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Rana SP, Dey M, Loretoni R, Duranti M, Ghavami M, Dudley S, Tiberi G. Radiation-Free Microwave Technology for Breast Lesion Detection Using Supervised Machine Learning Model. Tomography 2023; 9:105-129. [PMID: 36648997 PMCID: PMC9844448 DOI: 10.3390/tomography9010010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/08/2023] [Accepted: 01/09/2023] [Indexed: 01/14/2023] Open
Abstract
Mammography is the gold standard technology for breast screening, which has been demonstrated through different randomized controlled trials to reduce breast cancer mortality. However, mammography has limitations and potential harms, such as the use of ionizing radiation. To overcome the ionizing radiation exposure issues, a novel device (i.e. MammoWave) based on low-power radio-frequency signals has been developed for breast lesion detection. The MammoWave is a microwave device and is under clinical validation phase in several hospitals across Europe. The device transmits non-invasive microwave signals through the breast and accumulates the backscattered (returned) signatures, commonly denoted as the S21 signals in engineering terminology. Backscattered (complex) S21 signals exploit the contrast in dielectric properties of breasts with and without lesions. The proposed research is aimed to automatically segregate these two types of signal responses by applying appropriate supervised machine learning (ML) algorithm for the data emerging from this research. The support vector machine with radial basis function has been employed here. The proposed algorithm has been trained and tested using microwave breast response data collected at one of the clinical validation centres. Statistical evaluation indicates that the proposed ML model can recognise the MammoWave breasts signal with no radiological finding (NF) and with radiological findings (WF), i.e., may be the presence of benign or malignant lesions. A sensitivity of 84.40% and a specificity of 95.50% have been achieved in NF/WF recognition using the proposed ML model.
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Affiliation(s)
| | - Maitreyee Dey
- School of Engineering, London South Bank University, London SE1 0AA, UK
| | - Riccardo Loretoni
- Breast Screening and Diagnostic Breast Cancer Unit, AUSL Umbria 2, 06034 Foligno, Italy
| | - Michele Duranti
- Department of Diagnostic Imaging, Perugia Hospital, 06156 Perugia, Italy
| | - Mohammad Ghavami
- School of Engineering, London South Bank University, London SE1 0AA, UK
| | - Sandra Dudley
- School of Engineering, London South Bank University, London SE1 0AA, UK
| | - Gianluigi Tiberi
- School of Engineering, London South Bank University, London SE1 0AA, UK
- Umbria Bioengineering Technologies (UBT) Srl, 06081 Perugia, Italy
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Moussaoui S, Chauvin P, Ibanez G, Soler M, Nael V, Morgand C, Robert S. Construction and Validation of an Individual Deprivation Index: a Study Based on a Representative Cohort of the Paris Metropolitan Area. J Urban Health 2022; 99:1170-1182. [PMID: 35653078 PMCID: PMC9161768 DOI: 10.1007/s11524-022-00648-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/15/2022] [Indexed: 12/31/2022]
Abstract
The association between health status and deprivation is well established. However, it is difficult to measure deprivation at an individual level and already-existing indices in France are not validated or do not meet the needs of health practitioners. The aim of this work was to establish a validated, easy-to-use, multidimensional, relevant index that was representative of the population in the Paris metropolitan area. From the SIRS 2010 cohort study, 14 socio-economic characteristics were selected: health insurance, educational background, socio-professional category, professional status, feelings of loneliness, emotional situation, household type, income, perceived financial situation, social support (support in daily life, financial and emotional), housing situation, and migration origin. In addition, a total of 12 health status, healthcare use, and nutrition-related variables were also selected. Content validity and internal validity of the index were explored. The 14 socio-economic indicators were associated to varying degrees with poorer health status, less use of healthcare, and poorer nutrition and were distributed across the 14 multiple-choice questions of the index. Each answer was rated from 0 to 2. The index value of 10 that isolates 20% of the most deprived individuals was used as threshold. "Being deprived," as defined with this value, was significantly associated with 9 of the 12 studied health variables. This index could be a relevant instrument in the assessment of deprivation and social inequalities of health.
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Affiliation(s)
- Sohela Moussaoui
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France.
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France.
| | - Pierre Chauvin
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
| | - Gladys Ibanez
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France
| | - Marion Soler
- University Hospital of Montpellier, 191 Av. du Doyen Gaston Giraud, 34295, Montpellier, France
| | - Virginie Nael
- Bordeaux University, 146 Rue Léo Saignat, 33076, Bordeaux, France
| | - Claire Morgand
- Inserm UMRS 1137, Paris, France
- Evaluation Department and Tools for Quality and Safety of Care, French National Authority for health, Saint Denis, France
| | - Sarah Robert
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Department of Social Epidemiology, F75012, Paris, France
- Sorbonne Université, Faculty of Medicine Pierre et Marie Curie, Department of Education and Research in General Medicine, F75012, Paris, France
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Edmonds MC, Kim SJ, Wells M, Dahman B, Sheppard VB. A Mixed Method Approach to Examine Surveillance Mammography Experiences in Black and White Breast Cancer Survivors. Clin Breast Cancer 2022; 22:801-811. [PMID: 36137937 DOI: 10.1016/j.clbc.2022.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 08/02/2022] [Accepted: 08/21/2022] [Indexed: 01/25/2023]
Abstract
PURPOSE The use of surveillance mammography following a breast cancer (BC) diagnosis is associated with early detection of disease relapse and increased overall survival; yet Black women compared to White women have the lowest surveillance mammography rates, with limited explanation. To further understand this racial disparity the present study examines the association of mammography beliefs, knowledge, and healthcare delivery factors on receipt of surveillance mammography among Black and White breast cancer survivors. METHODS This is a convergent parallel mixed method study design of an online survey and online focus groups among Black and White BC survivors (N = 266) recruited from community engagement. The online focus groups consisted of a series of theory-informed questions via social media platforms (eg Breastcancer.org, Quora, Reddit). An in-depth thematic analysis approach was used to extract themes from online focus group data. Bivariate (χ2) and multivariable logistic regression analyses were conducted using the survey data to examine associated factors with receipt of a surveillance mammography within 12 months (yes vs. no). RESULTS 76% (n = 177) of women were Black, 62% were <5 years since diagnosis, 98% had health insurance, with an age range from 23 to 79 (mean = 55) years. 72% of the sample received a surveillance mammogram relative to 27%. Women more frequently received a surveillance mammogram if they reported perceived mammography benefits (<.001), underwent lumpectomy (P< .001) and had health insurance (P = .04). Black women without communication about surveillance care with providers had a lower likelihood of receiving a surveillance mammogram (OR:0.09,95% CI: 0.01-0.45, P = .003). Thematic findings from online focus groups included motivators for receipt of surveillance mammograms: physician recommendation, regular physical exams, and knowledge of recommended guidelines. Barriers of non-receipt of surveillance mammograms included: transportation, medical cost/financial barriers, feeling ignored from providers, and medical mistrust. CONCLUSION Women may require more individualized information regarding their surveillance care to support routine guideline concordant follow-up. Patient-provider-communication is an integral part of Black survivors' surveillance care needs. Improving patient-provider communication for Black women's is necessary to address this group cancer care needs.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Matthew Wells
