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Lee Argov EJ, Rodriguez CB, Agovino M, Schmitt KM, Desperito E, Karr AG, Wei Y, Terry MB, Tehranifar P. Screening mammography frequency following dense breast notification among a predominantly Hispanic/Latina screening cohort. Cancer Causes Control 2024; 35:1133-1142. [PMID: 38607569 DOI: 10.1007/s10552-024-01871-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 03/11/2024] [Indexed: 04/13/2024]
Abstract
PURPOSE Nationally legislated dense breast notification (DBN) informs women of their breast density (BD) and the impact of BD on breast cancer risk and detection, but consequences for screening participation are unclear. We evaluated the association of DBN in New York State (NYS) with subsequent screening mammography in a largely Hispanic/Latina cohort. METHODS Women aged 40-60 were surveyed in their preferred language (33% English, 67% Spanish) during screening mammography from 2016 to 2018. We used clinical BD classification from mammography records from 2013 (NYS DBN enactment) through enrollment (baseline) to create a 6-category variable capturing prior and new DBN receipt (sent only after clinically dense mammograms). We used this variable to compare the number of subsequent mammograms (0, 1, ≥ 2) from 10 to 30 months after baseline using ordinal logistic regression. RESULTS In a sample of 728 women (78% foreign-born, 72% Hispanic, 46% high school education or less), first-time screeners and women who received DBN for the first time after prior non-dense mammograms had significantly fewer screening mammograms within 30 months of baseline (Odds Ratios range: 0.33 (95% Confidence Interval (CI) 0.12-0.85) to 0.38 (95% CI 0.17-0.82)) compared to women with prior mammography but no DBN. There were no differences in subsequent mammogram frequency between women with multiple DBN and those who never received DBN. Findings were consistent across age, language, health literacy, and education groups. CONCLUSION Women receiving their first DBN after previous non-dense mammograms have lower mammography participation within 2.5 years. DBN has limited influence on screening participation of first-time screeners and those with persistent dense mammograms.
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Affiliation(s)
- Erica J Lee Argov
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
- Division of Academics, Columbia University School of Nursing, New York, NY, USA
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, NY, USA
| | - Anita G Karr
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, USA
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168Th St., New York, NY, 10032, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, NY, USA.
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Wielema M, Sijens PE, Pijnappel RM, De Bock GH, Zorgdrager M, Kok MGJ, Rainer E, Varga R, Clauser P, Oudkerk M, Dorrius MD, Baltzer PAT. Image quality of DWI at breast MRI depends on the amount of fibroglandular tissue: implications for unenhanced screening. Eur Radiol 2024; 34:4730-4737. [PMID: 38008743 PMCID: PMC11213722 DOI: 10.1007/s00330-023-10321-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 06/29/2023] [Accepted: 07/05/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES To compare image quality of diffusion-weighted imaging (DWI) and contrast-enhanced breast MRI (DCE-T1) stratified by the amount of fibroglandular tissue (FGT) as a measure of breast density. METHODS Retrospective, multi-reader, bicentric visual grading analysis study on breast density (A-D) and overall image and fat suppression quality of DWI and DCE-T1, scored on a standard 5-point Likert scale. Cross tabulations and visual grading characteristic (VGC) curves were calculated for fatty breasts (A/B) versus dense breasts (C/D). RESULTS Image quality of DWI was higher in the case of increased breast density, with good scores (score 3-5) in 85.9% (D) and 88.4% (C), compared to 61.6% (B) and 53.5% (A). Overall image quality of DWI was in favor of dense breasts (C/D), with an area under the VGC curve of 0.659 (p < 0.001). Quality of DWI and DCE-T1 fat suppression increased with higher breast density, with good scores (score 3-5) for 86.9% and 45.7% of density D, and 90.2% and 42.9% of density C cases, compared to 76.0% and 33.6% for density B and 54.7% and 29.6% for density A (DWI and DCE-T1 respectively). CONCLUSIONS Dense breasts show excellent fat suppression and substantially higher image quality in DWI images compared with non-dense breasts. These results support the setup of studies exploring DWI-based MR imaging without IV contrast for additional screening of women with dense breasts. CLINICAL RELEVANCE STATEMENT Our findings demonstrate that image quality of DWI is robust in women with an increased amount of fibroglandular tissue, technically supporting the feasibility of exploring applications such as screening of women with mammographically dense breasts. KEY POINTS • Image and fat suppression quality of diffusion-weighted imaging are dependent on the amount of fibroglandular tissue (FGT) which is closely connected to breast density. • Fat suppression quality in diffusion-weighted imaging of the breast is best in women with a high amount of fibroglandular tissue. • High image quality of diffusion-weighted imaging in women with a high amount of FGT in MRI supports that the technical feasibility of DWI can be explored in the additional screening of women with mammographically dense breasts.
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Affiliation(s)
- Mirjam Wielema
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Paul E Sijens
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Ruud M Pijnappel
- Department of Radiology, Utrecht University, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Geertruida H De Bock
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marcel Zorgdrager
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Marius G J Kok
- Department of Radiology, Medisch Spectrum Twente, Enschede, the Netherlands
| | - Eva Rainer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Raoul Varga
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | | | - Monique D Dorrius
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
- Department of Epidemiology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Pascal A T Baltzer
- Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria.
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Isautier JMJ, Wang S, Houssami N, McCaffery K, Brennan ME, Li T, Nickel B. The impact of breast density notification on psychosocial outcomes in racial and ethnic minorities: A systematic review. Breast 2024; 74:103693. [PMID: 38430905 PMCID: PMC10918326 DOI: 10.1016/j.breast.2024.103693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 02/11/2024] [Accepted: 02/13/2024] [Indexed: 03/05/2024] Open
Abstract
BACKGROUND High breast density is an independent risk factor for breast cancer and decreases the sensitivity of mammography. This systematic review synthesizes the evidence on the impact of breast density (BD) information and/or notification on women's psychosocial outcomes among women from racial and ethnic minority groups. METHODS A systematic search was performed in March 2023, and the articles were identified using CINHAL, Embase, Medline, and PsychInfo databases. The search strategy combined the terms "breast", "density", "notification" and synonyms. The authors specifically kept the search terms broad and did not include terms related to race and ethnicity. Full-text articles were reviewed for analysis by race, ethnicity and primary language of participants. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. RESULTS Of 1784 articles, 32 articles published from 2003 to 2023 were included. Thirty-one studies were conducted in the United States and one in Australia, with 28 quantitative and four qualitative methodologies. The overall results in terms of breast density awareness, knowledge, communication with healthcare professionals, screening intentions and supplemental screening practice were heterogenous across studies. Barriers to understanding BD notifications and intentions/access to supplemental screening among racial and ethnic minorities included socioeconomic factors, language, health literacy and medical mistrust. CONCLUSIONS A one-size approach to inform women about their BD may further disadvantage racial and ethnic minority women. BD notification and accompanying information should be tailored and translated to ensure readability and understandability by all women.
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Affiliation(s)
- J M J Isautier
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia
| | - S Wang
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - N Houssami
- Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia; The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - K McCaffery
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia
| | - M E Brennan
- Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Sydney, Australia; National School of Medicine, University of Notre Dame Australia, Sydney, Australia
| | - T Li
- The Daffodil Centre, The University of Sydney, a Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
| | - B Nickel
- The University of Sydney, Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, New South Wales Australia; Wiser Healthcare, School of Public Health, The University of Sydney, New South Wales, Australia.
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Nave O, Shor Y, Bar R, Segal EE, Sigron M. A new treatment for breast cancer using a combination of two drugs: AZD9496 and palbociclib. Sci Rep 2024; 14:1307. [PMID: 38225243 PMCID: PMC10789805 DOI: 10.1038/s41598-023-48305-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 11/24/2023] [Indexed: 01/17/2024] Open
Abstract
In this study, we examined a mathematical model of breast cancer (BC) treatment that combines an oral oestrogen receptor inhibitor, AZD9496 with Palbociclib, a selective inhibitor of cyclin- dependent kinases CDK4 and CDK6. Treatment is described by analytical functions that enable us to control the dosage and time interval of the treatment, thus personalising the treatment for each patient. Initially, we investigated the effect of each treatment separately, and finally, we investigated the combination of both treatments. By applying numerical simulations, we confirmed that the combination of AZD9496 with palbociclib was the optimal treatment for BC. The dosage of AZD9496 increased and decreased throughout the treatment period, while the intervals were constant between treatments. Palbociclib changed almost cyclically, whereas the time intervals remained constant. To investigate the mathematical model, we applied the singularly perturbed homotopy analysis method, which is a numerical algorithm. The significant advantage of this method is that the mathematical model does not have to contain a small parameter (as is standard in perturbation theory). However, it is possible to artificially introduce a small parameter into the system of equations, making it possible to study the model using asymptotic methods.
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Affiliation(s)
- Ophir Nave
- Department of Mathematics, Faculty of Science, Jerusalem College of Technology (JCT), Academic Level Centre, Jerusalem, Israel.
| | - Yehuda Shor
- Department of Computer Science, Jerusalem College of Technology (Mivchar), Jerusalem, Israel
| | - Raziel Bar
- Department of Computer Science, Jerusalem College of Technology (Mivchar), Jerusalem, Israel
| | - Eliezer Elimelech Segal
- Department of Computer Science, Jerusalem College of Technology (Mivchar), Jerusalem, Israel
| | - Moriah Sigron
- Department of Mathematics, Faculty of Science, Jerusalem College of Technology (JCT), Academic Level Centre, Jerusalem, Israel
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Sociodemographic Variations in Women's Reports of Discussions With Clinicians About Breast Density. JAMA Netw Open 2023; 6:e2344850. [PMID: 38010653 PMCID: PMC10682834 DOI: 10.1001/jamanetworkopen.2023.44850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/14/2023] [Indexed: 11/29/2023] Open
Abstract
Importance Breast density notifications advise women to discuss breast density with their clinicians, yet little is known about such discussions. Objectives To examine the content of women's reports of breast density discussions with clinicians and identify variations by women's sociodemographic characteristics (age, income, state legislation status, race and ethnicity, and literacy level). Design, Setting, and Participants This US nationwide, population-based, random-digit dial telephone survey study was conducted from July 1, 2019, to April 30, 2020, among 2306 women aged 40 to 76 years with no history of breast cancer who underwent mammography in the prior 2 years and had heard the term dense breasts or breast density. Results were analyzed from a subsample of 770 women reporting a conversation about breast density with their clinician after their last mammographic screening. Statistical analysis was conducted in April and July 2023. Main Outcomes and Measures Survey questions inquired whether women's clinicians had asked about breast cancer risk or their worries or concerns about breast density, had discussed mammography results or other options for breast cancer screening or their future risk of breast cancer, as well as the extent to which the clinician answered questions about breast density. Results Of the 770 women (358 [47%] aged 50-64 years; 47 Asian [6%], 125 Hispanic [16%], 204 non-Hispanic Black [27%], 317 non-Hispanic White [41%], and 77 other race and ethnicity [10%]) whose results were analyzed, most reported that their clinicians asked questions about breast cancer risk (88% [670 of 766]), discussed mammography results (94% [724 of 768]), and answered patient questions about breast density (81% [614 of 761]); fewer women reported that clinicians had asked about worries or concerns about breast density (69% [524 of 764]), future risk of breast cancer (64% [489 of 764]), or other options for breast cancer screening (61% [459 of 756]). Women's reports of conversations varied significantly by race and ethnicity; non-Hispanic Black women reported being asked questions about breast cancer risk more often than non-Hispanic White women (odds ratio [OR], 2.08 [95% CI, 1.05-4.10]; P = .04). Asian women less often reported being asked about their worries or concerns (OR, 0.42 [95% CI, 0.20-0.86]; P = .02), and Hispanic and Asian women less often reported having their questions about breast density answered completely or mostly (Asian: OR, 0.28 [95% CI, 0.13-0.62]; P = .002; Hispanic: OR, 0.48 [95% CI, 0.27-0.87]; P = .02). Women with low literacy were less likely than women with high literacy to report being asked about worries or concerns about breast density (OR, 0.64 [95% CI, 0.43-0.96]; P = .03), that mammography results were discussed with them (OR, 0.32 [95% CI, 0.16-0.63]; P = .001), or that their questions about breast density were answered completely or mostly (OR, 0.51 [95% CI, 0.32-0.81]; P = .004). Conclusions and Relevance In this survey study, although most women reported that their clinicians counselled them about breast density, the unaddressed worries or concerns and unanswered questions, especially among Hispanic and Asian women and those with low literacy, highlighted areas where discussions could be improved.
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Affiliation(s)
- Nancy R. Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
- Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Brown AL, Vijapura C, Patel M, De La Cruz A, Wahab R. Breast Cancer in Dense Breasts: Detection Challenges and Supplemental Screening Opportunities. Radiographics 2023; 43:e230024. [PMID: 37792590 DOI: 10.1148/rg.230024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Dense breast tissue at mammography is associated with higher breast cancer incidence and mortality rates, which have prompted new considerations for breast cancer screening in women with dense breasts. The authors review the definition and classification of breast density, density assessment methods, breast cancer risk, current legislation, and future efforts and summarize trials and key studies that have affected the existing guidelines for supplemental screening. Cases of breast cancer in dense breasts are presented, highlighting a variety of modalities and specific imaging findings that can aid in cancer detection and staging. Understanding the current state of breast cancer screening in patients with dense breasts and its challenges is important to shape future considerations for care. Shifting the paradigm of breast cancer detection toward early diagnosis for women with dense breasts may be the answer to reducing the number of deaths from this common disease. ©RSNA, 2023 Online supplemental material is available for this article. Quiz questions for this article are available through the Online Learning Center. See the invited commentary by Yeh in this issue.
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Affiliation(s)
- Ann L Brown
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Charmi Vijapura
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Mitva Patel
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Alexis De La Cruz
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
| | - Rifat Wahab
- From the Department of Radiology, University of Cincinnati Medical Center, 3188 Bellevue Ave, Cincinnati, OH 45219-0772 (A.L.B., C.V., A.D.L.C., R.W.); and Department of Radiology, Ohio State University Medical Center, Columbus, Ohio (M.P.)
