Predisposing factors associated with compliance to biennial breast screening among centers with and without nurses

A national cross-sectional study of adherence to timely mammography use in Malta

BACKGROUND

Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta.

METHODS

Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test.

RESULTS

At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively).

CONCLUSIONS

To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.

Practice of Breast Cancer Early Diagnosis Methods among Women Living in Samsun, and Factors Associated with This Practice

OBJECTIVE

The purpose of this study was to assess practice of breast cancer early diagnosis methods among women and the factors associated with this practice.

MATERIALS AND METHODS

The population of this cross-sectional study consisted of 410,377 women over the age of 20, living within the administrative borders of Samsun province. Stratified systematic sampling was used in the selection of the 800-member sample. The Health Belief Model Scale, a questionnaire consisting of open and closed-ended questions, was used to elicit women's demographic data and determine their awareness on early diagnostic techniques. The questionnaires were administered face-to-face by visiting individuals' addresses.

RESULTS

80.5% of women had knowledge on breast self-examination (BSE). 12.6% of the women who were aware of BSE stated that they regularly performed BSE. 30.4% of women had clinical breast examination (CBE) by health personnel at least once, while 36.8% of women over 40 years of age obtained mammography at least once. Factors associated with women's performance of BSE were age, having received education about breast health, perception of severity, barriers for BSE and self-efficacy. Factors affecting CBE included age, presence of history of breast cancer in a relative or friend, having received education about breast health; while factors associated with women's undergoing mammography were identified as age, a family member with a history of breast cancer and barriers for mammography.

CONCLUSION

Determination of the factors associated with practice of breast cancer early diagnosis methods, and implementation of planned training programs based on these results is important in increasing compliance with these methods.

Mammography use for breast cancer screening in Portugal: results from the 2005/2006 National Health Survey

BACKGROUND

Understanding the patterns of mammography use is essential to promote the participation in breast cancer screening.

OBJECTIVES

To describe the patterns of screening mammography use in Portugal.

METHODS

As part of the fourth National Health Survey (2005/2006), 3045 women were evaluated in face-to-face interviews. The previous use of mammography for screening was classified as never or ever, and the latter was further grouped according to the time elapsed since the latest mammography. Having undergone the latest mammography >2 years before was considered underuse. We assessed the determinants of never having been screened by mammography and, among those who had been tested, the determinants of mammography underuse, through age- and education-adjusted odds ratios (ORs), with 95% confidence intervals (95% CIs).

RESULTS

Among women aged 45-49 and 50-69 years, 86.3% and 88.0%, respectively, underwent a screening mammography before, and most of them were tested in the previous 2 years. The lowest risk of never having been screened was in Norte (OR = 0.41, 95% CI: 0.21-0.80) and the highest in Açores (OR = 4.04, 95% CI: 2.37-6.92), in comparison with Centro (the region with organized screening for a longer time). Participants with <4 years of formal education were more likely to have never been screened than the more educated (OR = 4.27, 95% CI: 1.67-10.89). Women with private health insurance (OR = 0.16, 95% CI: 0.04-0.65), as well as those who had undergone cervical cytology screening before (OR = 0.50, 95% CI: 0.30-0.85), had a lower risk of underuse.

CONCLUSIONS

This study provides useful information to improve the allocation of resources to breast cancer screening.

Beliefs about optimal age and screening frequency predict breast screening adherence in a prospective study of female relatives from the Ontario site of the Breast Cancer Family Registry

Background

Although few studies have linked cognitive variables with adherence to mammography screening in women with family histories of breast and/or ovarian cancer, research studies suggest cognitive phenomena can be powerful adherence predictors.

Methods

This prospective study included 858 women aged 30 to 71 years from the Ontario site of the Breast Cancer Family Registry with at least one first-degree relative diagnosed with breast and/or ovarian cancer. Data on beliefs about breast cancer screening and use of mammography were obtained from annual telephone interviews spanning three consecutive years. Self-reported mammogram dates were confirmed with medical imaging reports. Associations between beliefs about breast cancer screening and adherence with annual mammography were estimated using polytomous logistic regression models corrected for familial correlation. Models compared adherers (N = 329) with late-screeners (N = 382) and never-screeners (N = 147).

Results

Women who believed mammography screening should occur annually were more likely to adhere to annual screening recommendations than women who believed it should happen less often (OR: 5.02; 95% CI: 2.97-8.49 for adherers versus late-screeners; OR: 6.82; 95% CI: 3.29-14.16 for adherers versus never-screeners). Women who believed mammography screening should start at or before age 50 (rather than after) (OR: 9.72; 95% CI: 3.26-29.02) were significantly more likely to adhere when compared with never-screeners.

Conclusions

Study results suggest that women with a family history of breast cancer should be strongly communicated recommendations about initial age of screening and screening intervals as related beliefs significantly predict adequate adherence.

Satisfaction with initial screen and compliance with biennial breast screening at centers with and without nurses

BACKGROUND

A woman's experience during her initial breast screen can influence her participation in subsequent screening.

OBJECTIVE

The purpose of this study was to determine the association between a woman's satisfaction with her initial screening experience and compliance to biennial screening at centers with and without nurses.

METHODS

A stratified random sample of compliers and noncompliers to biennial screening was selected from a cohort of 16 858 eligible women aged 50 to 65 years attending centers with and without nurses for their initial screen at the Ontario Breast Screening Program in 2002. Of these eligible women, 3387 were sent questionnaires, 2640 (77.9%) were contacted, and 1901 (72.0%) were interviewed. The association between satisfaction with initial screen and compliance was estimated separately for centers with and without nurses using logistic regression.

RESULTS

Women attending centers with nurses were significantly less likely to comply with their next screen after their clinical breast examination if they were not completely satisfied with the service they received (odds ratio, 0.21; 95% confidence interval, 0.08-0.57) or agreed that the clinical breast examination caused discomfort to their breasts (odds ratio, 0.65; 95% confidence interval, 0.45-0.94). In addition, women attending centers with or without nurses were significantly less likely to comply if they did not understand why they needed to return for screening.

CONCLUSIONS

: Nurses at screening centers have an opportunity to significantly impact a woman's compliance to biennial breast screening by providing a positive initial screening experience.

IMPLICATIONS FOR PRACTICE

Emphasis should be placed on improving a woman's overall satisfaction with her initial screening experience.

The breast care nurse: the care specialist in breast centres

BACKGROUND

In Europe, breast cancer is the most common form of cancer in women; 26.5 per cent of all new malignant diseases and 17.5 per cent of all cancer deaths are due to this type of cancer. In Germany, approximately every tenth woman is diagnosed with breast cancer during her lifetime.

OBJECTIVE

In order to increase the quality of life of breast cancer patients, the European Society of Mastology (EUSOMA) requires the availability of, and an integration of qualified and specialized care into the interdisciplinary team. Thus, in Germany, a new type of job profile for 'breast nurse' as a qualified care specialist has to be established and has to be oriented towards the international standards of a breast care nurse (BCN).

METHODS

The Charité's Academy of Health--in cooperation with the Interdisciplinary Breast Centre of the Charité--has offered a career advisory service curriculum for the BCN since 2006 in accordance with the EUSOMA guidelines.

RESULTS

In three courses, 45 BCNs have been trained. In the first refresher seminar in May 2009, the BCNs were given an opportunity to exchange with fellow BCNs their experiences.

CONCLUSION

We were able to set up a new curriculum to train nurses as BCNs as to improve the quality of care for breast cancer patients and to orientate the training towards the international standards of a BCN qualification.