recurrence risk were provided for patient sub-groups with DCIS and with low-, intermediate-, and high-risk invasive disease. Women's perceived risk of systemic recurrence (0% to 100%) was categorized as overestimation, reasonably accurate estimation, or underestimation (0% for invasive disease) and was compared across identified factors and by clinical presentation. RESULTS Women identified 9 main factors related to their clinical experience (e.g., diagnosis and testing; treatment) and non-clinical beliefs (e.g., uncertainty; spirituality). Women who mentioned at least one clinical experience factor were significantly less likely to overestimate their risk (12% v. 43%, P < 0.001). Most women who were influenced by "communication with a clinician" had reasonably accurate recurrence estimates (68%). "Uncertainty" and "family and personal history" were associated with overestimation, particularly for women with DCIS (75%; 84%). "Spirituality, religion, and faith" was associated with an underestimation of risk (63% v. 20%, P < 0.001). LIMITATIONS The quantification of our qualitative results is subject to any biases that may have occurred during the coding process despite rigorous methodology. CONCLUSIONS Patient-clinician communication is important for breast cancer patients' understanding of their numeric risk of systemic recurrence. Clinician discussions about recurrence risk should address uncertainty and relevance of family and personal history.
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Affiliation(s)
- Kamaria L. Lee
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Nancy K. Janz
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
| | - Brian J. Zikmund-Fisher
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Behavior and Health Education, Ann Arbor, MI
- University of Michigan, Center for Bioethics and Social Sciences in Medicine, Ann Arbor, MI
| | - Reshma Jagsi
- University of Michigan, Department of Radiation Oncology, Ann Arbor, MI
| | - Lauren P. Wallner
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Epidemiology, Ann Arbor, MI
| | - Allison W. Kurian
- Stanford University, Departments of Medicine and Health Research and Policy, Stanford, CA
| | - Steven J. Katz
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
| | - Paul Abrahamse
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
| | - Sarah T. Hawley
- University of Michigan, Department of Internal Medicine, Division of General Medicine, Ann Arbor, MI
- University of Michigan, Department of Health Management and Policy, Ann Arbor, MI
- Veterans Administration Center for Clinical Management Research, Ann Arbor VA Health Care System, Ann Arbor, MI
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White AJ, DeRoo LA, Weinberg CR, Sandler DP. Lifetime Alcohol Intake, Binge Drinking Behaviors, and Breast Cancer Risk. Am J Epidemiol 2017; 186:541-549. [PMID: 28486582 DOI: 10.1093/aje/kwx118] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Accepted: 10/24/2016] [Indexed: 01/21/2023] Open
Abstract
The prevalence of binge drinking in the United States is rising. While alcohol is a risk factor for breast cancer, less is known about the impact of episodic heavy drinking. In 2003-2009, women aged 35-74 years who were free of breast cancer were enrolled in the Sister Study (n = 50,884). Residents of the United States or Puerto Rico who had a sister with breast cancer were eligible. Multivariable Cox regression was used to estimate adjusted hazard ratios and 95% confidence intervals for breast cancer. During follow-up (mean = 6.4 years), 1,843 invasive breast cancers were diagnosed. Increased breast cancer risk was observed for higher lifetime alcohol intake (for ≥230 drinks/year vs. <60 drinks/year, hazard ratio (HR) = 1.35, 95% confidence interval (CI): 1.15, 1.58). Relative to low-level drinkers (<60 drinks/year), hazard ratios were increased for ever binge drinking (HR = 1.29, 95% CI: 1.15, 1.45) or blacking out (HR = 1.39, 95% CI: 1.17, 1.64). Compared with low-level drinkers who never binged, moderate drinkers (60-229 drinks/year) who binged had a higher risk (HR = 1.25, 95% CI: 1.08, 1.44). There was evidence of effect modification between moderate lifetime drinking and binging (relative excess risk due to interaction = 0.33, 95% CI: 0.10, 0.57). Our findings support the established association between lifetime alcohol intake and breast cancer and provide evidence for an increased risk associated with heavy episodic drinking, especially among moderate lifetime drinkers.