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Gauci SL, Couto JG, Mizzi D. Survey of knowledge and awareness of breast density amongst Maltese Women undergoing mammography screening. Radiography (Lond) 2023; 29:911-917. [PMID: 37473492 DOI: 10.1016/j.radi.2023.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 06/12/2023] [Accepted: 07/07/2023] [Indexed: 07/22/2023]
Abstract
INTRODUCTION The ratio of breast glandular tissue to fatty tissue is known as breast density. This study assessed the knowledge and awareness of breast density of Maltese women undergoing mammography screening at the National Screening Unit. Increased breast density knowledge may lead to an increase in supplementary imaging attendance. In Europe, there are very limited studies assessing the knowledge and awareness of breast density, providing a solid rationale for this study to be done locally. METHODS Women aged 50 to 69 who were eligible for breast cancer screening at the National Screening Unit were given a validated closed-ended questionnaire as part of a quantitative, prospective, cross-sectional, and descriptive study. The questionnaire was designed to achieve the aims of the study. Using IBM-SPSS (v28) software, the data was analysed using the Friedman and Kruskal Wallis tests. RESULTS A total of 127 surveys were gathered, with a maximum margin of error of 8.66% based on a 95% confidence range. Breast density and the risks associated with it were not well known or understood (average scores ranging from 2.80 to 3.34 out of 5), but supplemental screening was more widely known (3.65). Participants' knowledge and awareness were correlated with their age, profession, and degree of education. Leaflets (40%) and medical experts (40%) were respondents' favourite sources of information. CONCLUSION The population under study lacks knowledge and awareness of breast density and the risks it entails. It's important to provide women more details about breast density. With this information, women will be empowered to seek the finest care. IMPLICATIONS FOR PRACTICE Although some socio-demographic parameters were linked to women's knowledge and awareness, it is advised that more research be done using a bigger sample size through interviews and other studies. Moreover, more information regarding breast density must be provided to women undergoing breast cancer screening in Malta to increase their knowledge and awareness.
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Affiliation(s)
- S L Gauci
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - J G Couto
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
| | - D Mizzi
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta.
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Berg WA, Bandos AI, Sava MG. Analytic Hierarchy Process Analysis of Patient Preferences for Contrast-Enhanced Mammography Versus MRI as Supplemental Screening Options for Breast Cancer. J Am Coll Radiol 2023; 20:758-768. [PMID: 37394083 DOI: 10.1016/j.jacr.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 04/20/2023] [Accepted: 05/03/2023] [Indexed: 07/04/2023]
Abstract
OBJECTIVE To guide implementation of supplemental breast screening by assessing patient preferences for contrast-enhanced mammography (CEM) versus MRI using analytic hierarchy process (AHP) methodology. METHODS In an institutional review board-approved, HIPAA-compliant protocol, from March 23 to June 3, 2022, we contacted 579 women who had both CEM screening and MRI. Women were e-mailed an invitation to complete an online survey developed using an AHP-based model to elicit preferences for CEM or MRI. Methods for categorical data analysis were used to evaluate factors affecting preferences, under the Bonferroni correction for multiplicity. RESULTS Complete responses were received from 222 (38.3%) women; the 189 women with a personal history of breast cancer had a mean age 61.8 years, and the 34 women without a personal history of breast cancer had a mean age of 53.6 years. Of 222 respondents, 157 (70.7%, confidence interval [CI]: 64.7-76.7) were determined to prefer CEM to MRI. Breast positioning was the most important criterion for 74 of 222 (33.3%) respondents, with claustrophobia, intravenous line placement, and overall stress most important for 38, 37, and 39 women (17.1%, 16.7%, and 17.6%), respectively, and noise level, contrast injection, and indifference being emphasized least frequently (by 10 [4.5%], 11 [5.0%], and 13 [5.9%] women, respectively). CEM preference was most prevalent (MRI least prevalent) for respondents emphasizing claustrophobia (37 of 38 [97%], CI: 86.2-99.9); CEM preference was least prevalent (MRI most prevalent) for respondents emphasizing breast positioning (40 of 74 [54%], CI: 42.1-65.7). CONCLUSIONS AHP-based modeling reveals strong patient preferences for CEM over MRI, with claustrophobia favoring preference for CEM and breast positioning relatively favoring preference for MRI. Our results should help guide implementation of screening CEM and MRI.
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Affiliation(s)
- Wendie A Berg
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, Pennsylvania; ACR and the Society of Breast Imaging, Honorary Fellow of the Austrian Roentgen Society, and voluntary Chief Scientific Advisor to DenseBreast-info website.
| | - Andriy I Bandos
- Department of Biostatistics, University of Pittsburgh School of Public Health, Pittsburgh, Pennsylvania
| | - M Gabriela Sava
- Wilbur O. and Ann Powers College of Business, Clemson University, Clemson, South Carolina; current affiliation: Department of Applied Statistics and Operations Research, Allen W. and Carol M. Schmidhorst College of Business, Bowling Green State University, Bowling Green, Ohio
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Women's Reactions to Breast Density Information Vary by Sociodemographic Characteristics. Womens Health Issues 2023; 33:435-442. [PMID: 37087312 PMCID: PMC10330326 DOI: 10.1016/j.whi.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 02/27/2023] [Accepted: 03/07/2023] [Indexed: 04/24/2023]
Abstract
BACKGROUND Breast density information aims to increase awareness of breast density and its risks and to foster more informed future breast screening decisions among women with dense breasts. We explored associations between such information and outcomes including anxiety, confusion, or feeling informed, and whether they varied by race/ethnicity or literacy, or differentially affected future mammography plans. METHODS A national telephone survey of a diverse sample of women previously informed of personal breast density (N = 1,322) assessed reactions to receipt of breast density information and future mammography plans. RESULTS Most women (86%) felt informed after receiving personal breast density information; however, some felt anxious (15%) or confused (11%). Reactions varied significantly by sociodemographics; non-Hispanic Black, Asian, and Hispanic women and women with low literacy were nearly two to three times more likely to report anxiety than non-Hispanic White women (all ps < .05). Asian women and those with low literacy less often felt informed and more often felt confused. Non-Hispanic Black and Asian women were nearly twice as likely to report that knowing their breast density made them more likely to have future mammograms. Women with low literacy were more likely to change mammography plans, with some being more likely and others less likely to plan to have future mammograms. Greater anxiety and confusion were associated with higher likelihood of planning future mammograms; those feeling informed were less likely to plan future mammography. CONCLUSIONS Differential reactions to breast density information are concerning if associated with disparate future screening plans. Future breast density education efforts should ensure that such information is readily accessible and understandable to all women in order to lead to desired effects.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J Slanetz
- Department of Radiology, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts; The Dartmouth Institute for Health Policy and Clinical Practice and Dartmouth Cancer Center, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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Beidler LB, Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. Perceptions of Breast Cancer Risks Among Women Receiving Mammograph Screening. JAMA Netw Open 2023; 6:e2252209. [PMID: 36689223 PMCID: PMC9871800 DOI: 10.1001/jamanetworkopen.2022.52209] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 12/02/2022] [Indexed: 01/24/2023] Open
Abstract
Importance Breast density is an independent risk factor for breast cancer. Despite the proliferation of mandated written notifications about breast density following mammography, there is little understanding of how women perceive the relative breast cancer risk associated with breast density. Objective To assess women's perception of breast density compared with other breast cancer risks and explore their understanding of risk reduction. Design, Setting, and Participants This mixed-methods qualitative study used telephone surveys and semistructured interviews to investigate perceptions about breast cancer risk among a nationally representative, population-based sample of women. Eligible study participants were aged 40 to 76 years, reported having recently undergone mammography, had no history of prior breast cancer, and had heard of breast density. Survey participants who had been informed of their personal breast density were invited for a qualitative interview. Survey administration spanned July 1, 2019, to April 30, 2020, with 2306 women completing the survey. Qualitative interviews were conducted from February 1 to May 30, 2020. Main Outcomes and Measures Respondents compared the breast cancer risk associated with breast density with 5 other risk factors. Participants qualitatively described what they thought contributed to breast cancer risk and ways to reduce risk. Results Of the 2306 women who completed the survey, 1858 (166 [9%] Asian, 503 [27%] Black, 268 [14%] Hispanic, 792 [43%] White, and 128 [7%] other race or ethnicity; 358 [19%] aged 40-49 years, 906 [49%] aged 50-64 years, and 594 [32%] aged ≥65 years) completed the revised risk perception questions and were included in the analysis. Half of respondents thought breast density to be a greater risk than not having children (957 [52%]), having more than 1 alcoholic drink per day (975 [53%]), or having a prior breast biopsy (867 [48%]). Most respondents felt breast density was a lesser risk than having a first-degree relative with breast cancer (1706 [93%]) or being overweight or obese (1188 [65%]). Of the 61 women who were interviewed, 6 (10%) described breast density as contributing to breast cancer risk, and 43 (70%) emphasized family history as a breast cancer risk factor. Of the interviewed women, 17 (28%) stated they did not know whether it was possible to reduce their breast cancer risk. Conclusions and Relevance In this qualitative study of women of breast cancer screening age, family history was perceived as the primary breast cancer risk factor. Most interviewees did not identify breast density as a risk factor and did not feel confident about actions to mitigate breast cancer risk. Comprehensive education about breast cancer risks and prevention strategies is needed.
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Affiliation(s)
- Laura B. Beidler
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
| | - Nancy R. Kressin
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | | | - Tracy A. Battaglia
- Section of General Internal Medicine, Boston University Chobanian and Avedesian School of Medicine, Boston, Massachusetts
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Christine M. Gunn
- Dartmouth Cancer Center, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire
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11
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Kressin NR, Wormwood JB, Battaglia TA, Slanetz PJ, Gunn CM. A letter is not enough: Women's preferences for and experiences of receiving breast density information. PATIENT EDUCATION AND COUNSELING 2022; 105:2450-2456. [PMID: 35534300 PMCID: PMC9250336 DOI: 10.1016/j.pec.2022.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Despite evidence of disparate uptake of breast density (BD) information, little is known about diverse women's preferences for and experiences learning about BD. METHODS Telephone survey among 2306 racially/ethnically and literacy diverse women; qualitative interviews with 61 survey respondents. Responses by participant race/ethnicity and literacy were examined using bivariate, then multivariable analyses. Interviews were content-analyzed for themes. RESULTS Most women (80%) preferred learning of personal BD from providers, with higher rates among Non-Hispanic Black (85%) than Non-Hispanic White women (80%); and among Non-Hispanic White than Asian women (72%, all ps<0.05). Women with low literacy less often preferred receiving BD information from providers (76% v. 81%), more often preferring written notification (21% vs. 10%); women with high literacy more often preferred learning through an online portal (9% vs 3%). Most women (93%) received BD information from providers (no between group differences). Qualitative findings detailed women's desires for obtaining BD information from providers, written information, and visual depictions of BD. CONCLUSIONS When educating women about BD, one size does not fit all. PRACTICE IMPLICATIONS Additional educational methods are needed beyond written BD notifications to sufficiently address the varying informational needs and preferences of all USA women.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Priscilla J Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, NH, USA
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12
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Kressin NR, Wormwood JB, Battaglia TA, Maschke AD, Slanetz PJ, Pankowska M, Gunn CM. Women's Understandings and Misunderstandings of Breast Density and Related Concepts: A Mixed Methods Study. J Womens Health (Larchmt) 2022; 31:983-990. [PMID: 35230164 PMCID: PMC9299527 DOI: 10.1089/jwh.2021.0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Most U.S. states require written notification of breast density after mammograms, yet effects of notifications on knowledge are mixed. Little is known about potential misunderstandings. Methods: We used a sequential mixed-methods study design to assess women's knowledge about breast density, after receiving a notification. We conducted a telephone survey among a racially/ethnically and health-literacy level diverse sample (N = 754) and qualitative interviews with 61 survey respondents. Results: In survey results, 58% of women correctly indicated that breast density is not related to touch, with higher accuracy among non-Hispanic White women and those with greater health literacy. Next, 87% of women recognized that breast density is identified visually via mammogram, with no significant differences in responses by race/ethnicity or health literacy. Most (81%) women recognized that a relationship exists between breast tissue types and density; Non-Hispanic White women were less likely to respond correctly. Only 47% of women correctly indicated that having dense breasts increases one's risk of breast cancer; women with low health literacy were more often correct. Qualitative results revealed additional dimensions of understanding: Some women incorrectly reported that density could be felt, or dense breasts were lumpier, thicker, or more compacted; others identified "dense" tissue as fatty. Interpretations of risk included that breast density was an early form of breast cancer. Conclusion: We found areas of consistent knowledge and identified misperceptions surrounding breast density across race/ethnicity and health literacy levels. Further education to address disparities and correct misunderstandings is essential to promote better knowledge, to foster informed decisions.
