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Sırlıer Emir B, Yıldız S, Kurt O, Emre E, Aydın S. Relationships between Anxiety, Depression, and Illness Perceptions in Lung and Breast Cancer Patients throughout the Cancer Continuum. Healthcare (Basel) 2023; 11:2794. [PMID: 37893868 PMCID: PMC10606067 DOI: 10.3390/healthcare11202794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 10/17/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Cancer is a devastating disease that has significant psychological and biological impacts. Generally, lung cancer primarily affects men while breast cancer primarily affects women. Thus, this study aimed to investigate the levels of anxiety and depression in patients with these prevalent cancer types, as well as their perceptions of the illness and any potential connections between them. The study included a total of 252 participants, consisting of 110 breast cancer patients, 112 lung cancer patients, and 30 healthy individuals as controls. The Beck Depression Inventory (BDI) and Beck Anxiety Inventory (BAI) were administered to assess mood, while the Illness Perception Questionnaire (IPQ) was used to evaluate cancer perceptions. Results revealed that both breast cancer and lung cancer patients had significantly higher BDI and BAI scores compared to the control group. Furthermore, the BDI and BAI scores were lower in breast cancer patients compared to lung cancer patients. The IPQ causal representation-immunity score was significantly higher in lung cancer patients than in breast cancer patients (p = 0.01). Positive correlations were found between BDI scores and BAI scores, as well as between BDI scores and certain subscale scores of the IPQ related to illness representation and causal representation. Additionally, a positive correlation was observed between BAI scores and the IPQ illness representation-timeline acute/chronic subscale, while a negative correlation was found between BAI scores and the IPQ causal representation-accident or chance scores. Overall, the study findings demonstrated that breast and lung cancer patients possess negative perceptions of their disease and experience high levels of anxiety and depression. To enhance the quality of life and promote resilience in these patients, it is recommended to incorporate psychological interventions that consider anxiety, depression, and disease perception.
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Affiliation(s)
- Burcu Sırlıer Emir
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Sevler Yıldız
- Department of Psychiatry, Elazığ Fethi Sekin City Hospital, 23100 Elazığ, Turkey;
| | - Osman Kurt
- Department of Public Health, Adıyaman Provincial Health Directorate, 02100 Adıyaman, Turkey;
| | - Elif Emre
- Department of Anatomy, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
| | - Süleyman Aydın
- Department of Biochemistry, Faculty of Medicine, University of Fırat, 23119 Elazığ, Turkey;
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Li M, Kwok OM, Ma P, Tseng TS, Chen LS. Are College Students Interested in Family Health History Education? A Large Needs Assessment Survey Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2596. [PMID: 36767961 PMCID: PMC9915439 DOI: 10.3390/ijerph20032596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 06/18/2023]
Abstract
Family health history (FHH) is an essential foundation for personalized disease prevention. As the incidence of early-onset chronic diseases is increasing among college students, it is important to provide them with the education required to learn about their FHH. This study aimed to assess college students' interest in receiving FHH education, preferred topics, and desired learning methods. We invited college students to complete an online survey from a large research-intensive university. A total of 2276 college students completed the survey. Nearly half of the participants self-identified as non-Hispanic white (45.5%). Slightly more than half of the sample (53.9%) were not interested in receiving FHH education mainly due to low prioritization. Among those who expressed interest in obtaining FHH education, the three most desired learning topics were the ability to interpret FHH information (76.1%), the application of FHH in disease prevention (72.0%), and FHH information collection strategies (63.6%). Computer-based learning (51.1%) was the most preferred educational method. Moreover, females, older individuals, those who have FHH in first-degree relatives, and participants who were members of racial and ethnic groups showed greater interests in receiving FHH education (ps < 0.05). Strategies to promote college students' awareness, collection, and use of FHH are needed.