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA; VCU Massey Cancer Center, Richmond, VA
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Edmonds MC, Dahman B, McGuire K, Sheppard VB. Influential factors in Black and White breast cancer survivors' beliefs about breast cancer. Psychooncology 2022; 31:271-281. [PMID: 34590395 PMCID: PMC8818015 DOI: 10.1002/pon.5807] [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: 03/19/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE Breast cancer beliefs are widely studied to improve preventative screening behaviors in women without cancer; however, limited research has examined breast cancer beliefs among breast cancer survivors. To fill this gap in research we investigated racial differences and the predicting role of influential factors (e.g., stage) in survivors' beliefs about their breast cancer. METHODS This study is a secondary analysis of data from the Narrowing Gap in Adjuvant Therapy Study (2006-2011), where Black (N = 210) and White women (N = 149) were interviewed within 20 weeks following their breast cancer diagnosis and primary surgery in Washington DC and Detroit, MI. Outcomes of this analysis were perceived susceptibility to a breast cancer recurrence and perceived severity of breast cancer. Bivariate analyses were conducted to assess racial differences in sample characteristics, and on the study outcomes. Adjusted multiple regression models examined correlates between independent variables (e.g., sociodemographic/clinical) and women's breast cancer beliefs about susceptibility of a recurrence and disease severity. RESULTS Most of the sample were Black women (58%), had breast-conserving surgery (64%), and were privately insured (67%). Black women reported higher perceived disease severity beliefs than White women (p = 0.004). Other associated factors with greater perceived severity beliefs included lower education (p = 0.008), public health insurance (p = 0.021) and greater levels of medical mistrust (p = 0.016). In our adjusted multiple regression models' women with lower satisfaction regarding financial aspects of their healthcare were more likely to have higher perceived severity beliefs (p = 0.007); women with stage II cancer compared to stage I had greater susceptibility beliefs to a cancer recurrence (p = 0.001). CONCLUSION We found racial differences in women's perceived severity beliefs, and identified theory-based clinical and psychosocial correlates in survivor's breast cancer beliefs by race. Specifically, women diagnosed at stage (II) compared to stage (I) reported greater perceived susceptibility to a recurrence. Survivors diagnosed at stage (I) and (III) cancers may serve as important target groups to monitor their surveillance and follow-up behaviors. This study contributes salient predictors in survivors' beliefs about their BC and informs navigation strategies to improve cancer survivorship recommendations in the context of psycho-oncology and follow-up cancer care.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Kandace McGuire
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- Office of Health Equity and Disparities Research, VCU Massey Cancer Center, Richmond, VA, USA
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Yedjou CG, Sims JN, Miele L, Noubissi F, Lowe L, Fonseca DD, Alo RA, Payton M, Tchounwou PB. Health and Racial Disparity in Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:31-49. [PMID: 31456178 PMCID: PMC6941147 DOI: 10.1007/978-3-030-20301-6_3] [Citation(s) in RCA: 229] [Impact Index Per Article: 45.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. It currently affects more than one in ten women worldwide. The chance for a female to be diagnosed with breast cancer during her lifetime has significantly increased from 1 in 11 women in 1975 to 1 in 8 women (Altekruse, SEER Cancer Statistics Review, 1975-2007. National Cancer Institute, Bethesda, 2010). This chance for a female of being diagnosed with cancer generally increases with age (Howlader et al, SEER Cancer Statistics Review, 1975-2010. National Cancer Institute, Bethesda, 2013). Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in the White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic population has continued to grow. The goal of the work presented in this book chapter is to highlight similarities and differences in breast cancer morbidity and mortality rates among non-Hispanic white and non-Hispanic black populations. This book chapter also provides an overview of breast cancer, racial/ethnic disparities in breast cancer, breast cancer incidence and mortality rate linked to hereditary, major risk factors of breast cancer among minority population, breast cancer treatment, and health disparity. A considerable amount of breast cancer treatment research have been conducted, but with limited success for African Americans compared to other ethnic groups. Therefore, new strategies and approaches are needed to promote breast cancer prevention, improve survival rates, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities. In addition, it is vital that leaders and medical professionals from minority population groups be represented in decision-making in research so that racial disparity in breast cancer can be well-studied, fully addressed, and ultimately eliminated in breast cancer.
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Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA.
| | - Jennifer N Sims
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Lucio Miele
- LSU Health Sciences Center, School of Medicine, Department of Genetics, New Orleans, LA, USA
| | - Felicite Noubissi
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Leroy Lowe
- Getting to Know Cancer (NGO), Truro, NS, Canada
| | - Duber D Fonseca
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Richard A Alo
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Marinelle Payton
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
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Wegwarth O, Widschwendter M, Cibula D, Sundström K, Portuesi R, Lein I, Rebitschek FG. What do European women know about their female cancer risks and cancer screening? A cross-sectional online intervention survey in five European countries. BMJ Open 2018; 8:e023789. [PMID: 30593552 PMCID: PMC6318519 DOI: 10.1136/bmjopen-2018-023789] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Informed decisions about cancer screening require accurate knowledge regarding cancer risks and screening. This study investigates: (1) European women's knowledge of their risk of developing breast, ovarian, cervical or endometrial cancer, (2) their knowledge about mammography screening and (3) whether an evidence-based leaflet improves their knowledge. DESIGN Cross-sectional online intervention survey. SETTING National samples from five European countries (Czech Republic, Germany, UK, Italy and Sweden)-drawn from the Harris Interactive and the Toluna panel, respectively, in January 2017-were queried on their knowledge of age-specific risks of developing breast, cervical, ovarian or endometrial cancer within the next 10 years and of mammography screening before and after intervention. PARTICIPANTS Of 3629 women (inclusion criteria: age 40-75 years) invited, 2092 responded and 1675 completed the survey (response rate: 61.4%). INTERVENTION Evidence-based leaflet summarising information on age-adjusted female cancer risks, mammography and aspects of cancer prevention. PRIMARY OUTCOME MEASURES Proportion of women (1) accurately estimating their risk of four female cancers, (2) holding correct assumptions of mammography screening and (3) changing their estimations and assumptions after exposure to leaflet. FINDINGS Across countries, 59.2% (95% CI 56.8% to 61.6%) to 91.8% (95% CI 90.3% to 93.0%) overestimated their female cancer risks 7-33 fold (mediansacross tumours: 50.0 to 200.0). 26.5% (95% CI 24.4% to 28.7%) were aware that mammography screening has both benefits and harms. Women who accurately estimated their breast cancer risk were less likely to believe that mammography prevents cancer (p<0.001). After leaflet intervention, knowledge of cancer risks improved by 27.0 (95% CI 24.9 to 29.2) to 37.1 (95% CI 34.8 to 39.4) percentage points and of mammography by 23.0 (95% CI 21.0 to 25.1) percentage points. CONCLUSION A considerable number of women in five European countries may not possess the prerequisites for an informed choice on cancer screening. Evidence-based information in patient leaflets can improve this situation.