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Affiliation(s)
- Nancy R. Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jolie B. Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire, USA
| | - Tracy A. Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ariel D. Maschke
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Priscilla J. Slanetz
- Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Magdalena Pankowska
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Christine M. Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine, Dartmouth College, Hanover, New Hampshire, USA
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13
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Smith RE, Sprague B, Henderson LM, Kerlikowske K, Miglioretti DL, Buist DSM, Wernli KJ, Onega T, Schifferdecker K, Jackson-Nefertiti G, Johnson D, Budesky J, Tosteson ANA. Breast Density Knowledge in a Screening Mammography Population Exposed to Density Notification. J Am Coll Radiol 2022; 19:615-624. [PMID: 35341697 PMCID: PMC9119699 DOI: 10.1016/j.jacr.2022.02.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 02/06/2022] [Accepted: 02/11/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVE Women are increasingly informed about their breast density due to state density reporting laws. However, accuracy of personal breast density knowledge remains unclear. We compared self-reported with clinically assessed breast density and assessed knowledge of density implications and feelings about future screening. METHODS From December 2017 to January 2020, we surveyed women aged 40 to 74 years without prior breast cancer, with a normal screening mammogram in the prior year, and ≥1 recorded breast density measures in four Breast Cancer Surveillance Consortium registries with density reporting laws. We measured agreement between self-reported and BI-RADS breast density categorized as "ever-dense" if heterogeneously or extremely dense within the past 5 years or "never-dense" otherwise, knowledge of dense breast implications, and feelings about future screening. RESULTS Survey participation was 28% (1,528 of 5,408), and 59% (896 of 1,528) of participants had ever-dense breasts. Concordance between self-report versus clinical density was 76% (677 of 896) among women with ever-dense breasts and 14% (89 of 632) among women with never-dense breasts, and 34% (217 of 632) with never-dense breasts reported being told they had dense breasts. Desire for supplemental screening was more frequent among those who reported having dense breasts 29% (256 of 893) or asked to imagine having dense breasts 30% (152 of 513) versus those reporting nondense breasts 15% (15 of 102) (P = .003, P = .002, respectively). Women with never-dense breasts had 6.3-fold higher odds (95% confidence interval:3.39-11.80) of accurate knowledge in states reporting density to all compared to states reporting only to women with dense breasts. DISCUSSION Standardized communications of breast density results to all women may increase density knowledge and are needed to support informed screening decisions.
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Affiliation(s)
- Rebecca E Smith
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire.
| | - Brian Sprague
- Associate Professor of Surgery, Director of the Vermont Breast Cancer Surveillance System, and Senior Epidemiologist at the Vermont Center on Behavior and Health, Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Louise M Henderson
- Professor of Radiology, Director of the Carolina Mammography Registry, and Director of the North Carolina Lung Screening Registry, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Professor of Medicine and Epidemiology and Biostatistics, Co-Director of the Women's Clinic, and Director of the Women's Health Fellowship at the San Francisco Veterans Affairs Medical Center, Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, California
| | - Diana L Miglioretti
- Dean's Professor and Division Chief of Biostatistics, Department of Public Health Sciences, University of California, Davis, CA, USA; Principal Investigator of the Breast Cancer Surveillance Consortium (BCSC) Administrative Core, and Affiliate Scientific Investigator, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Diana S M Buist
- Affiliate Professor of Epidemiology, Affiliate Professor of Health Systems and Population Health, and Director of Research and Strategic Partnerships, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Karen J Wernli
- Affiliate Associate Professor of Epidemiology and Affiliate Associate Professor of Health Systems and Population Health, Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Tracy Onega
- Jon M. and Karen Huntsman Presidential Professor in Cancer Research, Senior Director of Population Sciences, and Professor of Population Health Sciences, Department of Population Health Science, Huntsman Cancer Institute, University of Utah, Salt Lake City, Utah
| | - Karen Schifferdecker
- Associate Professor, and Director of the Center for Program Design and Evaluation, The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth College, Lebanon, New Hampshire
| | | | - Dianne Johnson
- Department of Public Health Sciences, University of California, Davis, California
| | - Jill Budesky
- Department of Public Health Sciences, University of California, Davis, California
| | - Anna N A Tosteson
- James J Carroll Professor, The Dartmouth Institute for Health Policy and Clinical Practice, and Departments of Medicine and of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA; and Associate Director for Population Sciences, Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH USA
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14
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Ridgeway JL, Jenkins S, Borah B, Suman VJ, Patel BK, Ghosh K, Rhodes DJ, Norman A, Ramos E, Jewett M, Gonzalez CR, Hernandez V, Singh D, Sosa M, Breitkopf CR, Vachon CM. Evaluating educational interventions to increase breast density awareness among Latinas: A randomized trial in a Federally Qualified Health Center. Cancer 2022; 128:1038-1047. [PMID: 34855208 PMCID: PMC8837698 DOI: 10.1002/cncr.34017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/08/2021] [Accepted: 10/12/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The objective of this randomized trial was to evaluate the short-term effect of bilingual written and interpersonal education regarding mammographic breast density (MBD). METHODS Latinas aged 40 to 74 years who were presenting for screening mammography were recruited and randomized 1:1:1 to receive a letter with their mammogram and MBD results (usual care [UC]), a letter plus a brochure (enhanced care [ENH]), or a letter plus a brochure and telephonic promotora education (interpersonal care [INT]). Surveys were administered at enrollment (T0 ) and 2 weeks to 6 months after intervention delivery (T1 ). Differences were assessed with χ2 , Kruskal-Wallis, and McNemar tests and pairwise comparisons as appropriate. INT metrics and audio recordings were analyzed with descriptive statistics and qualitative content analysis. RESULTS Between October 2016 and October 2019, 943 of 1108 Latina participants (85%) completed both surveys. At T1 , INT participants were more likely (P < .001) to report seeing their MBD results in the letter (70.2%) than UC (53.1%) or ENH participants (55.1%). The percentage of INT women who reported speaking with a provider about MBD (29.0%) was significantly greater (P < .001) than the percentage of UC (14.7%) or ENH participants (15.6%). All groups saw significant (P < .001) but nondifferential improvements in their knowledge of MBD as a masking and risk factor. In the INT group, the promotora delivered education to 77.1% of the 446 participants randomized to INT and answered questions at 28.3% of the encounters for an average of $4.70 per participant. CONCLUSIONS Among Latinas in a low-resource setting, MBD knowledge may increase with written or interpersonal education, but with modest investment, interpersonal education may better improve MBD awareness and prompt patient-provider discussions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Miranda Sosa
- University of Texas Rio Grande Valley, Edinburg and Brownsville, TX
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15
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Marcus EN, Yepes M, Dietz N. Perception of Breast Density Information Among Women in Miami, FL: a Qualitative Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:188-195. [PMID: 32506252 DOI: 10.1007/s13187-020-01778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The US Food and Drug Administration has proposed requiring that all women undergoing mammography receive written information about their breast density. Past research suggests many women may misperceive the meaning of breast density. Additionally, women with dense breasts may not understand the risks and benefits of pursuing additional imaging studies. The goal of this study was to explore women's beliefs about breast density and their preferences for how this information is conveyed. Women with increased breast density detected on mammography at a university-based breast imaging center in South Florida were recruited for a series of focus groups. Twenty-five women participated, ranging in age from 42 to 65 years. Nine women (36%) self-identified as Hispanic/Latina, eight (32%) as Black, four (16%) as White, three (12%) as Asian, and one as "other." Four focus groups were conducted in English and one in Spanish by professional moderators using a semi-structured format. A constant comparative method was used to identify common themes using a general inductive approach. Areas explored included understanding of the term breast density; personal reaction to being informed of dense breasts; questions about breast density; understanding of supplemental screening; and preferences for how to convey breast density information. Subthemes identified included a misperception that breast density is palpable; a feeling of fear on learning of increased breast density results; a concern about what causes increased breast density and whether it can be reversed; a desire to proceed with supplemental ultrasound imaging; and a preference for simple messages explaining the concept of breast density in multiple formats including video. Participants voiced the incorrect belief that caffeine intake could increase breast density and stated that they wanted to know specific details about their personal results. There is a need for better tools to communicate breast density in a way that allays anxiety while enabling women to make fully informed decisions about their breast health. Clinicians and cancer educators should be aware of misperceptions women may have about breast density. Policymakers should keep in mind potential public confusion about this complex topic when crafting density notification rules.
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Affiliation(s)
- Erin N Marcus
- Division of General Medicine, Miller School of Medicine, University of Miami, 1120 NW 14th St., CRB #964 (C-223), Miami, FL, 33136, USA.
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Miami, FL, 33136, USA.
| | - Monica Yepes
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Miami, FL, 33136, USA
- Department of Radiology, Miller School of Medicine, University of Miami, 1115 NW 14th St., Miami, FL, 33136, USA
| | - Noella Dietz
- Sylvester Comprehensive Cancer Center, University of Miami, 1475 NW 12th Ave., Miami, FL, 33136, USA
- Broward Health Medical Center, 1600 South Andrews Avenue, Fort Lauderdale, FL, 33316, USA
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16
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Zhang D, Abraham L, Sprague BL, Onega T, Advani S, Demb J, Miglioretti DL, Henderson LM, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, Chrischilles E, Braithwaite D, O'Meara ES. Mammography adherence in relation to function-related indicators in older women. Prev Med 2022; 154:106869. [PMID: 34762965 PMCID: PMC8724400 DOI: 10.1016/j.ypmed.2021.106869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 09/08/2021] [Accepted: 11/04/2021] [Indexed: 01/03/2023]
Abstract
Prior studies of screening mammography patterns by functional status in older women show inconsistent results. We used Breast Cancer Surveillance Consortium-Medicare linked data (1999-2014) to investigate the association of functional limitations with adherence to screening mammography in 145,478 women aged 66-74 years. Functional limitation was represented by a claims-based function-related indicator (FRI) score which incorporated 16 items reflecting functional status. Baseline adherence was defined as mammography utilization 9-30 months after the index screening mammography. Longitudinal adherence was examined among women adherent at baseline and defined as time from the index mammography to end of the first 30-month gap in mammography. Multivariable logistic regression and Cox proportional hazards models were used to investigate baseline and longitudinal adherence, respectively. Subgroup analyses were conducted by age (66-70 vs. 71-74 years). Overall, 69.6% of participants had no substantial functional limitation (FRI score 0), 23.5% had some substantial limitations (FRI score 1), and 6.8% had serious limitations (FRI score ≥ 2). Mean age at baseline was 68.5 years (SD = 2.6), 85.3% of participants were white, and 77.1% were adherent to screening mammography at baseline. Women with a higher FRI score were more likely to be non-adherent at baseline (FRI ≥ 2 vs. 0: aOR = 1.13, 95% CI = 1.06, 1.20, p-trend < 0.01). Similarly, a higher FRI score was associated with longitudinal non-adherence (FRI ≥ 2 vs. 0: aHR = 1.16, 95% CI = 1.11, 1.22, p-trend < 0.01). Effect measures of FRI did not differ substantially by age categories. Older women with a higher burden of functional limitations are less likely to be adherent to screening mammography recommendations.
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Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, VT, United States of America
| | - Tracy Onega
- Department of Population Health Sciences and the Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, United States of America
| | - Shailesh Advani
- Department of Oncology, Georgetown University School of Medicine, Washington DC, United States of America
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, CA, United States of America
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America; Department of Public Health Sciences, University of California, Davis, CA, United States of America
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, NC, United States of America
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, CA, United States of America
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, CA, United States of America; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, United States of America
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, MN, United States of America; Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, United States of America
| | - Elizabeth Chrischilles
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, United States of America
| | - Dejana Braithwaite
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, FL, United States of America; University of Florida Health Cancer Center, Gainesville, FL, United States of America; Department of Aging and Geriatric Research, University of Florida College of Medicine, Gainesville, Florida.
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, United States of America. Ellen.S.O'
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Lee Argov EJ, Rodriguez CB, Agovino M, Wei Y, Shelton RC, Kukafka R, Schmitt KM, Desperito E, Terry MB, Tehranifar P. Breast cancer worry, uncertainty, and perceived risk following breast density notification in a longitudinal mammography screening cohort. Breast Cancer Res 2022; 24:95. [PMID: 36544225 PMCID: PMC9773500 DOI: 10.1186/s13058-022-01584-2] [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: 03/16/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Dense breast notification (DBN) legislation aims to increase a woman's awareness of her personal breast density and the implications of having dense breasts for breast cancer detection and risk. This information may adversely affect women's breast cancer worry, perceptions of risk, and uncertainty about screening, which may persist over time or vary by sociodemographic factors. We examined short- and long-term psychological responses to DBN and awareness of breast density (BD). METHODS In a predominantly Hispanic New York City screening cohort (63% Spanish-speaking), ages 40-60 years, we assessed breast cancer worry, perceived breast cancer risk, and uncertainties about breast cancer risk and screening choices, in short (1-3 months)- and long-term (9-18 months) surveys following the enrollment screening mammogram (between 2016 and 2018). We compared psychological responses by women's dense breast status (as a proxy for DBN receipt) and BD awareness and examined multiplicative interaction by education, health literacy, nativity, and preferred interview language. RESULTS In multivariable models using short-term surveys, BD awareness was associated with increased perceived risk (odds ratio (OR) 2.27, 95% confidence interval (CI) 0.99, 5.20 for high, OR 2.19, 95% CI 1.34, 3.58 for moderate, vs. low risk) in the overall sample, and with increased uncertainty about risk (OR 1.97 per 1-unit increase, 95% CI 1.15, 3.39) and uncertainty about screening choices (OR 1.73 per 1-unit increase, 95% CI 1.01, 2.9) in Spanish-speaking women. DBN was associated with decreased perceived risk among women with at least some college education (OR 0.32, 95% CI 0.11, 0.89, for high, OR 0.50, 95% CI 0.29, 0.89, for moderate vs. low risk), while those with a high school education or less experienced an increase (OR 3.01, 95% CI 1.05, 8.67 high vs. low risk). There were no associations observed between DBN or BD awareness and short-term breast cancer worry, nor with any psychological outcomes at long-term surveys. CONCLUSIONS Associations of BD awareness and notification with breast cancer-related psychological outcomes were limited to short-term increases in perceived breast cancer risk dependent on educational attainment, and increases in uncertainty around breast cancer risk and screening choices among Spanish-speaking women.