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Paalosalo-Harris K, Skirton H. Mixed method systematic review: the relationship between breast cancer risk perception and health-protective behaviour in women with family history of breast cancer. J Adv Nurs 2016; 73:760-774. [DOI: 10.1111/jan.13158] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/30/2016] [Indexed: 12/18/2022]
Affiliation(s)
| | - Heather Skirton
- School of Nursing and Midwifery; Faculty of Health and Human Sciences; Plymouth University; Plymouth UK
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Seaman K, Dzidic P, Breen L, Saunders C. Exploring breast health practices of post-menopausal women: Implications to informed consent. J Health Psychol 2016; 23:1820-1831. [PMID: 27682335 DOI: 10.1177/1359105316669876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In light of the contention surrounding breast health practices, the research aimed to explore post-menopausal women's experiences of such practices. Semi-structured interviews were conducted in July and August 2015 with 13 Australian women aged 54-74 years. Data were analysed thematically. Participants deemed their engagement with breast health practices as the 'right' thing. However, engaging in these 'right' practices appeared to be fostered by misconceptions. The findings suggest that women may not be making evidence-informed decisions to engage in breast screening; identify contemporary barriers to promoting informed decisions; and may inform information pertinent to breast screening policy, campaigns and decision aid designs.
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Hartman SJ, Dunsiger SI, Marinac CR, Marcus BH, Rosen RK, Gans KM. Internet-based physical activity intervention for women with a family history of breast cancer. Health Psychol 2016; 34S:1296-304. [PMID: 26651471 DOI: 10.1037/hea0000307] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVE Physical inactivity is a modifiable risk factor for breast cancer. Physical activity interventions that can be delivered through the Internet have the potential to increase participant reach. The efficacy of an Internet-based physical activity intervention was tested in a sample of women at an elevated risk for breast cancer. METHOD A total of 55 women with at least 1 first-degree relative with breast cancer (but no personal history of breast cancer) were randomized to a 3-month theoretically grounded Internet-based physical activity intervention or an active control arm. Minutes of moderate to vigorous physical activity, psychosocial mediators of physical activity adoption and maintenance, as well as worry and perceived risk of developing breast cancer were assessed at baseline, 3-month, and 5-month follow up. RESULTS Participants were on average 46.2 (SD = 11.4) years old with a body mass index of 27.3 (SD = 4.8) kg/m2. The intervention arm significantly increased minutes of moderate to vigorous physical activity compared to the active control arm at 3 months (213 vs. 129 min/week) and 5 months (208 vs. 119 min/week; both ps < .001). Regression models indicated that participants in the intervention had significantly higher self-efficacy for physical activity at 3 months (p < .01) and borderline significantly higher self-efficacy at 5 months (p = .05). Baseline breast cancer worry and perceived risk were not associated with physical activity. CONCLUSION Findings from this study suggest that an Internet-based physical activity intervention may substantially increase physical activity in women with a family history of breast cancer.
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Affiliation(s)
- Sheri J Hartman
- Department of Family Medicine and Public Health and Moores Cancer Center, University of California, San Diego
| | - Shira I Dunsiger
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | | | - Bess H Marcus
- Department of Family Medicine and Public Health, University of California, San Diego
| | - Rochelle K Rosen
- Centers for Behavioral and Preventive Medicine, Miriam Hospital, Brown University
| | - Kim M Gans
- Department of Human Development and Family Studies, University of Connecticut
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Greenlee H, Sardo Molmenti CL, Falci L, Ulmer R, Deming-Halverson S, DeRoo LA, Sandler DP. High use of complementary and alternative medicine among a large cohort of women with a family history of breast cancer: the Sister Study. Breast Cancer Res Treat 2016; 156:527-538. [PMID: 27017506 DOI: 10.1007/s10549-016-3740-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Accepted: 02/28/2016] [Indexed: 12/01/2022]
Abstract
Use of complementary and alternative medicine (CAM) is high among U.S. women, yet information is limited on use among women at increased breast cancer risk. We analyzed CAM use among women with a family history of breast cancer. CAM use was analyzed among women enrolled 2003-2009 in the Sister Study cohort. Eligible women were aged 35-74, U.S. or Puerto Rican residents, no personal history of breast cancer, and had ≥1 sister with breast cancer. Baseline data on CAM use in the past year were available for 49,734 women. Logistic regression models examined the association between CAM use and Gail Model breast cancer risk score. Results were compared to female participants in the 2007 National Health Interview Survey (n = 7965). Among Sister Study participants, there was high use of vitamin/mineral supplements (79 %), mind-body practices (41 %), manipulative/body-based practices (32 %), and botanicals (23 %). Overall use was higher than the U.S. female population. No association was observed between familial breast cancer risk and CAM use. Black women were more likely to use spirituality/meditation-based CAM modalities, while non-Hispanic white and Asian women were high users of dietary supplements. In a cohort of women with increased breast cancer risk due to family history, CAM use is higher than women in the general U.S. population and is associated with race/ethnicity. Use was not associated with breast cancer risk. Given the high prevalence of CAM use among women at risk for breast caner, research on the effectiveness of CAM use for disease prevention is needed.