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Affiliation(s)
- Odette Wegwarth
- Center for Adaptive Rationality, Max Planck Institute for Human Development, Berlin, Germany
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | | | - David Cibula
- Department of Obstetrics and Gynecology, Charles University Prague (Czech Republic), Prague, UK
| | - Karin Sundström
- Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
- Laboratory Karolinska University Hospital, Karolinska University, Stockholm, Sweden
| | - Rosalba Portuesi
- Unit of Gynecology, Humanitas Research Hospital, Milan, Italy
- Unit of Preventive Gynecology, European Institute of Oncology, Milan, Italy
| | - Ines Lein
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
| | - Felix G Rebitschek
- Harding Center for Risk Literacy, Max Planck Institute for Human Development, Berlin, Germany
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Gonzales A, Alzaatreh M, Mari M, A Saleh A, Alloubani A. Beliefs and Behavior of Saudi Women in the University of Tabuk Toward Breast Self Examination Practice. Asian Pac J Cancer Prev 2018; 19:121-126. [PMID: 29373902 PMCID: PMC5844605 DOI: 10.22034/apjcp.2018.19.1.121] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Breast cancer is one of the most frequent types of malignancy worldwide, Breast Self Exam (BSE) is considered as a simple method to screen and detect breast cancer, then early beginning of treatment and enhancing survival rates. Aim: To Identify the health beliefs about breast Self-Examination and its relationships with the frequency of BSE among the women in the University of Tabuk at Saudi Arabia. Methods: Descriptive, cross-sectional correlational design was used; Champion Health Beliefs Model (CHBM) was utilized to assess health beliefs among 400 women who answered a self-administered questionnaire. Results: Among the 400 respondents, almost all the sample (382,95.5%) heard about BSE. However, only (7.8%) practiced BSE regularly each month in the past year, and (9%) is intended to perform BSE monthly in future. There was a positive relationship between performing BSE last year and the beliefs of susceptibility and confidence. While, intention to perform BSE in the future was significantly correlated to seriousness and confidence. Perceived barriers were negatively related to BSE performance in last 12 months and in future. Conclusion: Health beliefs affect the behavior of women in practicing BSE. Confidence was related positively to BSE in past year, and future practice, while barriers belief was as the negative factor to perform BSE.
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Affiliation(s)
- Analita Gonzales
- Department of Nursing, Faculty of Applied Medical Sciences, University of Tabuk, Saudi Arabia.
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When open access might not work: Understanding patient attitudes in appointment scheduling. Health Care Manage Rev 2017; 43:348-358. [PMID: 28125458 DOI: 10.1097/hmr.0000000000000150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Open-access (OA) systems aim to reduce delays to care. However, recent evidence suggests that OA systems might reduce patient satisfaction and result in poorer patient experiences due to patients' inability to obtain appointments with their usual care provider. We conducted a series of experiments to explore the role of risk attitudes, an individual difference variable that measures preferences for risky options, in patients' perception of OA systems. PURPOSE The aim of the study was to investigate the relationship between patient's risk attitudes and attitudes toward OA systems and demonstrate whether patients' attitudes toward OA systems will vary as a function of their risk attitudes. METHODOLOGY Three separate experiments were conducted to assess the relationship between patient risk attitudes and their attitudes about OA systems. Study 1 (patient population) explored the aforementioned relationship. We explored two potential moderators for this effect: how salient the tradeoff is between delays to care and quality of care (Study 2; online population) and the severity of the patient's health condition (Study 3; patient population). RESULTS Compared to risk-averse patients, risk-seeking patients have more favorable attitudes toward OA systems (a 1-point increase in risk attitudes on a 7-point scale resulted in a 0.44-point boost in attitudes toward OA systems on a 7-point scale). This relationship holds even when the tradeoff between access to care and quality of care is made salient (e.g., a practice informs patients they can have a same-day appointment but are unlikely to see their regular provider) and when people consider having a minor health condition. This relationship is attenuated when patients imagine having a serious medical condition because speedy access to care becomes a top priority. CONCLUSION Risk-seeking patients have more favorable attitudes toward OA systems. PRACTICE IMPLICATIONS Risk-seeking patients are primarily driven by speed to access at the potential expense of continuity of care. Organizations that better understand patient motives in scheduling medical appointments can introduce more effective interventions and positively impact patient experiences of care.
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Wampler NS, Ryschon T, Manson SM, Buchwald D. Knowledge, Attitudes, and Beliefs Regarding Breast Cancer Among American Indian Women From the Northern Plains. J Appl Gerontol 2016. [DOI: 10.1177/0733464805282729] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
American Indian women have low screening mammography rates. The authors’ goal was to compare the knowledge, attitudes, and beliefs about breast cancer among Northern Plains Reservation women who had and had not received screening mammography in the previous year. Another goal was to compare response rates achieved with an immediate monetary incentive to those achieved with an incentive after survey completion. Questionnaires were mailed to 234 women who had undergone screening mammography and 266 women who had not. Respondents included 144 (62%) of women who had been screened and 127 (48%) of women who had not. Women who had not received mammography less often were aware that older age increased breast cancer risk compared to women who had had a mammogram in the previous year. Findings suggest that Northern Plains women would benefit from educational efforts and discussions with clinicians about mammography. Immediate monetary incentives appear to increase response rates.