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Affiliation(s)
- Ming Li
- Department of Health Sciences, Towson University, Towson, MD 21252, USA
| | - Oi-Man Kwok
- Department of Educational Psychology, Texas A&M University, College Station, TX 77843, USA
| | - Ping Ma
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
| | - Tung-Sung Tseng
- Behavioral and Community Health Sciences Program, School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA 70112, USA
| | - Lei-Shih Chen
- Department of Health Behavior, School of Public Health, Texas A&M University, College Station, TX 77843, USA
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3
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Neto DD, Figueiras MJ, Sebastião R. Representations of depression and schizophrenia in the community: The role of illness and risk perceptions on help-seeking intentions. Front Psychol 2022; 13:1011195. [PMID: 36507011 PMCID: PMC9730322 DOI: 10.3389/fpsyg.2022.1011195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Objective Illness perceptions (IPs) are important in understanding human reactions to illnesses, including mental health disorders. They influence risk perceptions and several variables relevant to the adjustment to a disorder, treatment seeking, and health outcomes. This study sought to compare IP, risk perception, and help-seeking intention for depression and schizophrenia in a community sample and to assess the mediating role of risk perception in the relationship between IP and help-seeking intention. Materials and methods A total of 380 adults participated in this study and filled out self-report measures of IPs, risk perceptions, and help-seeking intention. The previous diagnosis of depression was used to control the comparisons between the two disorders. A structural equation model (SEM) was used to test the mediation relationship. Results Perceived consequences, expected timeline, lack of personal control, and symptom identity were higher for schizophrenia, while lack of treatment control and concern were higher for depression. An interaction occurred with a previous diagnosis of depression for several dimensions of IP. Concerning the SEM, a valid model was obtained for depression, explaining 15.5% of help-seeking intentions, but not for schizophrenia. Conclusion The results show that the general population represents depression and schizophrenia differently. These representations are influenced by having experienced depression, and that illness and risk perceptions contribute to explaining the intention to seek help. Considering these illness representations makes it possible to understand the general population's emotional and cognitive reactions to mental health disorders.
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Affiliation(s)
- David Dias Neto
- School of Psychology, ISPA-Instituto Universitário, Lisbon, Portugal,Applied Psychology Research Centre Capabilities and Inclusion, Lisbon, Portugal,*Correspondence: David Dias Neto,
| | - Maria João Figueiras
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates
| | - Rita Sebastião
- School of Psychology, ISPA-Instituto Universitário, Lisbon, Portugal,Applied Psychology Research Centre Capabilities and Inclusion, Lisbon, Portugal
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4
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Figueiras MJ, Neto DD, Marôco J, Carmo C. How Do Healthy Women Perceive the Risk of Breast Cancer? The Role of Illness Perceptions and Compared Risk between Portugal and the U.A.E. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12923. [PMID: 36232223 PMCID: PMC9566403 DOI: 10.3390/ijerph191912923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: Breast cancer (BC) shows significant epidemiological differences between Eastern and Western countries. These may arise from socio-cultural factors influencing how healthy young women perceive this condition, their risk of getting cancer, and the implications for preventive screening behaviors. In this study, the illness perceptions, individual risk perception, compared risk, and beliefs about preventive behaviors for BC of female university students were compared using an anonymous online survey between a European country (Portugal) and the United Arab Emirates. (2) Method: A structural equation model (SEM) was developed to investigate the hypothetical relationship between illness perceptions and compared risk as predictors of perceived risk for BC. (3) Results: There were significant differences between the study variables. The SEM was invariant, but the differences between regression coefficients in both countries were highly statistically significant. Mediation analyses revealed a significant indirect effect of compared risk on individual risk and a significantly stronger direct effect for the Emirati sample. (4) Conclusions: These findings suggest that cultural research may help to explain factors that may shape social comparison of individual risk characteristics and influence perceived risk. Moreover, providing culturally appropriate strategies to be designed and implemented can promote early detection behaviors for BC.