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Affiliation(s)
- Heather Greenlee
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA. .,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA.
| | - Christine L Sardo Molmenti
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA.,Herbert Irving Comprehensive Cancer Center, Columbia University, New York, NY, USA
| | - Laura Falci
- Mailman School of Public Health, Columbia University, 722 W. 168th Street, New York, NY, 10032, USA
| | | | - Sandra Deming-Halverson
- Social & Scientific Systems, Inc, Durham, NC, USA.,Division of Epidemiology, Vanderbilt University School of Medicine, Nashville, TN, USA
| | - Lisa A DeRoo
- National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Dale P Sandler
- National Institute of Environmental Health Sciences, Research Triangle Park, Durham, NC, USA
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Miller M, Bailey B, Govindarajah V, Levin L, Metzger T, Pinney SM, Leung YK, Ho SM. A community survey on knowledge of the impact of environmental and epigenetic factors on health and disease. Perspect Public Health 2016; 136:345-352. [PMID: 26941233 DOI: 10.1177/1757913916630341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
AIM An outreach effort was designed to survey breast cancer survivors, supporters and their families and friends with respect to their interest in, and knowledge of, the potential impact of the environment and epigenetics on health. METHODS Two nearly identical questionnaires (one for adolescents and one for adults) were designed to gauge the perception of this community as to whether the environment impacts health and cancer risk through processes other than genetics. The questionnaires were filled out at casual social gatherings, fundraisers and wellness campaigns as well as in schools (730 participants). The differences among correct (scientific consensus) versus other responses (incorrect and not known) were evaluated. Each answer was first analysed individually and then grouped into one of three categories (diet, inheritance and environment) with age, race and gender. Differences for each response, question or group were compared by repeated measures analysis of variance. RESULTS Respondents generally acknowledged that many factors could be associated with breast cancer although answers to key questions related to epigenetics based on diet, inheritance and environment were often incorrect or not known. The adult participants tended to answer more questions correctly than adolescents did. The majority of participants preferred the Internet as a major source for obtaining further information. CONCLUSION The growing awareness and educational needs for adolescents may bring new paradigm-related environmental risk factors, which may minimise negative epigenetic outcome in subsequent generations. There is an educational opportunity, especially using electronic media, for public education concerning the impact of the environment on human health.
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Affiliation(s)
- Marian Miller
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | | | - Vinothini Govindarajah
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | - Linda Levin
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati, Cincinnati, OH, USA
| | | | - Susan M Pinney
- Division of Epidemiology and Biostatistics, Department of Environmental Health, University of Cincinnati, Center for Environmental Genetics, Cincinnati, OH, USA
| | - Yuet-Kin Leung
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, Center for Environmental Genetics, University of Cincinnati, Cincinnati, OH, USA
| | - Shuk-Mei Ho
- Division of Environmental Genetics and Molecular Toxicology, Department of Environmental Health, USA; Center for Environmental Genetics, University of Cincinnati, University of Cincinnati Cancer Center, Cincinnati, OH, USA; Cincinnati Veterans Affairs Medical Center, Cincinnati, OH, USA
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Teufel-Shone NI, Cordova-Marks F, Susanyatame G, Teufel-Shone L, Irwin SL. Documenting Cancer Information Seeking Behavior and Risk Perception in the Hualapai Indian Community to Inform a Community Health Program. J Community Health 2015; 40:891-8. [PMID: 25791877 DOI: 10.1007/s10900-015-0009-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cancer incidence among American Indians (AIs) is low, yet their 5-year relative survival rate is the second lowest of all U.S. populations. Culturally relevant cancer prevention education is key to achieve health equity. This collaborative project of the Hualapai Tribe and University of Arizona modified the National Cancer Institute's 2003 Health Information National Trends Survey (HINTS) to yield a more culturally relevant cancer information survey to document the health seeking behaviors and perceptions of cancer risks and preventability of AI adults residing in the Hualapai Indian community. A team of health care providers, educators and cancer survivors (six native and three non-natives) completed the adaptation. Four trained native surveyors administered the survey using a random household survey design. The Hualapai HINTS was well accepted (<5% refusal rate) and was completed by 205 adults (20.5% of all adult residents). Respondents reported a preference for and a trust in verbal cancer information and communication with health care professionals (77.1% preference; 57.4% trust) and at workshops (75.2% preference; 45.5% trust). Respondents were aware of some health behaviors associated with a reduced cancer risk, e.g., avoid tobacco use and need for screening. Respondents were less well informed about the role of diet and exercise. These findings were used to inform local cancer prevention education efforts and to develop a series of monthly workshops that engaged local health professionals to reinforce and discuss pathways of the primary role of lifestyle related factors, specifically diet and exercise in reducing cancer risk.