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Affiliation(s)
- Erica J. Lee Argov
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA
| | - Carmen B. Rodriguez
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA
| | - Mariangela Agovino
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA
| | - Ying Wei
- grid.21729.3f0000000419368729Department of Biostatistics, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA
| | - Rachel C. Shelton
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY USA
| | - Rita Kukafka
- grid.21729.3f0000000419368729Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY USA ,grid.21729.3f0000000419368729Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, 622 West 168th St., New York, NY USA
| | - Karen M. Schmitt
- grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY USA ,grid.21729.3f0000000419368729Division of Academics, Columbia University School of Nursing, New York, NY USA
| | - Elise Desperito
- grid.239585.00000 0001 2285 2675Department of Radiology, Columbia University Irving Medical Center, New York, NY USA
| | - Mary Beth Terry
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY USA
| | - Parisa Tehranifar
- grid.21729.3f0000000419368729Department of Epidemiology, Columbia University Mailman School of Public Health, 722 W 168th St., New York, NY USA ,grid.239585.00000 0001 2285 2675Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, 161 Fort Washington Ave., New York, NY USA
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Shen C, Klein RW, Moss JL, Dodge DG, Chetlen AL, Stahl KA, Zhou S, Leslie DL, Ruffin MT, Lengerich EJ. Association Between Dense Breast Legislation and Cancer Stage at Diagnosis. Am J Prev Med 2021; 61:890-899. [PMID: 34376293 DOI: 10.1016/j.amepre.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/17/2021] [Accepted: 05/20/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Many states have mandated breast density notification and insurance coverage for additional screening; yet, the association between such legislation and stage of diagnosis for breast cancer is unclear. This study investigates this association and examines the differential impacts among different age and race/ethnicity subgroups. METHODS The Surveillance, Epidemiology, and End Results database was queried to identify patients with breast cancer aged 40-74 years diagnosed between 2005 and 2016. Using a difference-in-differences multinomial logistic model, the odds of being diagnosed at different stages of cancer relative to the localized stage depending on legislation and individual characteristics were examined. Analyses were conducted in 2020-2021. RESULTS The study included 689,641 cases. Overall, the impact of notification legislation was not significant, whereas insurance coverage legislation was associated with 6% lower odds (OR=0.94, 95% CI=0.91, 0.96) of being diagnosed at the regional stage. The association between insurance coverage legislation and stage of diagnosis was even stronger among women aged 40-49 years, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.96) of being diagnosed at the regional stage and 12% lower odds (OR=0.88, 95% CI=0.81, 0.96) of being diagnosed at the distant stage. Hispanic women benefited from notification laws, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.97) of being diagnosed at distant stage. Neither notification nor supplemental screening insurance coverage legislation showed a substantial impact on Black women. CONCLUSIONS The findings imply that improving insurance coverage is more important than being notified overall. Raising awareness is important among Hispanic women; improving communication about dense breasts and access to screening might be more important than legislation among Black women.
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Affiliation(s)
- Chan Shen
- Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania.
| | - Roger W Klein
- Department of Economics, Rutgers University, New Brunswick, New Jersey
| | - Jennifer L Moss
- Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania; Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Daleela G Dodge
- Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania
| | - Alison L Chetlen
- Penn State Cancer Institute, Hershey, Pennsylvania; Department of Radiology, Milton S. Hershey Medical Center, Penn State Health, Hershey, Pennsylvania
| | - Kelly A Stahl
- Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Shouhao Zhou
- Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania; Division of Biostatistics and Bioinformatics, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Douglas L Leslie
- Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Mack T Ruffin
- Penn State Cancer Institute, Hershey, Pennsylvania; Department of Family and Community Medicine, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Eugene J Lengerich
- Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania
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Nickel B, Copp T, Brennan M, Farber R, McCaffery K, Houssami N. The Impact of Breast Density Information or Notification on Women's Cognitive, Psychological, and Behavioral Outcomes: A Systematic Review. J Natl Cancer Inst 2021; 113:1299-1328. [PMID: 33544867 PMCID: PMC8486329 DOI: 10.1093/jnci/djab016] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 12/31/2020] [Accepted: 02/01/2021] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Breast density (BD) is an independent risk factor for breast cancer and reduces the sensitivity of mammography. This systematic review aims to synthesize evidence from existing studies to understand the impact of BD information and/or notification on women's cognitive, psychological, and behavioral outcomes. METHODS Studies were identified via relevant database searches up to March 2020. Two authors evaluated the eligibility of studies with verification from the study team, extracted and crosschecked data, and assessed the risk of bias. RESULTS Of the 1134 titles identified, 29 studies were included. Twenty-three studies were quantitative, including only 1 randomized controlled trial of women receiving BD information, and 6 were qualitative. Twenty-seven studies were conducted in the United States, with 19 conducted post-BD legislation. The overall results in terms of BD awareness, knowledge, attitudes, perceptions, and intentions were heterogeneous across included studies, with the strongest consistency demonstrated regarding the importance of communication with and involvement of health-care professionals. Together, the studies did, however, highlight that there is still limited awareness of BD in the community, especially in more socioeconomic disadvantaged communities, and limited knowledge about what BD means and the implications for women. Importantly, BD information in the context of overall breast cancer risk has not yet been studied. CONCLUSIONS There are important gaps in the understanding of the impact of BD information or notification on women and how best to communicate BD information to women. More high-quality evidence to inform both current and future practice related to BD is still needed.
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Affiliation(s)
- Brooke Nickel
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Tessa Copp
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Meagan Brennan
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- School of Medicine Sydney, The University of Notre Dame, Sydney, Australia
| | - Rachel Farber
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Kirsten McCaffery
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Sydney Health Literacy Lab, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Nehmat Houssami
- Wiser Healthcare, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
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20
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Austin JD, Agovino M, Rodriguez CB, Terry MB, Shelton RC, Wei Y, Desperito E, Schmitt KM, Kukafka R, Tehranifar P. Breast Density Awareness and Knowledge in a Mammography Screening Cohort of Predominantly Hispanic Women: Does Breast Density Notification Matter? Cancer Epidemiol Biomarkers Prev 2021; 30:1913-1920. [PMID: 34348958 DOI: 10.1158/1055-9965.epi-21-0172] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 05/10/2021] [Accepted: 07/29/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND New York State law mandates that women with dense breasts receive a written notification of their breast density (BD) and its implications, but data on the impact of dense breast notification (DBN) on BD awareness and knowledge in diverse populations remain limited. METHODS Between 2016 and 2018, we collected survey and mammographic data from 666 women undergoing screening mammography in New York City (ages 40-60, 80% Hispanic, 69% Spanish-speaking) to examine the impact of prior DBN on BD awareness by sociodemographic and breast cancer risk factors, and describe BD knowledge by sources of information. RESULTS Only 24.8% of the overall sample and 34.9% of women receiving DBN had BD awareness. In multivariable models adjusting for DBN, awareness was significantly lower in women who were Spanish-speaking [OR, 0.16; 95% confidence interval (CI), 0.09-0.30 vs. English speakers], were foreign-born (OR, 0.31; 95% CI, 0.16-0.58 vs. U.S.-born), and had lower educational attainment (e.g., high school degree or less; OR, 0.14; 95% CI, 0.08-0.26 vs. college or higher degree). Women receiving DBN were more likely to be aware of BD (OR, 2.61; 95% CI, 1.59-4.27) but not more knowledgeable about the impact of BD on breast cancer risk and detection. However, women reporting additional communication about their BD showed greater knowledge in these areas. CONCLUSIONS DBN increases BD awareness disproportionately across sociodemographic groups. IMPACT Efforts to improve communication of DBN must focus on addressing barriers in lower socioeconomic and racially and ethnically diverse women, including educational and language barriers.
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Affiliation(s)
- Jessica D Austin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York
| | - Mariangela Agovino
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Mary Beth Terry
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
| | - Ying Wei
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
| | - Elise Desperito
- Department of Radiology, Columbia University Irving Medical Center, New York, New York
| | - Karen M Schmitt
- Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Division of Academics, Columbia University School of Nursing, New York, New York
| | - Rita Kukafka
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York.,Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York. .,Herbert Irving Comprehensive Cancer Center, Columbia University Irving Medical Center, New York, New York
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21
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Seitzman RL, Pushkin J, Berg WA. Effect of an educational intervention on women's healthcare provider knowledge gaps about breast density, breast cancer risk, and screening. Menopause 2021; 28:909-917. [PMID: 33906202 DOI: 10.1097/gme.0000000000001780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES We sought to assess the effect of an educational intervention, based on DenseBreast-info.org website content, on women's healthcare provider knowledge of breast density, its risk and screening implications, and comfort level discussing these topics with patients. METHODS US-based women's healthcare providers participated in a web-based pretest/posttest study from May 14, 2019 to September 30, 2019. Pretest included demographics; comfort/knowledge discussing breast density impact on risk and screening; and educational material. Posttest contained the same knowledge and comfort questions. We assessed mean pretest/posttest score and comfort level differences (paired t tests) and pretest/posttest knowledge gap differences (McNemar test). We evaluated associations of baseline characteristics with pretest score and score improvement using multiple linear regression, and associations with knowledge gaps using logistic regression. RESULTS Of 177 providers analyzed, 74.0% (131/177) were physicians and 71.8% (127/177) practiced obstetrics/gynecology. Average test score increased from 40.9% (5.7/14) responses correct pretest to 72.1% (10.1/14) posttest (P < 0.001). Pretest, 56.5% (100/177) knew women with extremely dense breasts have four-to-six-fold greater breast cancer risk than those with fatty breasts; 29.4% (52/177) knew risk increases with increasing glandular tissue; only 5.6% (10/177) knew 3D/tomosynthesis does not improve cancer detection in extremely dense breasts over 2D mammography; and 70.6% (125/177) would consider supplemental ultrasound after mammography in an average-risk 50-year old with dense breasts. Postintervention, these knowledge gaps resolved or reduced (all P < 0.005) and comfort in discussing breast density implications increased (all P < 0.001). CONCLUSIONS Important knowledge gaps about implications of breast density exist among women's healthcare providers, which can be effectively addressed with web-based education.
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Affiliation(s)
| | | | - Wendie A Berg
- DenseBreast-info, Inc., Deer Park, NY
- Department of Radiology, University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Pittsburgh, PA
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22
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Matin J, Lucia RM, Lal K, Columbus A, Goodman D, Larsen K, Ziogas A, Park HL. Factors Associated with Women's Unwillingness to Decrease Alcohol Intake to Decrease Breast Cancer Risk. J Prim Care Community Health 2021; 12:21501327211000211. [PMID: 33749348 PMCID: PMC7983428 DOI: 10.1177/21501327211000211] [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] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE Alcohol intake is a known risk factor for breast cancer. National organizations recommend that women consume no more than one serving of alcohol per day, if at all; however, many women exceed this recommendation, and some are unwilling to decrease consumption. Our study sought to identify factors associated with women's unwillingness to decrease their alcohol intake to decrease their breast cancer risk. METHODS 942 women in a screening mammography cohort were asked questions about their demographics, personal and family health history, lifestyle factors, and willingness/unwillingness to decrease alcohol intake to decrease their breast cancer risk. Univariate and multivariate analyzes of their responses were performed. RESULTS 13.2% of women in our cohort indicated they were unwilling to decrease their alcohol intake to reduce their breast cancer risk. After adjusting for potential confounders, women who were 60 years and older were more than twice as unwilling to decrease their alcohol intake compared to their younger counterparts (P = .0002). Women who had an annual household income of more than $200,000 were 1.75 times more unwilling to decrease their alcohol intake compared to their less affluent counterparts (P = .033). Unwillingness was not significantly associated with race/ethnicity, education, having a first-degree family member with cancer, health perception, breast cancer risk perception, or BMI. CONCLUSIONS Levels of unwillingness to decrease alcohol intake differed by age and household income. An opportunity is present to potentially decrease breast cancer risk in the community by educating women, especially older and more affluent women, about alcohol as a risk factor for breast cancer and the importance of limiting one's alcohol intake.
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Affiliation(s)
- Jenna Matin
- Tulane University School of Medicine, New Orleans, LA, USA
| | | | - Krustina Lal
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Alyssa Columbus
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Deborah Goodman
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Kathryn Larsen
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Argyrios Ziogas
- University of California, Irvine School of Medicine, Irvine, CA, USA
| | - Hannah Lui Park
- University of California, Irvine School of Medicine, Irvine, CA, USA
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23
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Kressin NR, Battaglia TA, Wormwood JB, Slanetz PJ, Gunn CM. Dense Breast Notification Laws' Association With Outcomes in the US Population: A Cross-Sectional Study. J Am Coll Radiol 2020; 18:685-695. [PMID: 33358722 DOI: 10.1016/j.jacr.2020.11.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 11/28/2020] [Accepted: 11/30/2020] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Understanding whether states' breast density notifications are associated with desired effects, or disparities, can inform federal policy. We examined self-reported receipt of personal breast density information, breast density discussions with providers, knowledge about density's masking effect, and association with increased breast cancer risk by state legislation status and women's sociodemographic characteristics. METHODS Cross-sectional observational population-based telephone survey of women aged >40 years who underwent mammography within prior 2 years, had no history of breast cancer, and had heard the term "breast density." RESULTS Among 2,306 women, 57% received personal breast density information. Multivariate regression models adjusted for covariates indicated that women in notification states were 1.5 times more likely to receive density information, and older Black and Asian women of lower income and lower health literacy were less likely. Overall, only 39% of women discussed density with providers; women in notification states were 1.75 times as likely. Older and Asian women were less likely to have spoken with providers; women with high literacy or prior biopsy were more likely. State legislation status was not associated with differences in density knowledge, but Hispanic women and women of lower income or low health literacy had less knowledge regarding density's masking effects; older women were more knowledgeable. Hispanic women and women of lower income or low health literacy were more likely, and middle-aged women less likely, to recognize increased breast cancer risk. DISCUSSION Some positive effects were observed, but sociodemographic disparities suggest tailoring of future breast density communications for specific populations of women to ensure equitable understanding.
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Affiliation(s)
- Nancy R Kressin
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts.