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Affiliation(s)
- Maria J. Figueiras
- Department of Psychology, College of Natural Health and Sciences, Zayed University, Abu Dhabi P.O. Box 144534, United Arab Emirates
| | - David Dias Neto
- APPsyCI—Applied Psychology Research Center Capabilities & Inclusion, ISPA—Instituto Universitário, 1149-041 Lisboa, Portugal
| | - Joao Marôco
- William James Center for Research, ISPA—Instituto Universitário, 1149-041 Lisboa, Portugal
| | - Catarina Carmo
- School of Psychology, ISPA—Instituto Universitário, 1149-041 Lisboa, Portugal
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Silva RH, Moura JMB, Ferreira Júnior WS, Nascimento ALB, Albuquerque UP. Previous Experiences and Regularity of Occurrence in Evolutionary Time Affect the Recall of Ancestral and Modern Diseases. EVOLUTIONARY PSYCHOLOGICAL SCIENCE 2022. [DOI: 10.1007/s40806-022-00325-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Figueiras MJ, Neto DD, Marôco J. Understanding the relationship between illness perceptions of breast cancer and perceived risk in a sample of U.A.E. female university students: the role of comparative risk. BMC Womens Health 2022; 22:193. [PMID: 35614444 PMCID: PMC9131691 DOI: 10.1186/s12905-022-01771-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 04/29/2022] [Indexed: 11/10/2022] Open
Abstract
Background In the Middle East region, the incidence of breast cancer (BC) has substantially increased in the last years. Despite a considerable body of research about BC in Arab countries, how illness perceptions of healthy women about BC may influence risk perception is unknown. Methods A cross-sectional survey was conducted on a sample of 298 young Emirati women. The measures included demographic information, illness perceptions, and risk perception. Descriptive and correlational analyses were performed to assess illness perceptions about BC, perceived individual risk and comparative risk. A structural equation modelling (S.E.M.) was built to investigate the relationship between illness perceptions and perceived individual risk. Results Participants reported negative illness perceptions about BC The individual risk perception and the compared risk perception for BC were low. Participants with a family history of BC reported more negative illness and higher risk perceptions. The relationship between illness perceptions and perceived individual risk was significant and mediated by compared risk. The S.E.M. explained 55.9% of the variance in predicting perceived individual risk for BC. Conclusion Women's views of BC are important factors in risk perception and may provide culturally sensitive clues to promote early screening for BC in Arab countries. This may be important for policymakers to design intervention strategies to lower health risks, considering the different ways in which women perceive their risks for BC.
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Affiliation(s)
- Maria J Figueiras
- Department of Psychology, College of Natural and Health Sciences, Zayed University, Abu Dhabi, United Arab Emirates.
| | - David Dias Neto
- APPsyCI - Applied Psychology Research Center Capabilities and Inclusion, ISPA - Instituto Universitário, Lisbon, Portugal
| | - João Marôco
- William James Center for Research, ISPA - Instituto Universitário, Lisbon, Portugal
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Factors Influencing Family Health History Collection among Young Adults: A Structural Equation Modeling. Genes (Basel) 2022; 13:genes13040612. [PMID: 35456417 PMCID: PMC9027539 DOI: 10.3390/genes13040612] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/17/2022] [Accepted: 03/26/2022] [Indexed: 02/03/2023] Open
Abstract
Family health history (FHH) can serve as an entry point for preventive medicine by providing risk estimations for many common health conditions. College is a critical time for young adults to begin to understand the value of FHH collection, and to establish healthy behaviors to prevent FHH-related diseases. This study seeks to develop an integrated theoretical framework to examine FHH collection behavior and associated factors among college students. A sample of 2670 college students with an average age of 21.1 years completed a web-based survey. Less than half (49.8%) reported actively seeking FHH information from their family members. Respondents’ knowledge about FHH were generally low. Structural equation modeling findings suggested an adequate model fit between our survey data and the proposed integrated theoretical framework. Respondents who were members of racial/ethnic minority groups exhibited higher levels of anxiety and intention to obtain FHH information but had lower confidence in their ability to gather FHH information than non-Hispanic White respondents. Therefore, educational programs designed to enhance the level of young adults’ FHH knowledge, efficacy, and behavior in FHH collection, and change subjective norms are critically needed in the future, especially for these who are members of racial/ethnic minority groups.