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Affiliation(s)
- Nicolette I Teufel-Shone
- Family and Child Health, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, 85724, USA,
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Khakbazan Z, Taghipour A, Latifnejad Roudsari R, Mohammadi E. Help seeking behavior of women with self-discovered breast cancer symptoms: a meta-ethnographic synthesis of patient delay. PLoS One 2014; 9:e110262. [PMID: 25470732 PMCID: PMC4254513 DOI: 10.1371/journal.pone.0110262] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 09/16/2014] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Patient delay makes a critical contribution to late diagnosis and poor survival in cases of breast cancer. Identifying the factors that influence patient delay could provide information for adopting strategies that shorten this delay. The aim of this meta-ethnography was to synthesize existing qualitative evidence in order to gain a new understanding of help seeking behavior in women with self-discovered breast cancer symptoms and to determine the factors that influence patient delay. METHODS The design was a meta-ethnography approach. A systematic search of the articles was performed in different databases including Elsevier, PubMed, ProQuest and SCOPUS. Qualitative studies with a focus on help seeking behaviors in women with self-discovered breast cancer symptoms and patient delay, published in the English language between 1990 and 2013 were included. The quality appraisal of the articles was carried out using the Critical Appraisal Skills Programme qualitative research checklist and 13 articles met the inclusion criteria. The synthesis was conducted according to Noblit and Hare's meta-ethnographic approach (1988), through reciprocal translational analysis and lines-of-argument. FINDINGS The synthesis led to identification of eight repeated key concepts including: symptom detection, initial symptom interpretation, symptom monitoring, social interaction, emotional reaction, priority of medical help, appraisal of health services and personal-environmental factors. Symptom interpretation is identified as the important step of the help seeking process and which changed across the process through active monitoring of their symptoms, social interactions and emotional reactions. The perceived seriousness of the situation, priority to receive medical attention, perceived inaccessibility and unacceptability of the health care system influenced women's decision-making about utilizing health services. CONCLUSION Help seeking processes are influenced by multiple factors. Educational programs aimed at correcting misunderstandings, erroneous social beliefs and improving self-awareness could provide key strategies to improve health policy which would reduce patient delay.