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Associate Director of the Belkin Breast Health Center, Boston Medical Center, and Director, Women's Health Group, Boston Medical Center
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, New Hampshire
| | - Priscilla J Slanetz
- Vice Chair of Academic Affairs and Associate Program Director of the Diagnostic Radiology Residency, Department of Radiology, Boston University Medical Center; President-Elect of the Massachusetts Radiological Society and Chair of the ACR Appropriateness Criteria Committee Breast Imaging Panel; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
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24
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Ton N, Goncin U, Panahifar A, Chapman D, Wiebe S, Machtaler S. Developing a Microbubble-Based Contrast Agent for Synchrotron In-Line Phase Contrast Imaging. IEEE Trans Biomed Eng 2020; 68:1527-1535. [PMID: 33232220 DOI: 10.1109/tbme.2020.3040079] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE X-ray phase contrast imaging generates contrast from refraction of X-rays, enhancing soft tissue contrast compared to conventional absorption-based imaging. Our goal is to develop a contrast agent for X-ray in-line phase contrast imaging (PCI) based on ultrasound microbubbles (MBs), by assessing size, shell material, and concentration. METHODS Polydisperse perfluorobutane-core lipid-shelled MBs were synthesized and size separated into five groups between 1 and 10 μm. We generated two size populations of polyvinyl-alcohol (PVA)-MBs, 2-3 μm and 3-4 μm, whose shells were either coated or integrated with iron oxide nanoparticles (SPIONs). Microbubbles were then embedded in agar at three concentrations: 5 × 107, 5 × 106 and 5 × 105 MBs/ml. In-line phase contrast imaging was performed at the Canadian Light Source with filtered white beam micro-computed tomography. Phase contrast intensity was measured by both counting detectable MBs, and comparing mean pixel values (MPV) in minimum and maximum intensity projections of the overall samples. RESULTS Individual lipid-MBs 6-10 μm, lipid-MBs 4-6 μm and PVA-MBs coated with SPIONs were detectable at each concentration. At the highest concentration, lipid-MBs 6-10 μm and 4-6 μm showed an overall increase in positive contrast, whereas at a moderate concentration, only lipid-MBs 6-10 μm displayed an increase. Negative contrast was also observed from two largest lipid-MBs at high concentration. CONCLUSION These data indicate that lipid-MBs larger than 4 μm are candidates for PCI, and 5 × 106 MBs/ml may be the lowest concentration suitable for generating visible phase contrast in vivo. SIGNIFICANCE Identifying a suitable MB for PCI may facilitate future clinical translation.
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25
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Kim J, Kim HJ, Kim C, Kim WH. Artificial intelligence in breast ultrasonography. Ultrasonography 2020; 40:183-190. [PMID: 33430577 PMCID: PMC7994743 DOI: 10.14366/usg.20117] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Although breast ultrasonography is the mainstay modality for differentiating between benign and malignant breast masses, it has intrinsic problems with false positives and substantial interobserver variability. Artificial intelligence (AI), particularly with deep learning models, is expected to improve workflow efficiency and serve as a second opinion. AI is highly useful for performing three main clinical tasks in breast ultrasonography: detection (localization/segmentation), differential diagnosis (classification), and prognostication (prediction). This article provides a current overview of AI applications in breast ultrasonography, with a discussion of methodological considerations in the development of AI models and an up-to-date literature review of potential clinical applications.
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Affiliation(s)
- Jaeil Kim
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Korea
| | - Hye Jung Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
| | - Chanho Kim
- School of Computer Science and Engineering, Kyungpook National University, Daegu, Korea
| | - Won Hwa Kim
- Department of Radiology, School of Medicine, Kyungpook National University, Kyungpook National University Chilgok Hospital, Daegu, Korea
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26
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Hair E, Niaura RS, Rath JM. Prospective associations between nicotine beliefs and tobacco-related susceptibility, curiosity, and use in U.S. adults. Prev Med 2020; 140:106285. [PMID: 33068605 PMCID: PMC7779116 DOI: 10.1016/j.ypmed.2020.106285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 09/22/2020] [Accepted: 10/11/2020] [Indexed: 11/16/2022]
Abstract
Low harm perceptions of tobacco products have been associated with use of those products in youth and adults, but this relationship has not been assessed for nicotine beliefs. This study used data from a national sample of adults aged 18-40 in Wave 9 (Spring 2016) of the Truth Initiative Young Adult Cohort Study to examine correlations and prospective associations between the latent classes of nicotine beliefs and susceptibility, curiosity, and use of tobacco products in 3122 adults who also completed Wave 10 (Fall 2016). At Wave 9, four latent classes of beliefs characterized the role of nicotine in the health risks of smoking: Class 1, large role, 51%; Class 2, large role/don't know, 9.4%; Class 3, small role in health, 32.5%; and Class 4, none/small role in cancer, 7.5%. Latent classes of nicotine beliefs were highly correlated with susceptibility and curiosity to use cigarettes, e-cigarettes, and hookah, as well as past 30-day use of a range of tobacco products at Wave 9 among never users. Classes 3 and 4 had the highest prevalence of past 30-day tobacco use; never users in these classes reported the greatest susceptibility to try cigarettes, hookah, and e-cigarettes at Wave 9. Class 4 had higher odds of increased e-cigarettes use at follow-up compared to Class 1. There were few prospective associations between nicotine beliefs latent class, susceptibility, and curiosity at Wave 10. Nicotine beliefs are associated with tobacco-related outcomes and, if assessed, may provide novel information to guide tobacco prevention and intervention efforts.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, United States of America
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, United States of America
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences, Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, United States of America
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, United States of America
| | - Elizabeth Hair
- Schroeder Institute at Truth Initiative, United States of America
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, United States of America
| | - Jessica M Rath
- Schroeder Institute at Truth Initiative, United States of America
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27
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Tran ATN, Hwang JH, Choi E, Lee YY, Suh M, Lee CW, Kim Y, Choi KS. Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women. Cancer Res Treat 2020; 53:55-64. [PMID: 32810929 PMCID: PMC7812003 DOI: 10.4143/crt.2020.495] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/17/2020] [Indexed: 01/29/2023] Open
Abstract
PURPOSE This study sought to examine perceived risk and concerns for breast cancer according to awareness of breast density and states thereof among Korea women and to identify the impact of such awareness on screening intentions. Materials and Methods This study was based on the 2017 Korean National Cancer Screening Survey of a nationally representative and randomly selected sample of Koreans. Ordinal logistic regression was conducted to examine associations for awareness of and knowledge on breast density in relation to psychological factors. Multivariate logistic regression analyses were conducted to investigate significant factors associated with intentions to undergo breast cancer screening. RESULTS Among a total of 1,609 women aged 40-69 years, 62.0% were unaware of their breast density, and only 29.7% had good breast density knowledge. Awareness of one's breast density and knowledge about breast density were positively associated with perceptions of absolute and comparative risk and cancer worry. Women aware of their breast density (adjusted odds ratio [aOR], 1.35 for women aware of having a non-dense breast; aOR, 4.17 for women aware of having a dense breast) and women with a good level of breast density knowledge (aOR, 1.65) were more likely to undergo future breast cancer screening. CONCLUSION Breast density awareness and knowledge showed positive associations with psychological factors and breast cancer screening intentions. However, the majority of Korean women were not aware of their breast density status and demonstrated poor knowledge about breast density. These results demonstrate a need for better health communication concerning breast density.
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Affiliation(s)
- Anh Thi Ngoc Tran
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Ji Hae Hwang
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Eunji Choi
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Yun Yeong Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Chan Wha Lee
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea.,Center for Cancer Prevention and Detection, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Center for Cancer Prevention and Detection, National Cancer Center Hospital, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- National Cancer Center, Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
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28
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Niaura R, Rich I, Johnson AL, Villanti AC, Romberg AR, Hair EC, Vallone DM, Abrams DB. Young Adult Tobacco and E-cigarette Use Transitions: Examining Stability Using Multistate Modeling. Nicotine Tob Res 2020; 22:647-654. [PMID: 30820566 DOI: 10.1093/ntr/ntz030] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/22/2019] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The objective of this study was to describe tobacco and nicotine product use state transition probabilities among youth and young adults over time. METHODS A national sample of young adult tobacco product users and nonusers between the ages of 18 and 34 years at baseline was surveyed at 6-month intervals for 3 years. Use and nonuse states were defined as mutually exclusive categories based on self-reported, past 30-day use of the various products. Never use, noncurrent use, and current use of combustible, noncombustible tobacco, and electronic cigarette (e-cigarette) products was assessed at each interval. A multistate model was fit to estimate transition probabilities between states and length of stay within each state. RESULTS After 6 months, same-state transition probabilities were high for all use states (0.76-0.96), except for dual product use (0.48). After 3 years, transition probabilities were smaller and tended to converge toward combustible product use for baseline e-cigarette (0.42), combustible (0.51), and dual product users (0.52). Age was inversely associated with transition risk from never or noncurrent use to use of combustible or e-cigarette products. CONCLUSIONS Never and noncurrent users, followed by combustible product users, were most likely to remain in those states throughout the 3-year observation interval. Users of any tobacco or e-cigarette product at baseline were most likely to transition to combustible product use or noncurrent use by the final follow-up. IMPLICATIONS This study describes the probability of transitioning between various states of tobacco product use, including never and no current use, over a span of 3 years in a sample of young adults. This type of longitudinal description, which includes all tobacco product use states, is lacking in most studies that tend to focus on one or only a few products. The results suggest that it is important to assess outcomes over a sufficiently long period to capture true variability in patterns of product use.
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Affiliation(s)
- Raymond Niaura
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York, NY
| | - Ilan Rich
- Schroeder Institute at Truth Initiative, Washington, DC
| | | | - Andrea C Villanti
- Vermont Center on Behavior and Health, University of Vermont College of Medicine, Burlington, VT
| | | | | | | | - David B Abrams
- Department of Social and Behavioral Sciences, NYU College of Global Public Health, New York, NY
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Seitzman RL, Pushkin J, Berg WA. Radiologic Technologist and Radiologist Knowledge Gaps about Breast Density Revealed by an Online Continuing Education Course. JOURNAL OF BREAST IMAGING 2020; 2:315-329. [PMID: 38424967 DOI: 10.1093/jbi/wbaa039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Indexed: 03/02/2024]
Abstract
OBJECTIVE We sought to identify provider knowledge gaps and their predictors, as revealed by a breast density continuing education course marketed to the radiology community. METHODS The course, continually available online during the study period of November 2, 2016 and December 31, 2018, includes demographics collection; a monograph on breast density, breast cancer risk, and screening; and a post-test. Four post-test questions were modified during the study period, resulting in different sample sizes pre- and postmodification. Multiple logistic regression was used to identify predictors of knowledge gaps (defined as > 25% of responses incorrect). RESULTS Of 1649 analyzable registrants, 1363 (82.7%) were radiologic technologists, 226 (13.7%) were physicians, and 60 (3.6%) were other nonphysicians; over 90% of physicians and over 90% of technologists/nonphysicians specialized in radiology. Sixteen of 49 physicians (32.7%) and 80/233 (34.3%) technologists/nonphysicians mistakenly thought the Gail model should be used to determine "high-risk" status for recommending MRI or genetic testing. Ninety-nine of 226 (43.8%) physicians and 682/1423 (47.9%) technologists/nonphysicians misunderstood the inverse relationship between increasing age and lifetime breast cancer risk. Fifty-two of 166 (31.3%) physicians and 549/1151 (47.7%) technologists/nonphysicians were unaware that MRI should be recommended for women with a family history of BRCA1/BRCA2 mutations. Tomosynthesis effectiveness was overestimated, with 18/60 (30.0%) physicians and 95/272 (34.9%) technologists/nonphysicians believing sensitivity nearly equaled MRI. Knowledge gaps were more common in technologists/nonphysicians. CONCLUSIONS Important knowledge gaps about breast density, breast cancer risk assessment, and screening exist among radiologic technologists and radiologists. Continued education efforts may improve appropriate breast cancer screening recommendations.
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Affiliation(s)
- Robin L Seitzman
- Seitzman Consulting, San Diego, CA
- DenseBreast-info, Inc., Deer Park, NY
| | | | - Wendie A Berg
- DenseBreast-info, Inc., Deer Park, NY
- University of Pittsburgh School of Medicine, Magee-Womens Hospital of UPMC, Department of Radiology, Pittsburgh, PA
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Lian J, Li K. A Review of Breast Density Implications and Breast Cancer Screening. Clin Breast Cancer 2020; 20:283-290. [DOI: 10.1016/j.clbc.2020.03.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 02/10/2020] [Accepted: 03/12/2020] [Indexed: 12/15/2022]
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Impact of Breast Density Awareness on Knowledge about Breast Cancer Risk Factors and the Self-Perceived Risk of Breast Cancer. Diagnostics (Basel) 2020; 10:diagnostics10070496. [PMID: 32698375 PMCID: PMC7399945 DOI: 10.3390/diagnostics10070496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 07/12/2020] [Accepted: 07/18/2020] [Indexed: 12/24/2022] Open
Abstract
Breast density (BD) reduces sensitivity of mammography, and is a strong risk factor for breast cancer (BC). Data about women's awareness and knowledge of BD are limited. Our aim is to examine whether the BD information disclosure and BD awareness among women without BC are related to their knowledge about BC risk factors. We examined self-reported BC risk perception and its association to BD awareness and level of health literacy. A cross-sectional, single site study included 263 Croatian women without BC who had mammographic examination. Data were collected by interviews using questionnaires and a validated survey. Of the total, 77.1% had never heard of BD, and 22.9% were aware of their BD. Most participants who knew their BD (88.2%, p < 0.001) had higher levels of education. Majority of subjects (66.8%) had non-dense breasts and 33.2% had dense breasts. Subjects aware of their BD knew that post-menopausal hormone replacement therapy (p = 0.04) and higher BD (p = 0.03) are BC risk factors. They could more easily access information about health promotion (p = 0.03). High-BD informed women assessed their lifetime BC risk as significantly higher than all others (p = 0.03). Comprehension of BD awareness and knowledge is crucial for reinforcement of educational strategies and development of amendatory BC screening decisions.