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Wilcox ML, Acuña JM, Ward-Peterson M, Alzayed A, Alghamdi M, Aldaham S. Racial/ethnic disparities in annual mammogram compliance among households in Little Haiti, Miami-Dade County, Florida: An observational study. Medicine (Baltimore) 2016; 95:e3826. [PMID: 27399061 PMCID: PMC5058790 DOI: 10.1097/md.0000000000003826] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 04/27/2016] [Accepted: 05/10/2016] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Breast cancer is the most commonly diagnosed cancer and the 2nd leading cause of cancer-related deaths among women in the U.S. Although routine screening via mammogram has been shown to increase survival through early detection and treatment of breast cancer, only 3 out of 5 women age ≥40 are compliant with annual mammogram within the U.S. and the state of Florida. A breadth of literature exists on racial/ethnic disparities in compliance with mammogram; however, few such studies include data on individual Black subgroups, such as Haitians. This study assessed the association between race/ethnicity and annual mammogram compliance among randomly selected households residing in the largely Haitian community of Little Haiti, Miami-Dade County (MDC), Florida. METHODS This study used cross-sectional, health data from a random-sample, population-based survey conducted within households residing in Little Haiti between November 2011 and December 2012 (n = 951). Mammogram compliance was defined as completion of mammogram by all female household members within the 12 months prior to the survey. The association between mammogram compliance and race/ethnicity was assessed using binary logistic regression models. Potential confounders were identified as factors that were conservatively associated with both compliance and race/ethnicity (P ≤ 0.20). Analyses were restricted to households containing at least 1 female member age ≥40 (n = 697). RESULTS Overall compliance with annual mammogram was 62%. Race/ethnicity was significantly associated with mammogram compliance (P = 0.030). Compliance was highest among non-Hispanic Black (NHB) households (75%), followed by Hispanic (62%), Haitian (59%), and non-Hispanic White (NHW) households (51%). After controlling for educational level, marital status, employment status, the presence of young children within the household, health insurance status, and regular doctor visits, a borderline significant disparity in mammogram compliance was observed between Haitian and NHB households (adjusted odds ratio = 1.63, P = 0.11). No other racial/ethnic disparities were observed. DISCUSSION Compliance with annual mammogram was low among the surveyed households in Little Haiti. Haitian households underutilized screening by means of annual mammogram compared with NHB households, although this disparity was not significant. Compliance rates could be enhanced by conducting individualized, mammogram screening-based studies to identify the reasons behind low rate of compliance among households in this underserved, minority population.
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Affiliation(s)
- Meredith Leigh Wilcox
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work
| | - Juan Manuel Acuña
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Human and Molecular Genetics, Florida International University, Miami, Florida, USA
| | - Melissa Ward-Peterson
- Department of Medical and Population Health Sciences Research, Herbert Wertheim College of Medicine
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work
| | - Abdullah Alzayed
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Mushref Alghamdi
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Sami Aldaham
- College of Medicine, Al Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Choi E, Lee YY, Yoon HJ, Lee S, Suh M, Park B, Jun JK, Kim Y, Choi KS. Relationship between Cancer Worry and Stages of Adoption for Breast Cancer Screening among Korean Women. PLoS One 2015; 10:e0132351. [PMID: 26186652 PMCID: PMC4506072 DOI: 10.1371/journal.pone.0132351] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/13/2015] [Indexed: 11/20/2022] Open
Abstract
Background The possibility of developing breast cancer is a concern for all women; however, few studies have examined the relationship between cancer worry and the stages of adoption for breast cancer screening in Korea. Here, we investigated the associations between cancer worry, the stages of adopting breast cancer screening, and socio-demographic factors known to influence screening behaviors. Methods This study was based on the 2013 Korean National Cancer Screening Survey, an annual cross-sectional survey that utilized nationally representative random sampling to investigate cancer screening rates. Data were analyzed from 1,773 randomly selected women aged 40–74 years. Chi-squared tests and multinomial logistic analyses were conducted to determine the associations between cancer worry and the stages of adoption for breast cancer screening and to outline the factors associated with each stage. Results Korean women were classified into the following stages of adoption for breast cancer screening: pre-contemplation (24.7%), contemplation (13.0%), action/maintenance (50.8%), relapse risk (8.9%), and relapse (2.6%). Women in the action/maintenance stages reported more moderate to higher levels of worry about getting cancer than those in the pre-contemplation stage. Further, age of 40–49 years and having private cancer insurance were associated with women in the action/maintenance stages. Conclusion Interventions to address breast cancer worry may play an important role in increasing participation and equity in breast cancer screening.
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Affiliation(s)
- Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Hyo Joong Yoon
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Sangeun Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Gyeonggi-do, Republic of Korea
- National Cancer Control Institute, National Cancer Center, Goyang, Gyeonggi-do, Korea
- * E-mail:
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Jones TP, Katapodi MC, Lockhart JS. Factors influencing breast cancer screening and risk assessment among young African American women: An integrative review of the literature. J Am Assoc Nurse Pract 2015; 27:521-9. [PMID: 25736320 DOI: 10.1002/2327-6924.12223] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 04/21/2014] [Indexed: 01/24/2023]
Abstract
PURPOSE This integrative review was conducted to examine factors that influence mammography screening and use of cancer genetic services among younger African American women at increased risk for developing breast cancer. DATA SOURCES Research articles were identified using PubMed, CINAHL, PsychINFO, and Cochrane library to find studies published from 2003 to 2013. CONCLUSIONS Findings from this review indicate that while younger African American women receive mammograms more often than the general population, they are not being referred for genetic testing when appropriate. This is a major concern because African American women tend to experience more aggressive forms of breast cancer at an earlier age than the general population; it is imperative that they undergo genetic testing for optimal management of their breast cancer risk. IMPLICATIONS FOR PRACTICE Nurse practitioners have a significant role in breast cancer screening and genetic testing of at-risk women, particularly in identifying and referring young women for testing. Further communication efforts are needed to improve young women's knowledge of breast cancer risk and the benefits of genetic testing. Reducing barriers to breast healthcare services requires nursing efforts that focus on populations at greatest risk for poor health outcomes.
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Affiliation(s)
- Tarsha P Jones
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
| | - Maria C Katapodi
- Institute of Nursing Science/Institut für Pflegewissenschaft, Faculty of Medicine, University of Basel/Medizinische Fakultät, Universität Basel, Switzerland
| | - Joan S Lockhart
- School of Nursing, Duquesne University, Pittsburgh, Pennsylvania
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Wharam JF, Landon B, Zhang F, Xu X, Soumerai S, Ross-Degnan D. Mammography rates 3 years after the 2009 US Preventive Services Task Force Guidelines changes. J Clin Oncol 2015; 33:1067-74. [PMID: 25667290 DOI: 10.1200/jco.2014.56.9848] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In November 2009, the US Preventive Services Task Force (USPSTF) changed its mammography recommendations from every 1 to 2 years among women age ≥ 40 years to personalized screening decisions for women age 40 to 49 years and screening every 2 years for women age 50 to 74 years. METHODS We studied mammography trends among 5.5 million women age 40 to 64 years enrolled in a large national health insurer. We used 2005 to 2009 mammography trends to predict 2012 rates. Our primary measure was the estimated difference between observed and predicted 2012 annual and biennial mammography rates. We stratified results by age group and race/ethnicity. RESULTS Among women age 40 to 49 years, 2012 mammography rates declined by 9.9% (95% CI, -10.4% to -9.3%) relative to the predicted 2012 rate. Decreases were lowest among black women (-2.3%; 95% CI, -6.3% to 1.8%) and highest among Asian women (-17.4; 95% CI, -20.0 to -14.8). Annual mammography rates among women age 50 to 64 years declined by 6.1% (95% CI, -6.5% to -5.7%) by 2012. Regarding biennial mammography rates, women age 40 to 49 years experienced a 9.0% relative reduction (95% CI, -9.6% to -8.4%). White, Hispanic, and Asian women age 40 to 49 years demonstrated similar relative reductions of approximately 9% to 11%, whereas black women had no detectable changes (0.1%; 95% CI, -4.0% to 4.3%). Women age 50 to 64 years had a 6.2% relative reduction (95% CI, -6.6% to -5.7%) in biennial mammography that was similar among white, Hispanic, and Asian women. Black women age 50 to 64 years did not have changes in biennial mammography (0.4%; 95% CI, -2.6% to 3.5%). CONCLUSION Three years after publication of the 2009 USPSTF guidelines, mammography rates declined by 6% to 17% among white, Hispanic, and Asian women but not among black women. Small reductions in biennial mammography might be an unintended consequence of the updated guidelines.