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Affiliation(s)
- Zohreh Khakbazan
- School of Nursing and Midwifery, Mashhad University of medical science, Mashhad, Iran
| | - Ali Taghipour
- Health Sciences Research Center, Department of Epidemiology and Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Evidence-Based Care Research Center, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Eesa Mohammadi
- Medical Sciences Faculty, Nursing Department, Tarbiat Modares University, Tehran, Iran
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Al-Sharbatti SS, Shaikh RB, Mathew E, Al-Biate MA. Assessment of Breast Cancer Awareness among Female University Students in Ajman, United Arab Emirates. Sultan Qaboos Univ Med J 2014; 14:e522-9. [PMID: 25364556 PMCID: PMC4205065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/29/2014] [Accepted: 06/09/2014] [Indexed: 06/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to assess female university students' knowledge of breast cancer and its preventative measures and to identify their main misconceptions regarding breast cancer. METHODS This cross-sectional study was conducted between April 2011 and June 2012 and included female students from three large universities in Ajman, United Arab Emirates (UAE). A stratified random sampling procedure was used. Data were collected through a validated, pilot-tested, self-administered questionnaire. The questionnaire included 35 questions testing knowledge of risk factors, warning signs and methods for the early detection of breast cancer. Participants' opinions regarding breast cancer misconceptions were also sought. RESULTS The participants (n = 392) were most frequently between 18 and 22 years old (63.5%), non-Emirati (90.1%) and never married (89%). A family history of breast cancer was reported by 36 (9.2%) of the students. The percentage of participants who had low/below average knowledge scores regarding risk factors, warning signs and methods for early detection of breast cancer was 40.6%, 45.9% and 86.5%, respectively. Significantly higher knowledge scores on risk factors were noticed among participants with a family history of breast cancer (P = 0.03). The misconception most frequently identified was that "treatment for breast cancer affects a woman's femininity" (62.5%). CONCLUSION A profound lack of knowledge about breast cancer was noted among female university students in the three UAE universities studied. The most prominent gaps in knowledge identified were those concerning breast cancer screening methods.
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Affiliation(s)
| | - Rizwana B. Shaikh
- Department of Community Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Elsheba Mathew
- Department of Community Medicine, Gulf Medical University, Ajman, United Arab Emirates
| | - Mawahib A. Al-Biate
- Department of Obstetrics & Gynaecology, Gulf Medical College Hospital, Ajman, United Arab Emirates
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Allicock M, Graves N, Gray K, Troester MA. African American women's perspectives on breast cancer: implications for communicating risk of basal-like breast cancer. J Health Care Poor Underserved 2014; 24:753-67. [PMID: 23728042 DOI: 10.1353/hpu.2013.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
African American women suffer a disproportionately high burden of basal-like breast cancer, an aggressive subtype that has no targeted therapy. While epidemiologic research has identified key prevention strategies, little is known about how best to communicate risk to this population. This study explored women's knowledge, beliefs, and attitudes about breast cancer to learn about risk perceptions. Six focus groups were conducted in North Carolina with 57 women (ages 18-49). Age, race (especially perceptions of cancer as a "White disease"), and lack of family history of breast cancer were all shown to contribute to women's perceptions of low breast cancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little to no knowledge of breast cancer subtypes, and emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These findings will assist in developing health communication tools that encourage prevention.
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Affiliation(s)
- Marlyn Allicock
- University of North Carolina, Department of Nutrition, Schools of Medicine and Public Health, Chapel Hill, NC 27599, USA.
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Living my family's story: identifying the lived experience in healthy women at risk for hereditary breast cancer. Cancer Nurs 2013; 35:493-504. [PMID: 22544165 DOI: 10.1097/ncc.0b013e31824530fa] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Based on known or suggested genetic risk factors, a growing number of women now live with knowledge of a potential cancer diagnosis that may never occur. Given this, it is important to understand the meaning of living with high risk for hereditary breast cancer. OBJECTIVE The objective of the study was to explore how women at high risk for hereditary breast cancer (1) form self-identity, (2) apply self-care strategies toward risk, and (3) describe the meaning of care through a high-risk breast program. METHODS Interpretive hermeneutic phenomenology guided the qualitative research method. Women at high risk for hereditary breast cancer were recruited from a high-risk breast program. Open-ended interview questions focused on experiences living as women managing high risk for breast cancer. Consistent with hermeneutic methodology, the principal investigator led a team to analyze the interview transcripts. RESULTS Twenty women participated in in-depth interviews. Analysis revealed that women describe their own identity based on their family story and grieve over actual and potential familial loss. This experience influences self-care strategies, including seeking care from hereditary breast cancer risk experts for early detection and prevention, as well as maintaining a connection for early treatment "when" diagnosis occurs. CONCLUSIONS Healthy women living with high risk for hereditary breast cancer are living within the context of their family cancer story, which influences how they define themselves and engage in self-care. IMPLICATIONS FOR PRACTICE Findings present important practical, research, and policy information regarding health promotion, psychosocial assessment, and support for women living with hereditary breast cancer risk.