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Kyanko KA, Hoag J, Busch SH, Aminawung JA, Xu X, Richman IB, Gross CP. Dense Breast Notification Laws, Education, and Women's Awareness and Knowledge of Breast Density: a Nationally Representative Survey. J Gen Intern Med 2020; 35:1940-1945. [PMID: 31916210 PMCID: PMC7351910 DOI: 10.1007/s11606-019-05590-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/26/2019] [Accepted: 11/27/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND To date, 38 states have enacted dense breast notification (DBN) laws mandating that mammogram reports include language informing women of risks related to dense breast tissue. OBJECTIVE Nationally representative survey to assess the association between residing in a state with a DBN law and women's awareness and knowledge about breast density, and breast cancer anxiety. DESIGN Internet survey conducted in 2018 with participants in KnowledgePanel®, an online research panel. PARTICIPANTS English-speaking US women ages 40-59 years without a personal history of breast cancer who had received at least one screening mammogram (N = 1928; survey completion rate 68.2%). MAIN MEASURES (1) Reported history of increased breast density, (2) knowledge of the increased risk of breast cancer with dense breasts, (3) knowledge of the masking effect of dense breasts on mammography, and (4) breast cancer anxiety. KEY RESULTS Women residing in DBN states were more likely to report increased breast density (43.6%) compared with women residing in non-DBN states (32.7%, p < 0.01, adjusted odds ratio, 1.70, 95% CI,1.34-2.17). Interaction effect between DBN states and education status showed that the impact of DBN on women's reporting of dense breasts was significant for women with greater than high school education, but not among women with a high school education or less (p value = 0.01 for interaction). Only 23.0% of women overall knew that increased breast density was associated with a higher risk of breast cancer, and 68.0% of women understood that dense breasts decreased the sensitivity of mammography. There were no significant differences between women in DBN states and non-DBN states for these outcomes, or for breast cancer-related anxiety. CONCLUSIONS State DBN laws were not associated with increased understanding of the clinical implications of breast density. DBN laws were associated with a higher likelihood of women reporting increased breast density, though not among women with lower education.
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Affiliation(s)
- Kelly A Kyanko
- Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA.
| | | | | | | | - Xiao Xu
- Yale School of Medicine, New Haven, CT, USA
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Jiang X, McGuinness JE, Sin M, Silverman T, Kukafka R, Crew KD. Identifying Women at High Risk for Breast Cancer Using Data From the Electronic Health Record Compared With Self-Report. JCO Clin Cancer Inform 2020; 3:1-8. [PMID: 30869999 DOI: 10.1200/cci.18.00072] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE A barrier to chemoprevention uptake among high-risk women is the lack of routine breast cancer risk assessment in the primary care setting. We calculated breast cancer risk using the Breast Cancer Surveillance Consortium (BCSC) model, accounting for age, race/ethnicity, first-degree family history of breast cancer, benign breast disease, and mammographic density, using data collected from the electronic health records (EHRs) and self-reports. PATIENTS AND METHODS Among women undergoing screening mammography, we enrolled those age 35 to 74 years without a prior history of breast cancer. Data on demographics, first-degree family history, breast radiology, and pathology reports were extracted from the EHR. We assessed agreement between the EHR and self-report on information about breast cancer risk. RESULTS Among 9,514 women with known race/ethnicity, 1,443 women (15.2%) met high-risk criteria based upon a 5-year invasive breast cancer risk of 1.67% or greater according to the BCSC model. Among 1,495 women with both self-report and EHR data, more women with a first-degree family history of breast cancer (14.6% v 4.4%) and previous breast biopsies (21.3% v 11.3%) were identified by self-report versus EHR, respectively. However, more women with atypia and lobular carcinoma in situ were identified from the EHR. There was moderate agreement in identification of high-risk women between EHR and self-report data (κ, 0.48; 95% CI, 0.42-0.54). CONCLUSION By using EHR data, we determined that 15% of women undergoing screening mammography had a high risk for breast cancer according to the BCSC model. There was moderate agreement between information on breast cancer risk derived from the EHR and self-report. Examining EHR data may serve as an initial screen for identifying women eligible for breast cancer chemoprevention.
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Affiliation(s)
| | | | | | | | | | - Katherine D Crew
- Columbia University, New York, NY.,Herbert Irving Comprehensive Cancer Center, New York, NY
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Kressin NR, Wormwood JB, Battaglia TA, Gunn CM. Differences in Breast Density Awareness, Knowledge, and Plans Based on State Legislation Status and Sociodemographic Characteristics. J Gen Intern Med 2020; 35:1923-1925. [PMID: 31845108 PMCID: PMC7280429 DOI: 10.1007/s11606-019-05578-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/26/2019] [Accepted: 11/22/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Nancy R Kressin
- Veterans Affairs Boston Healthcare System, Boston, MA, USA. .,Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
| | - Jolie B Wormwood
- Department of Psychology, University of New Hampshire, Durham, NH, USA
| | - Tracy A Battaglia
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Christine M Gunn
- Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
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Schifferdecker KE, Tosteson ANA, Kaplan C, Kerlikowske K, Buist DSM, Henderson LM, Johnson D, Jaworski J, Jackson-Nefertiti G, Ehrlich K, Marsh MW, Vu L, Onega T, Wernli KJ. Knowledge and Perception of Breast Density, Screening Mammography, and Supplemental Screening: in Search of "Informed". J Gen Intern Med 2020; 35:1654-1660. [PMID: 31792869 PMCID: PMC7280373 DOI: 10.1007/s11606-019-05560-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 11/13/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND As of 2019, 37 US states have breast density notification laws. No qualitative study to date has examined women's perspectives about breast density in general or by states with and without notification laws. OBJECTIVE Explore women's knowledge and perceptions of breast density and experiences of breast cancer screening across three states with and without notification laws. DESIGN Qualitative research design using four focus groups conducted in 2017. PARTICIPANTS Forty-seven women who had a recent normal mammogram and dense breasts in registry data obtained through the Breast Cancer Surveillance Consortium. APPROACH Focus groups were 90 min, audio recorded, and transcribed for analysis. Data were analyzed using mixed deductive and inductive coding. KEY RESULTS Women reported variable knowledge levels of personal breast density and breast density in general, even among women living in states with a notification law. A number of women were aware of the difficulty of detecting cancer with dense breasts, but only one knew that density increased breast cancer risk. Across all states, very few women reported receiving information about breast density during healthcare visits beyond being encouraged to get supplemental imaging or to pay for new mammography technology (i.e., breast tomosynthesis). Women offered more imaging or different technology held strong convictions that these were "better," even though knowledge of differences, effectiveness, or harms across technologies seemed limited. Women from all states expressed a strong desire for more information about breast density. CONCLUSIONS More research needs to be done to understand how the medical community can best assist women in making informed decisions related to breast density, mammography, and supplemental screening. Options to explore include improved breast density notifications and education materials about breast density, continued development of personalized risk information tools, strategies for providers to discuss evidence and options based on risk stratification, and shared decision-making.
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Affiliation(s)
- Karen E Schifferdecker
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
- Center for Program Design and Evaluation at Dartmouth (CPDE), Lebanon, NH, USA.
| | - Anna N A Tosteson
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth and Dartmouth-Hitchcock Health System, Lebanon, NH, USA
| | - Celia Kaplan
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, CA, USA
- Department Epidemiology and Biostatistics, University of California, San Francisco, CA, USA
- General Internal Medicine Section, University of California, San Francisco, CA, USA
- Department of Veterans Affairs, University of California, San Francisco, CA, USA
| | - Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Dianne Johnson
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | - Jill Jaworski
- Department of Public Health Sciences, University of California, Davis, Davis, CA, USA
| | | | - Kelly Ehrlich
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Mary W Marsh
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa Vu
- Department of Medicine, University of California, San Francisco, CA, USA
| | - Tracy Onega
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Medicine, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
- Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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Gunn C, Maschke A, Bickmore T, Kennedy M, Hopkins MF, Fishman MDC, Paasche-Orlow MK, Warner ET. Acceptability of an Interactive Computer-Animated Agent to Promote Patient-Provider Communication About Breast Density: a Mixed Method Pilot Study. J Gen Intern Med 2020; 35:1069-1077. [PMID: 31919723 PMCID: PMC7174461 DOI: 10.1007/s11606-019-05622-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 12/13/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Half of women undergoing mammography have dense breasts. Mandatory dense breast notification and educational materials have been shown to confuse women, rather than empower them. OBJECTIVE This study used a mixed method, multi-stakeholder approach to assess acceptability of an interactive, computer-animated agent that provided breast density information to women and changes in knowledge, satisfaction, and informational needs. DESIGN A pre-post survey and qualitative focus groups assessed the acceptability of the computer-animated agent among women. An anonymous, online survey measuring acceptability was delivered to a multi-stakeholder group. PARTICIPANTS English-speaking, mammography-eligible women ages 40-74 were invited and 44 women participated in one of nine focus groups. In addition, 14 stakeholders representing primary care, radiology, patient advocates, public health practitioners, and researchers completed the online survey. INTERVENTIONS A prototype of a computer-animated agent was delivered to women in a group setting; stakeholders viewed the prototype independently. MAIN MEASURES Data collected included open-ended qualitative questions that guided discussion about the content and form of the computer-animated agent. Structured surveys included domains related to knowledge, acceptability, and satisfaction. Stakeholder acceptability was measured with a series of statements about aspects of the intervention and delivery approach and are reported as the proportion of respondents who endorsed each statement. KEY RESULTS Six of 12 knowledge items demonstrated improvement post-intervention, satisfaction with the agent was high (81%), but the number of unanswered questions did not improve (67% vs. 54%, p = 0.37). Understanding of the distinction between connective and fatty tissue in the breast did not increase (30% vs. 26%, p = 0.48). Results of the multi-stakeholder survey suggest broad acceptability of the approach and agent. CONCLUSIONS Findings highlight the benefits of a brief interactive educational exposure as well as misperceptions that persisted. Results demonstrate the need for an evidence-based, accessible intervention that is easy to understand for patients.
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Affiliation(s)
- Christine Gunn
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA.
| | - Ariel Maschke
- Department of Medicine, Section of General Internal Medicine, Women's Health Unit, Boston University School of Medicine, 801 Massachusetts Avenue, First Floor, Boston, MA, 02118, USA
| | - Timothy Bickmore
- Khoury College of Computer Sciences, Northeastern University, Boston, USA
| | | | | | - Michael D C Fishman
- Department of Radiology, Boston Medical Center, Section of Breast Imaging, Boston University School of Medicine, Boston, USA
| | - Michael K Paasche-Orlow
- Department of Medicine, Section of General Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, USA
| | - Erica T Warner
- Department of Medicine, Massachusetts General Hospital, Boston, USA
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Dench EK, Darcey EC, Keogh L, McLean K, Pirikahu S, Saunders C, Thompson S, Woulfe C, Wylie E, Stone J. Confusion and Anxiety Following Breast Density Notification: Fact or Fiction? J Clin Med 2020; 9:E955. [PMID: 32235552 PMCID: PMC7230559 DOI: 10.3390/jcm9040955] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/06/2020] [Accepted: 03/09/2020] [Indexed: 11/16/2022] Open
Abstract
In the absence of evidence-based screening recommendations for women with dense breasts, it is important to know if breast density notification increases women's anxiety. This study describes psychological reactions and future screening intentions of women attending a public mammographic screening program in Western Australia. Two-thirds of notified women indicated that knowing their breast density made them feel informed, 21% described feeling anxious, and 23% confused. Of the notified women who reported anxiety, 96% intended to re-screen when due (compared to 91% of all notified women and 93% of controls; p = 0.007 and p < 0.001, respectively). In summary, reported anxiety (following breast density notification) appears to increase women's intentions for future screening, not the reverse.
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Affiliation(s)
- Evenda K Dench
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
| | - Ellie C Darcey
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
| | - Louise Keogh
- Centre for Epidemiology and Biostatistics, The University of Melbourne, 3010 Melbourne, Victoria, Australia
| | - Kirsty McLean
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
| | - Sarah Pirikahu
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
| | - Christobel Saunders
- School of Medicine, The University of Western Australia, 6009 Perth, Western Australia, Australia
| | - Sandra Thompson
- Western Australian Centre for Rural Health, School of Population and Global Health, The University of Western Australia, 6009 Geraldton, Western Australia, Australia
| | - Catherine Woulfe
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
| | - Elizabeth Wylie
- School of Medicine, The University of Western Australia, 6009 Perth, Western Australia, Australia
- BreastScreen Western Australia, Women and Newborn Health Service, 6000 Perth, Western Australia, Australia
| | - Jennifer Stone
- Centre for Genetic Origins of Health and Disease, School of Population and Global Health, University of Western Australia, 6009 Perth, Australia
- The Medical Research Foundation, Royal Perth Hospital, 6000 Perth, Western Australia, Australia
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Mahorter SS, Knerr S, Bowles EJA, Wernli KJ, Gao H, Schwartz MD, O'Neill SC. Prior breast density awareness, knowledge, and communication in a health system-embedded behavioral intervention trial. Cancer 2020; 126:1614-1621. [PMID: 31977078 DOI: 10.1002/cncr.32711] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 11/22/2019] [Accepted: 12/16/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Breast density is an important breast cancer risk factor and a focus of recent national and state health policy efforts. This article describes breast density awareness, knowledge, and communication among participants in a health system-embedded trial with clinically elevated breast cancer risk 1 year before state-mandated density disclosure. METHODS Trial participants' demographics and prior health history were ascertained from electronic health records. The proportions of women reporting prior breast density awareness, knowledge of density's masking effect, and communication with a provider about their own breast density were calculated using baseline interview data collected from 2017 to 2018. Multiple logistic regression was used to estimate associations between women's characteristics and density awareness, knowledge, and communication. RESULTS Although the overwhelming majority of participants had heard of breast density (91%) and were aware of breast density's masking effect (87%), only 60% had ever discussed their breast density with a provider. Annual mammography screening was associated with prior breast density awareness (odds ratio [OR], 2.97; 95% confidence interval [CI], 1.29-6.81), knowledge (OR, 2.83; 95% CI, 1.20-6.66), and communication (OR, 2.87; 95% CI, 1.34-6.16) compared with an infrequent or unknown screening interval. Receipt of breast biopsy was also associated with prior knowledge (OR, 1.60; 95% CI, 1.04-2.45) and communication (OR, 1.36; 95% CI, 1.00-1.85). CONCLUSIONS Breast density awareness and knowledge are high among insured women participating in clinical research, even in the absence of mandated density disclosure. Patient-provider communication about personal density status is less common, particularly among women with fewer interactions with breast health specialists.