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Affiliation(s)
- J Frank Wharam
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA.
| | - Bruce Landon
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Fang Zhang
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Xin Xu
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Stephen Soumerai
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA
| | - Dennis Ross-Degnan
- All authors: Harvard Medical School; J. Frank Wharam, Fang Zhang, Xin Xu, Stephen Soumerai, and Dennis Ross-Degnan, Harvard Pilgrim Health Care Institute, Boston, MA
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Ahmadian M, Samah AA, Saidu MB. An outline of the need for psychology knowledge in health professionals: implications for community development and breast cancer prevention. Asian Pac J Cancer Prev 2014; 15:5097-105. [PMID: 24998591 DOI: 10.7314/apjcp.2014.15.12.5097] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Knowledge of health and community psychology in health professionals influences psychosocial and community determinants of health and promoting participation in disease prevention at the community level. This paper appraises the potential of knowledge on psychology in health care professionals and its contribution to community empowerment through individual behavior change and health practice. The authors proposed a schematic model for the use of psychological knowledge in health professionals to promote participation in health interventions/disease prevention programs in developing countries. By implication, the paper provides a vision on policies towards supporting breast cancer secondary prevention efforts for community health development in Asian countries.
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Affiliation(s)
- Maryam Ahmadian
- Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia, Selangor, Malaysia E-mail : ,
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15
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Matro JM, Ruth KJ, Wong YN, McCully KC, Rybak CM, Meropol NJ, Hall MJ. Cost sharing and hereditary cancer risk: predictors of willingness-to-pay for genetic testing. J Genet Couns 2014; 23:1002-11. [PMID: 24794065 DOI: 10.1007/s10897-014-9724-5] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 04/09/2014] [Indexed: 12/19/2022]
Abstract
Increasing use of predictive genetic testing to gauge hereditary cancer risk has been paralleled by rising cost-sharing practices. Little is known about how demographic and psychosocial factors may influence individuals' willingness-to-pay for genetic testing. The Gastrointestinal Tumor Risk Assessment Program Registry includes individuals presenting for genetic risk assessment based on personal/family cancer history. Participants complete a baseline survey assessing cancer history and psychosocial items. Willingness-to-pay items include intention for: genetic testing only if paid by insurance; testing with self-pay; and amount willing-to-pay ($25-$2,000). Multivariable models examined predictors of willingness-to-pay out-of-pocket (versus only if paid by insurance) and willingness-to-pay a smaller versus larger sum (≤$200 vs. ≥$500). All statistical tests are two-sided (α = 0.05). Of 385 evaluable participants, a minority (42%) had a personal cancer history, while 56% had ≥1 first-degree relative with colorectal cancer. Overall, 21.3% were willing to have testing only if paid by insurance, and 78.7% were willing-to-pay. Predictors of willingness-to-pay were: 1) concern for positive result; 2) confidence to control cancer risk; 3) fewer perceived barriers to colorectal cancer screening; 4) benefit of testing to guide screening (all p < 0.05). Subjects willing-to-pay a higher amount were male, more educated, had greater cancer worry, fewer relatives with colorectal cancer, and more positive attitudes toward genetic testing (all p < 0.05). Individuals seeking risk assessment are willing-to-pay out-of-pocket for genetic testing, and anticipate benefits to reducing cancer risk. Identifying factors associated with willingness-to-pay for genetic services is increasingly important as testing is integrated into routine cancer care.
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Affiliation(s)
- Jennifer M Matro
- Cancer Prevention and Control Program, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA, 19111, USA,
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Wegwarth O, Kurzenhäuser-Carstens S, Gigerenzer G. Overcoming the knowledge–behavior gap: The effect of evidence-based HPV vaccination leaflets on understanding, intention, and actual vaccination decision. Vaccine 2014; 32:1388-93. [DOI: 10.1016/j.vaccine.2013.12.038] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2013] [Revised: 11/08/2013] [Accepted: 12/12/2013] [Indexed: 11/28/2022]
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Fehniger J, Livaudais-Toman J, Karliner L, Kerlikowske K, Tice JA, Quinn J, Ozanne E, Kaplan CP. Perceived versus objective breast cancer risk in diverse women. J Womens Health (Larchmt) 2013; 23:420-7. [PMID: 24372085 DOI: 10.1089/jwh.2013.4516] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Prior research suggests that women do not accurately estimate their risk for breast cancer. Estimating and informing women of their risk is essential for tailoring appropriate screening and risk reduction strategies. METHODS Data were collected for BreastCARE, a randomized controlled trial designed to evaluate a PC-tablet based intervention providing multiethnic women and their primary care physicians with tailored information about breast cancer risk. We included women ages 40-74 visiting general internal medicine primary care clinics at one academic practice and one safety net practice who spoke English, Spanish, or Cantonese, and had no personal history of breast cancer. We collected baseline information regarding risk perception and concern. Women were categorized as high risk (vs. average risk) if their family history met criteria for referral to genetic counseling or if they were in the top 5% of risk for their age based on the Gail or Breast Cancer Surveillance Consortium Model (BCSC) breast cancer risk model. RESULTS Of 1,261 participants, 25% (N=314) were classified as high risk. More average risk than high risk women had correct risk perception (72% vs. 18%); 25% of both average and high risk women reported being very concerned about breast cancer. Average risk women with correct risk perception were less likely to be concerned about breast cancer (odds ratio [OR]=0.3; 95% confidence interval [CI]=0.2-0.4) while high risk women with correct risk perception were more likely to be concerned about breast cancer (OR=5.1; 95%CI=2.7-9.6). CONCLUSIONS Many women did not accurately perceive their risk for breast cancer. Women with accurate risk perception had an appropriate level of concern about breast cancer. Improved methods of assessing and informing women of their breast cancer risk could motivate high risk women to apply appropriate prevention strategies and allay unnecessary concern among average risk women.