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Moura JMB, Henriques da Silva R, Soares Ferreira Júnior W, Cristina da Silva T, Albuquerque UP. Memory for medicinal plants remains in ancient and modern environments suggesting an evolved adaptedness. PLoS One 2021; 16:e0258986. [PMID: 34695160 PMCID: PMC8544875 DOI: 10.1371/journal.pone.0258986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 10/08/2021] [Indexed: 11/30/2022] Open
Abstract
Adaptive memory is the propensity of human memory to easily store and retrieve important information to deal with challenges related to the Pleistocene. Recent evidence shows that humans have had a multiregional evolution across the African continent, including the rainforests and deciduous forests; however, there is little evidence regarding the implications of these origins and the relevant and recurring challenges of these environments on survival processing advantage in memory. In this study, we conducted an experiment with volunteers to analyze whether adaptive memory operates in the retrieval of important information to solve challenges of using medicinal plants to treat diseases in the ancestral environments of the savanna, rainforests, and deciduous forests compared to the modern environments of desert, tundra, coniferous forest, and urban areas. We used simulated survival environments and asked volunteers (30 per simulated scenario) to imagine themselves sick in one of these environments, and needing to find medicinal plants to treat their disease. The volunteers rated the relevance of 32 words to solve this challenge, followed by a surprise memory test. Our results showed no ancestral priority in recalling relevant information, as both ancestral and modern environments showed a similar recall of relevant information. This suggests that the evolved cognitive apparatus allows human beings to survive and can create survival strategies to face challenges imposed in various environments. We believe that this is only possible if the human mind operates through a flexible cognitive mechanism. This flexibility can reflect, for example, the different environments that the first hominids inhabited and the different dangerous situations that they faced.
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Affiliation(s)
- Joelson Moreno Brito Moura
- Departamento de Biologia, Universidade Federal Rural de Pernambuco, Recife, Pernambuco, Brazil
- Departamento de Botânica, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | - Risoneide Henriques da Silva
- Departamento de Biologia, Universidade Federal Rural de Pernambuco, Recife, Pernambuco, Brazil
- Departamento de Botânica, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
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The Link Between Adaptive Memory and Cultural Attraction: New Insights for Evolutionary Ethnobiology. Evol Biol 2020. [DOI: 10.1007/s11692-020-09516-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Gözüyeşil E, Taş F, Arıöz Düzgün A. 15-49 yaş arası kadınlarda meme kanseri endişesi ve sağlıklı yaşam biçimi davranışlarını etkileyen faktörler. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.493360] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Himes DO, Davis SH, Lassetter JH, Peterson NE, Clayton MF, Birmingham WC, Kinney AY. Does family communication matter? Exploring knowledge of breast cancer genetics in cancer families. J Community Genet 2019; 10:481-487. [PMID: 30877488 PMCID: PMC6754477 DOI: 10.1007/s12687-019-00413-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 02/28/2019] [Indexed: 12/24/2022] Open
Abstract
Knowledge of breast cancer genetics is critical for those at increased hereditary risk who must make decisions about breast cancer screening options. This descriptive study explored theory-based relationships among cognitive and emotional variables related to knowledge of breast cancer genetics in cancer families. Participants included first-degree relatives of women with breast cancer who had received genetic counseling and testing. Study participants themselves did not have breast cancer and had not received genetic counseling or testing. Data were collected by telephone interviews and surveys. Variables analyzed included numeracy, health literacy, cancer-related distress, age, education, and the reported amount of information shared by the participants' family members about genetic counseling. The multiple regression model explained 13.9% of variance in knowledge of breast cancer genetics (p = 0.03). Best fit of the multiple regression model included all variables except education. Reported amount of information shared was the only independently significant factor associated with knowledge (β = 0.28, p = 0.01). Participants who reported higher levels of information shared by a family member about information learned during a genetic counseling session also demonstrated increased knowledge about breast cancer genetics.
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Affiliation(s)
- Deborah O Himes
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA.