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Affiliation(s)
- Siobhan S Mahorter
- Department of Health Services, University of Washington, Seattle, Washington
| | - Sarah Knerr
- Department of Health Services, University of Washington, Seattle, Washington
| | | | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Marc D Schwartz
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | - Suzanne C O'Neill
- Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
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Supplemental screening in the dense breast: does molecular breast imaging have a role? ACTA ACUST UNITED AC 2019; 27:110-112. [PMID: 31880677 DOI: 10.1097/gme.0000000000001471] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
With the passage of a 2019 US federal law directing FDA to ensure that mammography facilities provide a summary to patients categorizing their breast density and explaining how it can influence mammography accuracy, providers will increasingly be called on to discuss the options for supplemental screening. Numerous studies have elucidated the extent of masking that occurs with mammography screening in dense breasts when mammography is compared with other supplemental screening modalities. Despite this evidence, there is currently no consensus among experts or imaging societies as to whether or with what supplemental screening should be performed, leaving providers to counsel patients regarding the balance of benefits and harms.
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40
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Hair E, Rath JM, Niaura RS. Latent Classes of Nicotine Beliefs Correlate with Perceived Susceptibility and Severity of Nicotine and Tobacco Products in US young adults. Nicotine Tob Res 2019; 21:S91-S100. [PMID: 31867640 PMCID: PMC6939776 DOI: 10.1093/ntr/ntz156] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 08/21/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pervasive misperceptions about nicotine may influence uptake of quit smoking aids and the impact of policies addressing nicotine as a tobacco product constituent. METHODS Latent class analyses were conducted using four items on nicotine beliefs asked of 4037 adults aged 18-40 in wave 9 (February-March 2016) of the Truth Initiative Young Adult Cohort Study. Confirmatory factor analyses identified three factors from 12 items: nicotine susceptibility (NSUS), nicotine severity (NSEV), and tobacco severity (TSEV). Analyses assessed correlations between latent classes, sociodemographics, and nicotine/tobacco factor scores. RESULTS A four-class model of nicotine beliefs was the best fit, with the largest class believing that nicotine plays a major part in smoking risks (class 1, n = 2070; 52%). Class 2 shared that belief but also responded "Don't know" to addiction questions (class 2, n = 382; 11%). Fewer belonged in class 3, who reported that nicotine plays a small part in health risks (n = 1277; 30%), and class 4, who perceived nicotine as not cancer causing (n = 308; 7%). Latent class membership was correlated with sociodemographics, peer smoking, and past 30-day tobacco use. Classes 1 and 2 had similar NSUS scores and classes 3 and 4 had similar NSEV and TSEV scores. DISCUSSION Differences in the perceptions of nicotine and tobacco-related harms can be partially explained by clustering of underlying nicotine beliefs. These classes of beliefs are correlated with sociodemographic predictors of smoking. These findings may help to identify specific beliefs or groups to be targeted by public education efforts on nicotine. IMPLICATIONS The current study supports that underlying nicotine beliefs are associated with perceived harms of specific nicotine and tobacco products (relative to cigarettes), with greater false beliefs about nicotine correlated with greater perceived susceptibility to nicotine addiction. Two important inferences emerge from this study: first, that education to address nicotine beliefs may also reframe perceptions of the harms of nicotine and tobacco products; and second, that this type of education may differentially impact perceptions of the harms of nicotine products (e.g., nicotine replacement therapy and e-cigarettes) and tobacco products (e.g., cigars, smokeless, and hookah).
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT
| | - Jennifer L Pearson
- Division of Social and Behavioral Sciences/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, Reno, NV
| | - Olivia A Wackowski
- Center for Tobacco Studies, Rutgers School of Public Health, State University of New Jersey, New Brunswick, NJ
| | | | | | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY
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Patel BK, Ridgeway JL, Ghosh K, Rhodes DJ, Borah B, Jenkins S, Suman VJ, Norman A, Jewett M, Singh D, Vachon CM, Radecki Breitkopf C. Behavioral and psychological impact of returning breast density results to Latinas: study protocol for a randomized clinical trial. Trials 2019; 20:744. [PMID: 31852492 PMCID: PMC6921571 DOI: 10.1186/s13063-019-3939-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 11/26/2019] [Indexed: 01/07/2023] Open
Abstract
Background Breast cancer is the most common cancer and the leading cause of cancer mortality among Latinas. As more is learned about the association between mammographic breast density (MBD) and breast cancer risk, a number of U.S. states adopted legislation and now a federal law mandates written notification of MBD along with mammogram results. These notifications vary in content and readability, though, which may limit their effectiveness and create confusion or concern, especially among women with low health literacy or barriers to screening. The purpose of this study is to determine whether educational enhancement of MBD notification results in increased knowledge, decreased anxiety, and adherence to continued mammography screening among Latina women in a limited-resources setting. Methods Latinas LEarning About Density (LLEAD) is a randomized clinical trial (RCT) comparing the impact of three notification approaches on behavioral and psychological outcomes in Latina women. Approximately 2000 Latinas undergoing screening mammography in a safety-net community clinic will be randomized 1:1:1 to mailed notification (usual care); mailed notification plus written educational materials (enhanced); or mailed notification, written educational materials, plus verbal explanation by a promotora (interpersonal). The educational materials and verbal explanations are available in Spanish or English. Mechanisms through which written or verbal information influences future screening motivation and behavior will be examined, as well as moderating factors such as depression and worry about breast cancer, which have been linked to diagnostic delays among Latinas. The study includes multiple psychological measures (anxiety, depression, knowledge about MBD, perceived risk of breast cancer, worry, self-efficacy) and behavioral outcomes (continued adherence to mammography). Measurement time points include enrollment, 2–4 weeks post-randomization, and 1 and 2 years post-randomization. Qualitative inquiry related to process and outcomes of the interpersonal arm and cost analysis related to its implementation will be undertaken to understand the intervention’s delivery and transferability. Discussion Legislation mandating written MBD notification may have unintended consequences on behavioral and psychological outcomes, particularly among Latinas with limited health literacy and resources. This study has implications for cancer risk communication and will offer evidence on the potential of generalizable educational strategies for delivering information on breast density to Latinas in limited-resource settings. Trial registration ClinicalTrials.gov, NCT02910986. Registered on 21 September 2016. Items from the WHO Trial Registration Data Set can be found in this protocol.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Matt Jewett
- Mountain Park Health Center, Phoenix, AZ, USA
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Rhodes DJ, Jenkins SM, Hruska CB, Vachon CM, Breitkopf CR. Breast Density Awareness, Knowledge, and Attitudes Among US Women: National Survey Results Across 5 Years. J Am Coll Radiol 2019; 17:391-404. [PMID: 31756308 DOI: 10.1016/j.jacr.2019.11.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 10/25/2019] [Accepted: 11/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To assess changes in breast density (BD) awareness, knowledge, and attitudes among US women over a period of 5 years. METHODS Using a probability-based web panel representative of the US population, we administered an identical BD survey in 2012 and 2017 to women aged 40 to 74 years. RESULTS In 2017, 65.8% had heard of BD (versus 57.5% in 2012; P = .0002). BD awareness in both 2012 and 2017 was significantly associated with race, income, and education. Among women aware of BD in 2017, 76.5% had knowledge of BD's relationship to masking (versus 71.5% in 2012; P = .04); 65.5% had knowledge of BD's relationship to cancer risk (versus 58.5%; P = .009); and 47.3% had discussed BD with a provider (versus 43.1% in 2012; P = .13). After multivariable adjustment, residence in a state with BD legislation was associated in 2017 with knowledge of BD's relationship to risk but not to masking. Most women wanted to know their BD (62.5% in 2017 versus 59.8% in 2012; P = .46); this information was anticipated to cause anxiety in 44.8% (versus 44.9% in 2012; P = .96); confusion in 35.9% (versus 43.0%; P = .002); and feeling informed in 89.7% (versus 90.4%; P = .64). Over three-quarters supported federal BD legislation in both surveys. Response rate to the 2017 survey was 55% (1,502 of 2,730) versus 65% (1,506 of 2,311) in 2012. CONCLUSION Although BD awareness has increased, important disparities persist. Knowledge of BD's impact on risk has increased; knowledge about masking and BD discussions with providers have not. Most women want to know their BD, would not feel anxious or confused as a result of knowing, and would feel empowered to make decisions. The federal BD notification legislation presents an opportunity to improve awareness and knowledge and encourage BD conversations with providers.
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Villanti AC, Naud S, West JC, Pearson JL, Wackowski OA, Niaura RS, Hair E, Rath JM. Prevalence and correlates of nicotine and nicotine product perceptions in U.S. young adults, 2016. Addict Behav 2019; 98:106020. [PMID: 31238235 PMCID: PMC6947657 DOI: 10.1016/j.addbeh.2019.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 06/05/2019] [Accepted: 06/07/2019] [Indexed: 01/31/2023]
Abstract
INTRODUCTION Nicotine is not a human carcinogen and combustion compounds in tobacco smoke, rather than nicotine, cause tobacco-related cardiovascular disease. Few recent studies examine the public's beliefs about nicotine in relation to smoking. METHODS Participants aged 18-40 (n = 4,091) in Wave 10 (Fall 2016) of the Truth Initiative Young Adult Cohort Study responded to nineteen items on nicotine and nicotine product perceptions, including addictiveness and health harms of nicotine patch/gum and e-cigarettes compared to cigarettes. Analyses conducted in 2018 examined prevalence of perceptions and sociodemographic and tobacco use correlates of selected perceptions. RESULTS The majority of young adults reported that nicotine was responsible for a "relatively" or "very large" part of the health risks (66%) and cancer (60%) caused by smoking. More than half of young adults (55%) believed that nicotine is a cause of cancer. Between 23% and 43% of young adults responded "don't know" to items on nicotine. Females, blacks, Hispanics, and those with less than some college education were more likely to report true or "don't know" vs. false to "nicotine is a cause of cancer" and had higher odds of believing that nicotine was responsible for a "relatively" or "very large" part of the health risks of smoking and cancer caused by smoking. Past 30-day tobacco users had lower odds of reporting these beliefs. CONCLUSIONS Misperceptions of nicotine are widespread in young adults. Public education is needed to maximize the public health impact of FDA's required nicotine warning label and proposed nicotine reduction policies.
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Affiliation(s)
- Andrea C Villanti
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Shelly Naud
- Department of Medical Biostatistics, University of Vermont, Burlington, VT, USA
| | - Julia C West
- Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont, Burlington, VT, USA
| | - Jennifer L Pearson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Division of Social and Behavioral Sciences/Health Administration and Policy, School of Community Health Sciences, University of Nevada, Reno, Reno, NV, USA
| | - Olivia A Wackowski
- Center for Tobacco Studies, School of Public Health, Rutgers, the State University, Piscataway, NJ, USA
| | - Raymond S Niaura
- Department of Social and Behavioral Sciences, College of Global Public Health, New York University, New York, NY, USA
| | - Elizabeth Hair
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
| | - Jessica M Rath
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute at Truth Initiative, Washington, DC, USA
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Johnson AL, Collins LK, Villanti AC, Pearson JL, Niaura RS. Patterns of Nicotine and Tobacco Product Use in Youth and Young Adults in the United States, 2011-2015. Nicotine Tob Res 2019; 20:S48-S54. [PMID: 30125012 PMCID: PMC6093370 DOI: 10.1093/ntr/nty018] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
Introduction As cigarette smoking has decreased among youth and young adults (YAs) in the United States, the prevalence of other tobacco and nicotine product use has increased. Methods This study identified common past 30-day patterns of tobacco and nicotine product use in youth (grades 6–12) and YAs (aged 18–24). Using data from the 2011–2015 National Youth Tobacco Survey (NYTS) and corresponding years of the Truth Initiative Young Adult Cohort Study (TIYAC), past 30-day use of the following products was assessed: cigarettes, e-cigarettes, any type of cigar, smokeless tobacco, hookah, and other tobacco products (pipe, bidis, kreteks, dissolvable tobacco, and snus). A user-generated program in R was used to assess all possible combinations of product-specific and polytobacco use. Results The top five patterns of past 30-day use in youth were exclusive cigarette use (12.0%), exclusive cigar use (10.3%), exclusive e-cigarette use (10.0%), dual use of cigarettes and cigars (6.1%), and exclusive hookah use (5.2%). In YAs, the top five patterns were exclusive cigarette use (46.5%), exclusive cigar use (10.0%), dual use of cigarettes and cigars (6.4%), exclusive hookah use (5.9%), and dual use of cigarettes and e-cigarettes (3.9%). Conclusions As noncigarette tobacco and nicotine products become increasingly popular among tobacco users, further research is needed to identify predictors and correlates of specific tobacco use patterns in youth and YAs. This analysis can inform tobacco prevention efforts focusing on emerging tobacco products such as e-cigarettes and hookah. Educational and other intervention efforts should focus on the diversity of products and use patterns in these age groups. Implications This study uses population-based data to provide new information on the most prevalent patterns of past 30-day nicotine and tobacco use over a 5-year period among youth and young adults. Study findings demonstrate that youth and young adults report using tobacco and nicotine products in different combinations, with varying popularity over time. Additionally, by examining young adults as a separate group, this study highlights the unique patterns of use not previously discussed in the adult literature.