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Affiliation(s)
- Julia Fehniger
- 1 Department of Medicine, Division of General Internal Medicine, University of California , San Francisco, California
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18
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Orom H, Kiviniemi MT, Shavers VL, Ross L, Underwood W. Perceived risk for breast cancer and its relationship to mammography in Blacks, Hispanics, and Whites. J Behav Med 2013; 36:466-76. [PMID: 22772713 PMCID: PMC3565065 DOI: 10.1007/s10865-012-9443-z] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 06/20/2012] [Indexed: 12/23/2022]
Abstract
A challenge for health behavior science is to develop theory and best practices that take cultural diversity into account. Using data from Black, Hispanic, and White respondents to the 2003 Health Information National Trends Survey, we examined racial/ethnic differences in: (1) breast cancer risk perceptions/worry; (2) the associations between perceived risk/worry and ever having received a mammogram; and (3) perceived risk/worry and having had at least 2 mammograms over a 4-year period (consecutive mammography). Compared to White race/ethnicity, Black race/ethnicity was associated with lower perceived absolute risk and comparative risk for developing cancer. For the sample as a whole, higher perceived risk (both absolute risk and comparative risk) and worry predicted greater odds of mammography use; however, this was not true for Hispanics. In stratified analyses, perceived risk and worry were not associated with mammography use for either Hispanics or Blacks whereas they were for Whites; however, this interaction effect was significant only for Hispanics vs. Whites. Results support the need for formative research to identify determinants of health behavior prior to cancer prevention message planning for diverse audiences in order to accommodate racial/ethnic differences not only in the level of perceived risk, but also the association between risk perception to behavior change in that community.
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Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, The State University of New York, Buffalo, NY 14214, USA.
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Ahmadian M, Samah AA. Application of Health Behavior Theories to Breast Cancer Screening among Asian Women. Asian Pac J Cancer Prev 2013; 14:4005-13. [DOI: 10.7314/apjcp.2013.14.7.4005] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Ahmadian M, Samah AA, Redzuan M, Emby Z. Predictors of mammography screening among Iranian women attending outpatient clinics in Tehran, Iran. Asian Pac J Cancer Prev 2012; 13:969-74. [PMID: 22631681 DOI: 10.7314/apjcp.2012.13.3.969] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Mammography utilization is low in Iran compared with other countries. Here a cross-sectional survey design was used to investigate psycho-social and individual factors associated with mammography among 400 women asymptomatic of breast cancer. The study was carried out at the four outpatient clinics of Tehran during the period from July through October, 2009. We found that mammography screening was related to higher self-efficacy and women's occupation. Future tailored interventions on potential psycho-social determinants and specific demographic factors are critical in increasing mammography screening rates among Iranian women.
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Affiliation(s)
- Maryam Ahmadian
- Department of Social and Development Sciences, Faculty of Human Ecology, Universiti Putra Malaysia, Selangor, Malaysia.
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Jonnalagadda S, Bergamo C, Lin JJ, Lurslurchachai L, Diefenbach M, Smith C, Nelson JE, Wisnivesky JP. Beliefs and attitudes about lung cancer screening among smokers. Lung Cancer 2012; 77:526-31. [PMID: 22681870 DOI: 10.1016/j.lungcan.2012.05.095] [Citation(s) in RCA: 124] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Revised: 05/01/2012] [Accepted: 05/09/2012] [Indexed: 12/23/2022]
Abstract
The National Lung Screening Trial (NLST) recently reported that annual computed tomography (CT) screening is associated with decreased lung cancer mortality in high-risk smokers. Beliefs about lung cancer and screening, particularly across race and ethnicity, and their influence on CT screening utilization are largely unexamined. Our study recruited asymptomatic, high-risk smokers, 55-74 years of age from primary care clinics in an academic urban hospital. Guided by the self-regulation theory, we evaluated cognitive and affective beliefs about lung cancer. Intention to screen for lung cancer with a CT scan was assessed by self-report. We used univariate and logistic regression analyses to compare beliefs about screening and intention to screen among minority (Blacks and Hispanics) and non-minority participants. Overall, we enrolled 108 participants, of which 40% were Black and 34% were Hispanic; the mean age was 62.3 years, and median pack-years of smoking was 26. We found that intention to screen was similar among minorities and non-minorities (p=0.19); however, Hispanics were less likely to report intention to screen if they had to pay for the test (p=0.02). Fatalistic beliefs, fear of radiation exposure, and anxiety related to CT scans were significantly associated with decreased intention to screen (p<0.05). Several differences were observed in minority versus non-minority participants' beliefs toward lung cancer and screening. In conclusion, we found that concerns about cost, which were particularly prominent among Hispanics, as well as fatalism and radiation exposure fears may constitute barriers to lung cancer screening. Lung cancer screening programs should address these factors to ensure broad participation, particularly among minorities.
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Affiliation(s)
- Sirisha Jonnalagadda
- Doris Duke Clinical Research Fellows, UMDNJ-Robert Wood Johnson Medical School, New York, NY 10029, USA
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Fair AM, Monahan PO, Russell K, Zhao Q, Champion VL. The interaction of perceived risk and benefits and the relationship to predicting mammography adherence in African American women. Oncol Nurs Forum 2012; 39:53-60. [PMID: 22201655 DOI: 10.1188/12.onf.53-60] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To test the interaction of perceived risk and benefits and how they impact stage of mammography readiness and adherence. DESIGN Cross-sectional study. SETTING Community gathering centers and healthcare clinics across Indiana. SAMPLE 299 African American women who had not had a mammogram in more than 18 months. METHODS In-person interviews were used to collect data on sociodemographics, health belief variables, and stage of readiness to undertake mammography screening. Four categories were created to measure the combined magnitude of high or low levels of perceived risk and benefit, with health belief variables linked to modified mammography screening behavior. MAIN RESEARCH VARIABLES Perceived risks and benefits, stage of readiness, and mammography adherence. FINDINGS The lowest rate of mammography adherence was in women with a high perceived risk and low perceived benefit toward mammography adherence (26%). The highest rate of adherence was in women with a high perceived benefit and low perceived risk (46%). Differences in mammography adherence were statistically significant between the groups (p = 0.009). CONCLUSIONS The interaction of high perceived risk and low perceived benefits impacted readiness to undergo screening mammography. IMPLICATIONS FOR NURSING Reducing disparities in breast cancer diagnosis and survival requires timely and efficient mammography adherence. African American medically underserved women with high perceived risk and low perceived benefits exhibited a reluctance to move forward with mammography adherence. Interventions are needed to increase the perception of mammography benefit and to subsequently reduce breast cancer mortality rates in that population.