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Damman OC, Timmermans DRM. Educating health consumers about cardio-metabolic health risk: what can we learn from lay mental models of risk? PATIENT EDUCATION AND COUNSELING 2012; 89:300-308. [PMID: 22878027 DOI: 10.1016/j.pec.2012.06.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 06/14/2012] [Accepted: 06/22/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To study lay conceptions of cardio-metabolic risk and compare them with those of experts, in order to formulate focal points for better educational risk information. METHODS 40 Dutch lay people were interviewed about the risks of developing cardio-metabolic diseases. Following a 'mental models approach', their conceptions were qualitatively analyzed and compared to an expert model. RESULTS We identified four key themes representing lay conceptions: (1) "same factors, different value" (e.g. the dominance of certain factors, such as stress); (2) "superficiality and incoherence" (e.g. a focus on health and illness in general); (3) "misjudged elevated risk concept" (e.g. either being sick or not); and (4) "no concept of a link between cardio-metabolic diseases" (e.g. separate links between causes and diseases). CONCLUSION Potential mismatches between lay and expert conceptions do not seem to indicate a lack of basic knowledge among consumers, but rather that certain risk factors are not effectively translated into a coherent risk picture. PRACTICE IMPLICATIONS In improving educational materials, we could more explicitly take into account factors that lay people find important. Additionally, effort should be made to produce a more coherent risk understanding among consumers, for example through an alternative information structure.
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Affiliation(s)
- Olga C Damman
- Department of Public and Occupational Health and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
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McLeish L, Reis MM, Stewart C, Goudie DR, Berg JN, Harvie M, Hanning KA, Vysny H, Steel CM. Lifestyle Changes in Women at Genetic Risk of Breast Cancer: an Observational Study. Int J Behav Med 2012; 20:514-21. [DOI: 10.1007/s12529-012-9263-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Keogh LA, McClaren BJ, Apicella C, Hopper JL. How do women at increased, but unexplained, familial risk of breast cancer perceive and manage their risk? A qualitative interview study. Hered Cancer Clin Pract 2011; 9:7. [PMID: 21896163 PMCID: PMC3177765 DOI: 10.1186/1897-4287-9-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 09/06/2011] [Indexed: 11/10/2022] Open
Abstract
Background The perception of breast cancer risk held by women who have not had breast cancer, and who are at increased, but unexplained, familial risk of breast cancer is poorly described. This study aims to describe risk perception and how it is related to screening behaviour for these women. Methods Participants were recruited from a population-based sample (the Australian Breast Cancer Family Study - ABCFS). The ABCFS includes women diagnosed with breast cancer and their relatives. For this study, women without breast cancer with at least one first- or second-degree relative diagnosed with breast cancer before age 50 were eligible unless a BRCA1 or BRCA2 mutation had been identified in their family. Data collection consisted of an audio recorded, semi-structured interview on the topic of breast cancer risk and screening decision-making. Data was analysed thematically. Results A total of 24 interviews were conducted, and saturation of the main themes was achieved. Women were classified into one of five groups: don't worry about cancer risk, but do screening; concerned about cancer risk, so do something; concerned about cancer risk, so why don't I do anything?; cancer inevitable; cancer unlikely. Conclusions The language and framework women use to describe their risk of breast cancer must be the starting point in attempts to enhance women's understanding of risk and their prevention behaviour.
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Affiliation(s)
- Louise A Keogh
- Centre for Women's Health, Gender and Society, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
| | - Belinda J McClaren
- Genetics Education and Health ResearchGroup, Murdoch Childrens Research Institute, Melbourne, Australia
| | - Carmel Apicella
- Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
| | - John L Hopper
- Centre for Molecular, Environmental, Genetic & Analytic Epidemiology, Melbourne School of Population Health, The University of Melbourne, Melbourne, Australia
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Vadaparampil ST, Quinn GP, Gjyshi A, Pal T. Development of a brochure for increasing awareness of inherited breast cancer in black women. Genet Test Mol Biomarkers 2011; 15:59-67. [PMID: 21275654 DOI: 10.1089/gtmb.2010.0102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Low levels of awareness about hereditary breast cancer and ovarian cancer and underutilization of genetic services combined with the high incidence of early onset breast cancer in the black community underscore the urgent need to provide information about hereditary breast and ovarian cancer to black women. The primary goal of the present study was to develop a culturally targeted brochure designed to increase awareness about inherited breast cancer among black women using the principles of Learner Verification. Three focus groups were conducted with black women, including those with or without a history of breast cancer (n = 46), to evaluate the brochure. Data were analyzed through hand coding using a simple classification system placing participants' responses in the predetermined Learner Verification categories. On the basis of the feedback obtained, the brochure has been modified to improve cultural-targeting, relevance, and clarity and has been made available for dissemination. Our study illustrates the importance of obtaining feedback from the target audience when developing a culturally targeted informational brochure for black women. Further, the complexity of our subject matter (i.e., inherited breast and ovarian cancer) underscores the importance of using inviting visuals and personal vignettes, while maintaining a simple and clear message.