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Affiliation(s)
- Amanda L Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Lauren K Collins
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Andrea C Villanti
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Raymond S Niaura
- College of Global Public Health, New York University, New York, NY
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Johnson AL, Villanti AC, Williams V, Rath JM, Vallone DM, Abrams DB, Hedeker D, Mermelstein RJ. Smoking Trajectory Classes and Impact of Social Smoking Identity in Two Cohorts of U.S. Young Adults. EMERGING ADULTHOOD (PRINT) 2019; 7:258-269. [PMID: 38250305 PMCID: PMC10798807 DOI: 10.1177/2167696818763949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
This study describes cigarette smoking trajectories, the influence of social smoker self-identification (SSID), and correlates of these trajectories in two cohorts of U.S. young adults: a sample from the Chicago metropolitan area (Social Emotional Contexts of Adolescent and Young Adult Smoking Patterns [SECAP], n = 893) and a national sample (Truth Initiative Young Adult Cohort Study [YA Cohort], n = 1,491). Using latent class growth analyses and growth mixture models, five smoking trajectories were identified in each sample: in SECAP: nonsmoking (n = 658, 73.7%), declining smoking (n = 20, 2.2%), moderate/stable smoking (n = 114, 12.8%), high/stable smoking (n = 79, 8.9%), and escalating smoking (n = 22, 2.5%); and in YA Cohort: nonsmoking (n = 1,215, 81.5%), slowly declining smoking (n = 52, 3.5%), rapidly declining smoking (n = 50, 3.4%), stable smoking (n = 139, 9%), and escalating smoking (n = 35, 2.4%). SSID was most prevalent in moderate/stable smoking (35.5% SECAP), rapidly declining smoking (25.2% YA Cohort), and nonsmoking. Understanding nuances of how smoking identity is formed and used to limit or facilitate smoking behavior in young adults will allow for more effective interventions to reduce tobacco use.
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Affiliation(s)
| | - Andrea C. Villanti
- Truth Initiative Schroeder Institute
- Department of Psychiatry, Vermont Center on Behavior & Health, University of Vermont
| | - Valerie Williams
- General Dynamics Information Technology/General Dynamics Health Solutions
| | - Jessica M. Rath
- Truth Initiative Schroeder Institute
- Deparment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
| | - Donna M. Vallone
- Truth Initiative Schroeder Institute
- Deparment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health
- College of Global Public Health, New York University
| | - David B. Abrams
- Truth Initiative Schroeder Institute
- College of Global Public Health, New York University
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center
| | - Donald Hedeker
- Department of Public Health Sciences, University of Chicago
| | - Robin J. Mermelstein
- Department of Psychology and Institute for Health Research and Policy, University of Illinois at Chicago
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Moran MB, Villanti AC, Johnson A, Rath J. Patterns of Alcohol, Tobacco, and Substance Use Among Young Adult Peer Crowds. Am J Prev Med 2019; 56:e185-e193. [PMID: 31104724 PMCID: PMC6538284 DOI: 10.1016/j.amepre.2019.02.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 10/26/2022]
Abstract
INTRODUCTION The association between peer crowd identification and substance use is well documented among adolescents, but less is known about substance use among young adult peer crowds. METHODS This study leverages data from the Truth Initiative Young Adult Cohort Study (Wave 8, June-July 2015), a nationally representative cohort sample of young adults aged 18-34 years. The current cross-sectional analyses (conducted in 2018) focused on 1,341 individuals aged 18-24 years in this sample. Participants reported their peer crowd identification and current use of alcohol, marijuana, other drugs, and tobacco (cigarettes, little cigars/cigarillos, e-cigarettes, hookah, smokeless tobacco). Adjusted logistic regression models assessed associations between peer crowd identification and substance use. RESULTS In general, young adults who identified as homebody, young professional, or religious had lower odds of substance use than their counterparts. Young adults who identified as social/partier were more likely to be current users of alcohol, marijuana, any tobacco, cigarettes, and e-cigarettes than those who did not identify as social/partier. Those who identified as alternative were more likely to be current users of marijuana and other drugs than those not identified as alternative. Those who identified as country were more likely than those not identified as country to be current users of cigarettes and smokeless tobacco. Those who identified as hip hop were more likely to be current users of marijuana and e-cigarettes. CONCLUSIONS Peer crowd identification is associated with substance use among young adults. These findings can help identify target populations for prevention and cessation interventions and inform intervention design and delivery.
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Affiliation(s)
- Meghan Bridgid Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Andrea C Villanti
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; Vermont Center on Behavior and Health, Department of Psychiatry, University of Vermont Larner College of Medicine, Burlington, Vermont; Schroeder Institute at Truth Initiative, Washington, District of Columbia
| | - Amanda Johnson
- Schroeder Institute at Truth Initiative, Washington, District of Columbia
| | - Jessica Rath
- Schroeder Institute at Truth Initiative, Washington, District of Columbia
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Haas JS, Giess CS, Harris KA, Ansolabehere J, Kaplan CP. Randomized Trial of Personalized Breast Density and Breast Cancer Risk Notification. J Gen Intern Med 2019; 34:591-597. [PMID: 30091121 PMCID: PMC6445917 DOI: 10.1007/s11606-018-4622-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Revised: 06/15/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Despite widespread implementation of mammographic breast density (MBD) notification laws, the impact of these laws on knowledge of MBD and knowledge of breast cancer risk is limited by the lack of tools to promote informed decision-making in practice. OBJECTIVE To develop and evaluate whether brief, personalized informational videos following a normal mammogram in addition to a legislatively required letter about MBD result can improve knowledge of MBD and breast cancer risk compared to standard care (i.e., legislatively required letter about MBD included with the mammogram result). DESIGN/PARTICIPANTS Prospective randomized controlled trial of English-speaking women, age 40-74 years, without prior history of breast cancer, receiving a screening mammogram with a normal or benign finding (intervention group n = 235, control group n = 224). INTERVENTION brief (3-5 min) video, personalized to a woman's MBD result and breast cancer risk. MAIN MEASURES Primary outcomes were a woman's knowledge of her MBD and risk of breast cancer. Secondary outcomes included whether a woman reported that she discussed the results of her mammogram with her primary care provider (PCP). KEY RESULTS Relative to women in the control arm, women in the intervention arm had greater improvement in their knowledge of both their personal MBD (intervention pre/post 39.2%/ 77.5%; control pre/post 36.2%/ 37.5%; odds ratio (OR) 5.34 for change for intervention vs. control, 95% confidence interval (CI) 3.87-7.36; p < 0.001) and risk of breast cancer (intervention pre/post: 66.8%/74.0%; control pre/post 67.9%/ 65.2%; OR 1.42, 95% confidence interval (CI) 1.09-1.84; p = 0.01). Women in the intervention group were more likely than those in the control group to report discussing the results of their mammogram with their PCP (p = 0.05). CONCLUSIONS Brief, personalized videos following mammography can improve knowledge of MBD and personal risk of breast cancer compared to a legislatively mandated informational letter. Trial Registration Clinicaltrials.gov (NCT02986360).
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Affiliation(s)
- Jennifer S Haas
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.
| | - Catherine S Giess
- Department of Radiology, Division of Breast Imaging, Brigham and Women's Hospital, Boston, MA, USA
| | - Kimberly A Harris
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Julia Ansolabehere
- Division of General Medicine and Primary Care, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine, University of California, San Francisco, San Francisco, CA, USA
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Busch SH, Hoag JR, Aminawung JA, Xu X, Richman IB, Soulos PR, Kyanko KA, Gross CP. Association of State Dense Breast Notification Laws With Supplemental Testing and Cancer Detection After Screening Mammography. Am J Public Health 2019; 109:762-767. [PMID: 30896987 DOI: 10.2105/ajph.2019.304967] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the association of state dense breast notification (DBN) laws with use of supplemental tests and cancer diagnosis after screening mammography. METHODS We examined screening mammograms (n = 1 441 544) performed in 2014 and 2015 among privately insured women aged 40 to 59 years living in 9 US states that enacted DBN laws in 2014 to 2015 and 25 US states with no DBN law in effect. DBN status at screening mammography was categorized as no DBN, generic DBN, and DBN that mandates notification of possible benefits of supplemental screening (DBN+SS). We used logistic regression to examine the change in rate of supplemental ultrasound, magnetic resonance imaging, breast biopsy, and breast cancer detection. RESULTS DBN+SS laws were associated with 10.5 more ultrasounds per 1000 mammograms (95% CI = 3.0, 17.6 per 1000; P = .006) and 0.37 more breast cancers detected per 1000 mammograms (95% CI = 0.05, 0.69 per 1000; P = .02) compared with no DBN law. No significant differences were found for generic DBN laws in either ultrasound or cancer detection. CONCLUSIONS DBN legislation is associated with increased use of ultrasound and cancer detection after implementation only when notification of the possible benefits of supplemental screening is required.
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Affiliation(s)
- Susan H Busch
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jessica R Hoag
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Jenerius A Aminawung
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Xiao Xu
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Ilana B Richman
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Pamela R Soulos
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Kelly A Kyanko
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
| | - Cary P Gross
- Susan H. Busch is with the Department of Health Policy and Management, Yale School of Public Health, New Haven, CT. Jessica R. Hoag, Jenerius A. Aminawung, Pamela R. Soulos, and Cary P. Gross are with Department of Internal Medicine, Cancer Outcomes, Public Policy and Effectiveness Research (COPPER) Center, Yale School of Medicine, New Haven. Xiao Xu is with the Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine. Ilana B. Richman is with the Department of Internal Medicine, Yale School of Medicine. Kelly A. Kyanko is with the Department of Population Health, New York University School of Medicine, New York, NY
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Pacsi-Sepulveda AL, Shelton RC, Rodriguez CB, Coq AT, Tehranifar P. "You probably can't feel as safe as normal women": Hispanic women's reactions to breast density notification. Cancer 2019; 125:2049-2056. [PMID: 30768781 DOI: 10.1002/cncr.32002] [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: 10/08/2018] [Revised: 12/21/2018] [Accepted: 01/04/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patient advocacy has led to state-level legislative mandates for the release of personal mammographic breast density information to women undergoing screening mammography. More research is needed to understand the impact of this information on women's perceptions and mammography screening behavior. METHODS Semistructured interviews were conducted in English and Spanish with 24 self-identified Hispanic women who had undergone at least 1 mammogram since breast density notification was enacted in New York State. The women ranged in age from 43 to 63 years. Women were asked about their understanding and perceptions of the communication of New York State-mandated breast density information, and any actions they have taken or would take in response to this information. A content analysis of the qualitative data from the translated and transcribed interviews was conducted. RESULTS The majority of participants had no prior knowledge of breast density and expressed confusion and apprehension regarding the meaning of dense breasts when presented with the notification information. Many participants understood having dense breasts to be a serious and abnormal condition, and reported feelings of worry and vulnerability. Participants mostly expressed a strong interest in learning about breast density and obtaining additional and more frequent breast cancer screening tests. These behavioral intentions were consistent with participants' overall favorable view of breast cancer screening and a belief that their faith, as well as regular screening, can help to protect them from breast cancer morbidity and mortality. CONCLUSIONS Hispanic women conveyed proactive breast cancer screening intentions in response to breast density notification, despite inadequate comprehension of this information and negative emotional responses.
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Affiliation(s)
| | - Rachel C Shelton
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, New York.,Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York
| | - Carmen B Rodriguez
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Arielle T Coq
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Parisa Tehranifar
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, New York.,Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
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Gunn CM, Fitzpatrick A, Waugh S, Carrera M, Kressin NR, Paasche-Orlow MK, Battaglia TA. A Qualitative Study of Spanish-Speakers' Experience with Dense Breast Notifications in a Massachusetts Safety-Net Hospital. J Gen Intern Med 2019; 34:198-205. [PMID: 30350031 PMCID: PMC6374252 DOI: 10.1007/s11606-018-4709-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 09/04/2018] [Accepted: 10/01/2018] [Indexed: 12/01/2022]
Abstract
BACKGROUND Legislation requiring mammography facilities to notify women if they have dense breast tissue found on mammography has been enacted in 34 US states. The impact of dense breast notifications (DBNs) on women with limited English proficiency (LEP) is unknown. OBJECTIVE This study sought to understand Spanish-speaking women's experience receiving DBNs in a Massachusetts safety-net hospital. DESIGN Eligible women completed one audio-recorded, semi-structured interview via telephone with a native Spanish-speaking research assistant trained in qualitative methods. Interviews were professionally transcribed verbatim and translated. The translation was verified by a third reviewer to ensure fidelity with audio recordings. PARTICIPANTS Nineteen Spanish-speaking women ages 40-74 who received mammography with a normal result and recalled receiving a DBN. APPROACH Using the verified English transcripts, we conducted a content analysis to identify women's perceptions and actions related to receiving the notification. A structured codebook was developed. Transcripts were independently coded and assessed for agreement with a modification of Cohen's kappa. Content codes were grouped to build themes related to women's perceptions and actions after receiving a DBN. KEY RESULTS Nineteen Spanish-speaking women completed interviews. Nine reported not receiving the notification in their native language. Four key themes emerged: (1) The novelty of breast density contributed to notification-induced confusion; (2) women misinterpreted key messages in the notification; (3) varied actions were taken to seek further information; and (4) women held unrealized expectations and preferences for follow-up. CONCLUSIONS Not having previous knowledge of breast density and receiving notifications in English contributed to confusion about its meaning and inaccurate interpretations of key messages by Spanish speakers. Tools that promote understanding should be leveraged in seeking equity in risk-based breast cancer screening for women with dense breasts.
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Affiliation(s)
- Christine M Gunn
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA. .,Department of Health Law, Policy, and Management, School of Public Health, Boston University, Boston, MA, USA.
| | - Amy Fitzpatrick
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Sarah Waugh
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Michelle Carrera
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
| | - Nancy R Kressin
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA, USA.,Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Michael K Paasche-Orlow
- Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, Boston, MA, USA
| | - Tracy A Battaglia
- Women's Health Unit, Section of General Internal Medicine, Evans Department of Medicine, School of Medicine, Boston University, 801 Massachusetts Avenue, First Floor, Women's Health, Boston, MA, 02118, USA
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