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Affiliation(s)
- Alecia Malin Fair
- Research Support Services at Vanderbilt Institute for Clinical Translational Research, Vanderbilt University, Nashville, TN, USA.
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Phillips CA, Green HJ, Morrissey SA. Cognitive and affective correlates of decisional balance regarding screening mammography in older women. PSYCHOL HEALTH MED 2011; 17:164-75. [PMID: 21780961 DOI: 10.1080/13548506.2011.596550] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Participation in screening mammography remains suboptimal. This research aimed to improve understanding of ways to facilitate screening mammography attendance. One hundred and forty-two women from Gold Coast, Australia, aged 50-75, participated in the study. Social cognitive variables were assessed as potential predictors of mammography attendance. Most participants (79%) were maintaining regular screening mammography. Greater knowledge of breast cancer was the strongest predictor of decisional balance in favor of attending screening. Women who had relapsed from screening had significantly lower breast cancer worry than those contemplating attending for the first time. The results were consistent with previous research and point to factors screening services could consider to increase uptake.
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Affiliation(s)
- Christine A Phillips
- School of Psychology and Griffith Health Institute, Griffith University, Gold Coast, Australia
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Kelly KM, Shedlosky-Shoemaker R, Porter K, Desimone P, Andrykowski M. Cancer recurrence worry, risk perception, and informational-coping styles among Appalachian cancer survivors. J Psychosoc Oncol 2011; 29:1-18. [PMID: 21240722 DOI: 10.1080/07347332.2011.534014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite a growing literature on the psychosocial impact of the threat of cancer recurrence, underserved populations, such as those from the Appalachian region, have been understudied. To examine worry and perceived risk in cancer survivors, Appalachian and non-Appalachian cancer patients at an ambulatory oncology clinic in a university hospital were surveyed. Appalachians had significantly higher worry than non-Appalachians. Cancer type and lower need for cognition were associated with greater worry. Those with missing perceived risk data were generally older, less educated, and lower in monitoring, blunting, and health literacy. Additional resources are needed to assist Appalachians and those with cancers with poor prognoses (e.g., liver cancer, pancreatic cancer) to cope with worry associated with developing cancer again. More attention for cancer prevention is critical to improve quality of life in underserved populations where risk of cancer is greater.
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Affiliation(s)
- Kimberly M Kelly
- School of Pharmacy and Mary Babb Randolph Cancer Center, West Virginia University, Morgantown, WV 26506, USA.
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Engelman KK, Daley CM, Gajewski BJ, Ndikum-Moffor F, Faseru B, Braiuca S, Joseph S, Ellerbeck EF, Greiner KA. An assessment of American Indian women's mammography experiences. BMC Womens Health 2010; 10:34. [PMID: 21159197 PMCID: PMC3018433 DOI: 10.1186/1472-6874-10-34] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/15/2010] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey. METHODS AND DESIGN The three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements. DISCUSSION This formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.
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Affiliation(s)
- Kimberly K Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA.
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Bartle-Haring S. Living in the context of poverty and trajectories of breast cancer worry, knowledge, and perceived risk after a breast cancer risk education session. Womens Health Issues 2010; 20:406-13. [PMID: 20688528 DOI: 10.1016/j.whi.2010.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 06/22/2010] [Accepted: 06/23/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The purpose of this paper was to demonstrate how living in neighborhoods with high levels of poverty (while controlling for personal income) impacts personal characteristics, which in turn impacts retention of breast cancer risk knowledge and changes in worry and perceived risk. METHODS The data from this project come from a larger, National Cancer Institute-funded study that included a pretest, a breast cancer risk education session, a posttest, the option of an individualized risk assessment via the Gail Model and three follow-up phone calls over the next 9 months. RESULTS The percent of individuals living below poverty in the community in which the participant resided was predictive of the personal characteristics assessed, and these characteristics were predictive of changes in breast cancer worry and knowledge across time. CONCLUSION Differentiation of self and monitoring, two of the individual characteristics that seem to allow people to process and use information to make "rational" decisions about health care, seem to be impacted by the necessity for adaptation to a culture of poverty. Thus, as a health care community, we need to tailor our messages and our recommendations with an understanding of the complex intersection of poverty and health care decision making.
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Affiliation(s)
- Suzanne Bartle-Haring
- Human Development and Family Science Department, The Ohio State University, Columbus, Ohio 43210, USA.
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Fair AM, Wujcik D, Lin JMS, Zheng W, Egan KM, Grau AM, Champion VL, Wallston KA. Psychosocial determinants of mammography follow-up after receipt of abnormal mammography results in medically underserved women. J Health Care Poor Underserved 2010; 21:71-94. [PMID: 20173286 DOI: 10.1353/hpu.0.0264] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This article targets the relationship between psychosocial determinants and abnormal screening mammography follow-up in a medically underserved population. Health belief scales were modified to refer to diagnostic follow-up versus annual screening. A retrospective cohort study design was used. Statistical analyses were performed examining relationships among sociodemographic factors, psychosocial determinants, and abnormal mammography follow-up. Women with lower mean internal health locus of control scores (3.14) were two times more likely than women with higher mean internal health locus of control scores (3.98) to have inadequate follow-up (OR=2.53, 95% CI=1.12-5.36). Women with less than a high school education had lower cancer fatalism scores than women who had completed high school (47.5 vs. 55.2, p-value=.02) and lower mean external health locus of control scores (3.0 vs. 5.3) (p-value<.01). These constructs have implications for understanding mammography follow-up among minority and medically underserved women. Further comprehensive study of these concepts is warranted.
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Affiliation(s)
- Alecia Malin Fair
- Department of Surgery, Meharry Medical College, Nashville, TN 37208, USA.
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Elsie KM, Gonzaga MA, Francis B, Michael KG, Rebecca N, Rosemary BK, Zeridah M. Current knowledge, attitudes and practices of women on breast cancer and mammography at Mulago Hospital. Pan Afr Med J 2010; 5:9. [PMID: 21120008 PMCID: PMC2984320 DOI: 10.4314/pamj.v5i1.56186] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2010] [Accepted: 04/30/2010] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Breast cancer is the third commonest cancer in Ugandan women. Women present late for breast cancer management which leads to high mortality rates. The objective of the study was to assess the knowledge, attitudes and practices of Ugandan women concerning breast cancer and mammography. METHODS This was a descriptive cross-sectional study where 100 women reporting to the Radiology department were interviewed. We used consecutive sampling. Interviewer-administered questionnaires were used to collect opinions of the participants. For data analysis, answers were described as knowledge, attitude, practice and they were correlated with control variables through the chi-square. Bivariate and logistic regression analyses were also used. RESULTS Most of the women (71%) had no idea about mammography. More than 50% did not know about risk factors for breast cancer. The attitude towards mammography was generally negative. Regarding seeking for mammography; level of literacy, occupation and marital status were significant on bivariate analysis, however only level of literacy and employment remained the significant independent variables on logistic regression analysis. The main barrier to mammography was mainly lack of information. CONCLUSION Women in this study had inadequate knowledge and inappropriate practice related to mammography as a procedure for breast cancer investigation.