| | - Sarah H Davis
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Jane H Lassetter
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Neil E Peterson
- College of Nursing, Brigham Young University, 500 Spencer W. Kimball Tower, Provo, UT, USA
| | - Margaret F Clayton
- College of Nursing, University of Utah, 10 South 2000 East, Salt Lake City, UT, 84112, USA
| | - Wendy C Birmingham
- Department of Psychology, Brigham Young University, 1054 Spencer W. Kimball Tower, Provo, UT, 84604, USA
| | - Anita Y Kinney
- Department of Epidemiology - School of Public Health, Rutgers University, Piscataway, NJ, 08854, USA
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Rankin K, Sweeny K. Divided we stand, united we worry: Predictors of worry in anticipation of a political election. MOTIVATION AND EMOTION 2019. [DOI: 10.1007/s11031-019-09787-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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13
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Whitney CA, Dorfman CS, Shelby RA, Keefe FJ, Gandhi V, Somers TJ. Reminders of cancer risk and pain catastrophizing: relationships with cancer worry and perceived risk in women with a first-degree relative with breast cancer. Fam Cancer 2019; 18:9-18. [PMID: 29679190 DOI: 10.1007/s10689-018-0082-6] [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] [Indexed: 12/22/2022]
Abstract
First-degree relatives of women with breast cancer may experience increased worry or perceived risk when faced with reminders of their own cancer risk. Worry and risk reminders may include physical symptoms (e.g., persistent breast pain) and caregiving experiences. Women who engage in pain catastrophizing may be particularly likely to experience increased distress when risk reminders are present. We examined the degree to which persistent breast pain and experience as a cancer caregiver were related to cancer worry and perceived risk in first-degree relatives of women with breast cancer (N = 85) and how catastrophic thoughts about breast pain could impact these relationships. There was a significant interaction between persistent breast pain and pain catastrophizing in predicting cancer worry (p = .03); among women who engaged in pain catastrophizing, cancer worry remained high even in the absence of breast pain. Pain catastrophizing also moderated the relationships between caregiving involvement and cancer worry (p = .003) and perceived risk (p = .03). As the degree of caregiving responsibility increased, cancer worry and perceived risk increased for women who engaged in pain catastrophizing; levels of cancer worry and perceived risk remained low and stable for women who did not engage in pain catastrophizing regardless of caregiving experience. The results suggest that first-degree relatives of breast cancer survivors who engage in pain catastrophizing may experience greater cancer worry and perceived risk and may benefit from interventions aimed at reducing catastrophic thoughts about pain.
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Affiliation(s)
- Colette A Whitney
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Caroline S Dorfman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Rebecca A Shelby
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Francis J Keefe
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Vicky Gandhi
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA
| | - Tamara J Somers
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, 2200 W. Main Street, Suite 340, Durham, NC, 27705, USA.
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Karabulutlu EY, Avcı İA, Karayurt Ö, Gürsoy A, Köşgeroğlu N, Tuna A, Ersin F, Arıkan F, Karaman S. Evaluation of Illness Perception of Women with Breast Cancer in Turkey. Eur J Breast Health 2019; 15:98-104. [PMID: 31001611 DOI: 10.5152/ejbh.2019.4317] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/10/2018] [Indexed: 12/21/2022]
Abstract
Objective The aim of this study is to examine the illness perceptions of women with breast cancer and possible relationships between these perceptions and descriptive characteristics such as sociodemographic and clinical characteristics in Turkey. Materials and Methods The study was conducted in compliance with correlational, descriptive research principles. Three hundred eighty women with breast cancer who were treated in various hospitals in seven regions of the country were included in the study. A sociodemographic and clinical characteristics form, and The Illness Perception Questionnaire were used for data collection. Results The mean age of the patients with breast cancer was 49.8±11.5, among them, 83.95% were married, 37.37% were at stage 2 breast cancer, and 67.11% experienced mastectomy. It was found that the patients perceived higher personal control over illness (20.88±4.76). The patients perceived most common risk factors as the cause of the illness (19.42±6.38). This study show that variety sociodemographic and clinical characteristics of the patients affected their perceptions of illness. Conclusion The meaning of illness from the perspective of patient with breast cancer should be assessed. The care, education and counselling programs should be planned according to the patient's illness perceptions.