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Affiliation(s)
- Susan T Vadaparampil
- Division of Cancer Prevention and Control, Moffitt Cancer Center and Research Institute, Tampa, Florida 33612, USA.
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Abstract
PURPOSE To describe African American women's experience of being at high risk for breast cancer. DESIGN A hermeneutic phenomenological approach was used to guide in-depth interviews and analysis. Methods to ensure trustworthiness and rigor were included. METHODS Open interviews were conducted with 20 African American women who were at high risk for breast cancer (family history, personal history, genetic mutation). They were recruited from a cancer risk clinic and community-based settings. Data were transcribed verbatim, and themes were labeled among and between all interviews. FINDINGS Five themes were identified: (a) life-changing experience; (b) relationships: fears, support, and concerns; (c) the healthcare experience; (d) raising awareness; and (e) strong faith. CONCLUSIONS Young women at high risk for breast cancer have unique emotional and support needs that are shaped by stage in life, relationships with significant others, their faith, and interactions with the healthcare delivery system. CLINICAL RELEVANCE Breast cancer does occur in young women. This highlights the need for timely and sensitive approaches to care when young women present with breast health concerns or abnormal breast findings.
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Affiliation(s)
- Janice Phillips
- Center for Clinical Cancer Genetics and Global Health, University of Chicago Medical Center, Chicago, IL, USA.
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Lea DH, Skirton H, Read CY, Williams JK. Implications for Educating the Next Generation of Nurses on Genetics and Genomics in the 21st Century. J Nurs Scholarsh 2010; 43:3-12. [DOI: 10.1111/j.1547-5069.2010.01373.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Holmberg C, Daly M, McCaskill-Stevens W. SI RLTD: Risk Scores and Decision Making: The Anatomy of a Decision to Reduce Breast Cancer Risk. JOURNAL OF NURSING AND HEALTHCARE OF CHRONIC ILLNESS 2010; 2:271-280. [PMID: 21731580 PMCID: PMC3124706 DOI: 10.1111/j.1752-9824.2010.01068.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIM: To report the use of a risk score for risk treatment decision-making in women at risk for breast cancer in order to better understand their decision-making situation. BACKGROUND: Tamoxifen and Raloxifene are medications that have been proven to reduce the risk of breast cancer. However, women who understand their personal net benefit from Tamoxifen use chose not to take the medication. To understand this decision, the paper investigates the use of epidemiological risk information in the decision-making process for risk-reducing treatments. METHODS: The narratives of two women are analyzed as they recall their risk score and explain their decision-making process concerning participation in the Study of Tamoxifen and Raloxifene (STAR). Both in-depth interviews follow a narrative approach and were recorded in a U.S. cancer center in 2005. RESULTS: Thinking about risk by analyzing the chances of developing a disease is specific to complex decision-making situations. The associated risk-benefit analysis has to be conducted qualitatively as epidemiological risk information cannot know all details of a woman's life. In addition, a woman's decision is based on the perception of the condition as risk or as disease. Women are willing to treat risk that is perceived as disease, especially when it is based on bodily measurements on which the treatment has an effect. Women are not willing to treat a risk not perceived as disease. CONCLUSION: The net benefit of a treatment as calculated based on epidemiological data cannot easily be translated onto an individual's life. Thus, the complex experience of a woman's life at risk is highly important in decision-making situations. RELEVANCE TO CLINICAL PRACTICE: The ambiguity of statistical risk estimates should be acknowledged and the women's evaluation of her risk valued in risk treatment decision-making.
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Affiliation(s)
- Christine Holmberg
- Berlin School of Public Health, Charité - Universitätsmedizin Berlin, Germany
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