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Affiliation(s)
| | | | - Özgül Karayurt
- İzmir University of Economics School of Health Sciences, İzmir, Turkey
| | - Ayla Gürsoy
- Cyprus International University School of Health Sciences, Lefkoşa, Cyprus
| | - Nedime Köşgeroğlu
- Eskişehir Osmangazi University School of Health Sciences, Eskişehir, Turkey
| | - Arzu Tuna
- Sanko University School of Health Sciences, Gaziantep, Turkey
| | - Fatma Ersin
- Harran University School of Health Sciences, Şanlıurfa, Turkey
| | - Fatma Arıkan
- Akdeniz University School of Nursing, Antalya, Turkey
| | - Seda Karaman
- Atatürk University School of Nursing, Erzurum, Turkey
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Henriques da Silva R, Ferreira Júnior WS, Muniz de Medeiros P, Albuquerque UP. Adaptive memory and evolution of the human naturalistic mind: Insights from the use of medicinal plants. PLoS One 2019; 14:e0214300. [PMID: 30913230 PMCID: PMC6435313 DOI: 10.1371/journal.pone.0214300] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 03/11/2019] [Indexed: 11/18/2022] Open
Abstract
Throughout evolutionary history, humans have been exposed to a wide variety of diseases, some of which have serious and even lethal consequences. Memorizing medicinal plants for the treatment of serious diseases likely maximized the chances of survival and reproduction and was instrumental in the evolutionary success of our species. In the present study, we used the idea of adaptive memory to understand whether human memory evolved to recall information about medicinal plants for the treatment of serious diseases. We considered plant-disease pairs of words as units of information available in a medical system based on the use of medicinal plants. The pairs included in the categories of chronic infectious diseases and transmissible infectious diseases were considered to be of higher adaptive value, whereas those included in the category of common conditions were considered to be of lower adaptive value. Pairs grouped into the category of emerging and reemerging diseases were employed to investigate conformity bias; pairs belonging to the category esthetic uses were considered to be of little adaptive relevance and utilized as an experimental control. Our results revealed that plant-disease pairs associated with the category of common conditions, considered by us to be of lower severity and less adaptive relevance for humans, were better remembered and retained in the participants' memory. We believe that prior experience with common conditions and the frequency of these conditions in the population may have intensified the ability to remember the plant-disease pairs associated with this group of diseases.
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Affiliation(s)
- Risoneide Henriques da Silva
- Programa de Pós-Graduação em Botânica, Universidade Federal Rural de Pernambuco, Recife, Pernambuco, Brazil
- Laboratório de Ecologia e Evolução de Sistemas Socioecológicos (LEA), Centro de Biociências, Departamento de Botânica, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
| | | | - Patrícia Muniz de Medeiros
- Grupo de Etnobiologia e Ecologia Humana, Centro de Ciências Agrárias, Universidade Federal de Alagoas, Rio Largo, Alagoas, Brazil
| | - Ulysses Paulino Albuquerque
- Laboratório de Ecologia e Evolução de Sistemas Socioecológicos (LEA), Centro de Biociências, Departamento de Botânica, Universidade Federal de Pernambuco, Recife, Pernambuco, Brazil
- * E-mail:
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Miles R, Wan F, Onega TL, Lenderink-Carpenter A, O'Meara ES, Zhu W, Henderson LM, Haas JS, Hill DA, Tosteson ANA, Wernli KJ, Alford-Teaster J, Lee JM, Lehman CD, Lee CI. Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk. J Womens Health (Larchmt) 2018; 27:748-754. [PMID: 29341851 DOI: 10.1089/jwh.2017.6623] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection. MATERIALS AND METHODS We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use. RESULTS Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74). CONCLUSIONS While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.
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Affiliation(s)
- Randy Miles
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Fei Wan
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Tracy L Onega
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | | | - Ellen S O'Meara
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Weiwei Zhu
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Louise M Henderson
- 5 Department of Radiology, University of North Carolina , Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer S Haas
- 6 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Deirdre A Hill
- 7 Department of Internal Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Anna N A Tosteson
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Karen J Wernli
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Jennifer Alford-Teaster
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Janie M Lee
- 8 Department of Radiology, University of Washington School of Medicine , Seattle, Washington
| | - Constance D Lehman
- 9 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Christoph I Lee
- 10 Department of Radiology, University of Washington School of Medicine ; Department of Health Services, University of Washington School of Public Health ; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
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17
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April-Sanders A, Oskar S, Shelton RC, Schmitt KM, Desperito E, Protacio A, Tehranifar P. Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population. Womens Health Issues 2016; 27:237-244. [PMID: 27863982 DOI: 10.1016/j.whi.2016.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 09/01/2016] [Accepted: 10/10/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Worry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations. METHODS We collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression. RESULTS In multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28-2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23-6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation. CONCLUSIONS In Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates.
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Affiliation(s)
- Ayana April-Sanders
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Sabine Oskar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, New York
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York; Division of Academics, School of Nursing, Columbia University, New York, New York; Avon Foundation Breast Imaging Center-New York Presbyterian, New York, New York
| | - Elise Desperito
- Department of Radiology, Columbia University Medical Center-New York Presbyterian, New York, New York
| | - Angeline Protacio
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.
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18
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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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19
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Flores KG, Steffen LE, McLouth CJ, Vicuña BE, Gammon A, Kohlmann W, Vigil L, Dayao ZR, Royce ME, Kinney AY. Factors Associated with Interest in Gene-Panel Testing and Risk Communication Preferences in Women from BRCA1/2 Negative Families. J Genet Couns 2016; 26:480-490. [PMID: 27496122 DOI: 10.1007/s10897-016-0001-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 07/18/2016] [Indexed: 12/12/2022]
Abstract
Scientific advances have allowed the development of multiplex gene-panels to assess many genes simultaneously in women who have tested negative for BRCA1/2. We examined correlates of interest in testing for genes that confer modest and moderate breast cancer risk and risk communication preferences for women from BRCA negative families. Female first-degree relatives of breast cancer patients who tested negative for BRCA1/2 mutations (N = 149) completed a survey assessing multiplex genetic testing interest and risk communication preferences. Interest in testing was high (70 %) and even higher if results could guide risk-reducing behavior changes such as taking medications (79 %). Participants preferred to receive genomic risk communications from a variety of sources including: primary care physicians (83 %), genetic counselors (78 %), printed materials (71 %) and the web (60 %). Factors that were independently associated with testing interest were: perceived lifetime risk of developing cancer (odds ratio (OR) = 1.67: 95 % confidence interval (CI) 1.06-2.65) and high cancer worry (OR = 3.12: CI 1.28-7.60). Findings suggest that women from BRCA1/2 negative families are a unique population and may be primed for behavior change. Findings also provide guidance for clinicians who can help develop genomic risk communications, promote informed decision making and customize behavioral interventions.
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Affiliation(s)
- Kristina G Flores
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.
| | - Laurie E Steffen
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | | | - Belinda E Vicuña
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.,Department of Psychology, University of New Mexico, Albuquerque, NM, USA
| | - Amanda Gammon
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Wendy Kohlmann
- Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA
| | - Lucretia Vigil
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA
| | - Zoneddy R Dayao
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.,Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Melanie E Royce
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.,Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
| | - Anita Y Kinney
- University of New Mexico Comprehensive Cancer Center, University of New Mexico, MSC07 4025, 2325 Camino de Salud NE, Albuquerque, NM, 87131-0001, USA.,Department of Internal Medicine, University of New Mexico, Albuquerque, NM, USA
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20
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Terry MB, Goldberg M, Schechter S, Houghton LC, White ML, O’Toole K, Chung WK, Daly MB, Keegan TH, Andrulis IL, Bradbury AR, Schwartz L, Knight JA, John EM, Buys SS. Comparison of Clinical, Maternal, and Self Pubertal Assessments: Implications for Health Studies. Pediatrics 2016; 138:peds.2015-4571. [PMID: 27279647 PMCID: PMC4925080 DOI: 10.1542/peds.2015-4571] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/28/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Most epidemiologic studies of puberty have only 1 source of pubertal development information (maternal, self or clinical). Interpretation of results across studies requires data on reliability and validity across sources. METHODS The LEGACY Girls Study, a 5-site prospective study of girls aged 6 to 13 years (n = 1040) collected information on breast and pubic hair development from mothers (for all daughters) and daughters (if ≥10 years) according to Tanner stage (T1-5) drawings. At 2 LEGACY sites, girls (n = 282) were also examined in the clinic by trained professionals. We assessed agreement (κ) and validity (sensitivity and specificity) with the clinical assessment (gold standard) for both the mothers' and daughters' assessment in the subcohort of 282. In the entire cohort, we examined the agreement between mothers and daughters. RESULTS Compared with clinical assessment, sensitivity of maternal assessment for breast development was 77.2 and specificity was 94.3. In girls aged ≥11 years, self-assessment had higher sensitivity and specificity than maternal report. Specificity for both mothers and self, but not sensitivity, was significantly lower for overweight girls. In the overall cohort, maternal and daughter agreement for breast development and pubic hair development (T2+ vs T1) were similar (0.66, [95% confidence interval 0.58-0.75] and 0.69 [95% confidence interval 0.61-0.77], respectively), but declined with age. Mothers were more likely to report a lower Tanner stage for both breast and pubic hair compared with self-assessments. CONCLUSIONS These differences in validity should be considered in studies measuring pubertal changes longitudinally when they do not have access to clinical assessments.
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Affiliation(s)
- Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Herbert Irving Comprehensive Cancer Center and
| | - Mandy Goldberg
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Sarah Schechter
- Columbia University College of Physicians and Surgeons, New York, New York
| | - Lauren C. Houghton
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Melissa L. White
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Karen O’Toole
- Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, Utah
| | - Wendy K. Chung
- Herbert Irving Comprehensive Cancer Center and,Departments of Pediatrics and Medicine, Columbia University Medical Center, New York, New York
| | - Mary B. Daly
- Department of Clinical Genetics, Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - Theresa H.M. Keegan
- Division of Hematology and Oncology, University of California (UC) Davis School of Medicine, and UC Davis Comprehensive Cancer Center, Sacramento, California
| | - Irene L. Andrulis
- Department of Molecular Genetics and,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Angela R. Bradbury
- Departments of Medicine and Hematology/Oncology,,Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Lisa Schwartz
- Department of Pediatrics, Division of Oncology, The Children’s Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Julia A. Knight
- Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada;,Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Esther M. John
- Cancer Prevention Institute of California, Fremont, California; and,Department of Health Research and Policy (Epidemiology), Stanford University School of Medicine, and Stanford Cancer Institute, Stanford, California USA
| | - Saundra S. Buys
- Department of Medicine, University of Utah Health Sciences Center, Huntsman Cancer Institute, Salt Lake City, Utah
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21
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Sollie A, Helsper CW, Ader RJM, Ausems MGEM, van der Wouden JC, Numans ME. Primary care management of women with breast cancer-related concerns-a dynamic cohort study using a network database. Eur J Cancer Care (Engl) 2016; 25:1005-1014. [PMID: 27302697 DOI: 10.1111/ecc.12526] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 01/06/2023]
Abstract
The aim of this study was to determine the incidence, management and diagnostic outcomes of breast cancer-related concerns presented in primary care. A dynamic cohort study was performed in the anonymised routine electronic medical records (EMRs) extracted from 49 General Practices in the Netherlands (163,471 person-years, women aged 18-75). Main Outcome Measures were: (1) incidence rates for breast cancer-related concerns in Primary Care, (2) proportions of these women with and without symptoms of the breast referred for further investigation, (3) proportions of referrals (not) according to the guideline and (4) proportions of women with breast cancer-related concerns diagnosed with breast cancer during follow-up. Breast cancer-related concerns are presented frequently in Primary Care (incidence rate 25.9 per 1,000 women annually). About half these women are referred for further investigation. There is room to improve General Practitioner management, mainly for women with an increased lifetime risk of developing breast cancer. Information concerning family history of cancer is often missing in the EMR. Since cancer is rarely diagnosed during follow-up, particularly when symptoms are absent, reduction of unnecessary concerns is plausible if identification of those without an increased risk is improved.
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Affiliation(s)
- A Sollie
- Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands. .,Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands.
| | - C W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - R J M Ader
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - M G E M Ausems
- Department of Medical Genetics, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - J C van der Wouden
- Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - M E Numans
- Department of General Practice & Elderly Care Medicine, VU University Medical Centre and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, The Netherlands
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22
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Ribeiro Seabra C, Peuker AC, Armiliato MJ, Alves de Souza ML, Kern de Castro E. Early detection of breast cancer: the role of risk perception and family history. PSICOONCOLOGIA 1970. [DOI: 10.5209/psic.55813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Breast cancer is the neoplasm with the highest mortality rates among Brazilian women. Family history plays an important role in tracking the illness because its analysis reveals possible genetic risks. Objective: The aim of this study is to compare the risk perception and self-care for breast cancer among healthy women with and without family history. Method: The study included 211 women (mean age = 59.11 years, SD = 8.54) of which 55 (26.4%) had a family history of the illness. The instruments used were a sociodemographic and health behavior questionnaire and a risk perception questionnaire. Results and Conclusions: The results showed no significant differences in risk perception and self-care behavior among women with and without breast cancer history, signaling the need of guidelines for psychologists to act in breast cancer prevention among women with a family history, encompassing understanding of the risk factors and causes of the illness as well as women’s responsibility in tracking.
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