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Affiliation(s)
- Kiguli-Malwadde Elsie
- Radiology department, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Gigerenzer G, Mata J, Frank R. Public knowledge of benefits of breast and prostate cancer screening in Europe. J Natl Cancer Inst 2009; 101:1216-20. [PMID: 19671770 PMCID: PMC2736294 DOI: 10.1093/jnci/djp237] [Citation(s) in RCA: 202] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2008] [Revised: 05/18/2009] [Accepted: 06/29/2009] [Indexed: 11/17/2022] Open
Abstract
Making informed decisions about breast and prostate cancer screening requires knowledge of its benefits. However, country-specific information on public knowledge of the benefits of screening is lacking. Face-to-face computer-assisted personal interviews were conducted with 10,228 persons selected by a representative quota method in nine European countries (Austria, France, Germany, Italy, the Netherlands, Poland, Russia, Spain, and the United Kingdom) to assess perceptions of cancer-specific mortality reduction associated with mammography and prostate-specific antigen (PSA) screening. Participants were also queried on the extent to which they consulted 14 different sources of health information. Correlation coefficients between frequency of use of particular sources and the accuracy of estimates of screening benefit were calculated. Ninety-two percent of women overestimated the mortality reduction from mammography screening by at least one order of magnitude or reported that they did not know. Eighty-nine percent of men overestimated the benefits of PSA screening by a similar extent or did not know. Women and men aged 50-69 years, and thus targeted by screening programs, were not substantially better informed about the benefits of mammography and PSA screening, respectively, than men and women overall. Frequent consulting of physicians (r = .07, 95% confidence interval [CI] = 0.05 to 0.09) and health pamphlets (r = .06, 95% CI = 0.04 to 0.08) tended to increase rather than reduce overestimation. The vast majority of citizens in nine European countries systematically overestimate the benefits of mammography and PSA screening. In the countries investigated, physicians and other information sources appear to have little impact on improving citizens' perceptions of these benefits.
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Affiliation(s)
- Gerd Gigerenzer
- Harding Center for Risk Literacy, Max Planck Institute of Human Development, Lentzeallee 94, 14195 Berlin, Germany.
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Are women with functional limitations at high risk of underutilization of mammography screening? Womens Health Issues 2009; 19:79-87. [PMID: 19111790 DOI: 10.1016/j.whi.2008.09.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2008] [Revised: 08/14/2008] [Accepted: 09/05/2008] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Women with functional limitations face obstacles in adhering to established mammography guidelines owing to personal factors and barriers within the health care system. Whereas some studies have focused on either physical or cognitive limitations that correlate with lower rates of cancer screening, this study examined multiple functional limitations (physical, psychological, and sociability) and mammography screening. METHODS Data from the 2000 National Health Interview Survey were analyzed for 9,505 women aged > or =40 years. We hypothesized that women with functional limitations (physical, psychological, and/or sociability) are less likely to receive screening mammography. Access variables (insurance coverage and usual source of health care) and utilization variables (physician contact and receipt of clinical breast examination) were included. Using multiple logistic regression (MLR), we estimated the relative contribution of functional limitations on mammography use after accounting for sociodemographic characteristics and confounding variables. RESULTS An estimated 34.6% of women had physical limitations, 16.1% sociability limitations, and 8.1% psychological limitations. After controlling for all other variables, MLR analysis indicated that women with moderate or severe sociability limitations were less likely than their unimpaired counterparts to utilize mammography (odds ratio [OR], 0.62; 95% confidence interval [CI], 0.48-0.81). Interestingly, women with severe physical limitations were more likely than physically able women to utilize mammography screening (OR, 1.28; 95% CI, 1.07-1.53). Women with no insurance, no usual care, and no doctor's visit within the past year were substantially less likely to use mammography screening. CONCLUSIONS Sociability limitations, lack of access to health care, and limited regular checkups played significant roles in underutilization of screening mammography.
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Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 2008; 17:2913-23. [PMID: 18990731 DOI: 10.1158/1055-9965.epi-07-0633] [Citation(s) in RCA: 214] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.
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Affiliation(s)
- Mary A Gerend
- Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
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Schueler KM, Chu PW, Smith-Bindman R. Factors Associated with Mammography Utilization: A Systematic Quantitative Review of the Literature. J Womens Health (Larchmt) 2008; 17:1477-98. [DOI: 10.1089/jwh.2007.0603] [Citation(s) in RCA: 273] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristin M. Schueler
- Department of Radiology, Santa Clara Valley Medical Center; San Jose, California
| | - Philip W. Chu
- Department of Radiology, University of California, San Francisco, California
| | - Rebecca Smith-Bindman
- Department of Radiology, Santa Clara Valley Medical Center; San Jose, California
- Department of Radiology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- Department of Obstetrics, Gynecology and Reproductive Medicine, University of California, San Francisco, California
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Cronan TA, Villalta I, Gottfried E, Vaden Y, Ribas M, Conway TL. Predictors of mammography screening among ethnically diverse low-income women. J Womens Health (Larchmt) 2008; 17:527-37. [PMID: 18447760 DOI: 10.1089/jwh.2007.0331] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE Breast cancer is the second leading cause of cancer deaths among women in the United States. Minority women are less likely to be screened and more likely to die from breast cancer than are Caucasian women. Although some studies have examined ethnic disparities in mammography screening, no study has examined whether there are ethnic disparities among low-income, ethnically diverse women. The present study was designed to determine whether there are ethnic disparities in mammography screening and predictors of screening among low-income African American, Mexican American, and Caucasian women, and to determine whether the disparities and predictors vary across ethnic groups. METHODS The participants were 146 low-income women who were Mexican American (32%), African American (31%), or Caucasian (37%). Statistical analyses were performed to assess the relationships between mammography screening during the past 2 years and potential predictors of screening, both within ethnic groups and for the combined sample. RESULTS The results varied depending on whether analyses combined ethnic groups or were performed within each of the three ethnic groups. CONCLUSIONS It is, therefore, important to examine within-group differences when examining ethnic disparities in predictors of mammography.
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Williams KP, Sheppard VB, Todem D, Mabiso A, Wulu JT, Hines RD. Family matters in mammography screening among African-American women age > 40. J Natl Med Assoc 2008; 100:508-15. [PMID: 18507203 DOI: 10.1016/s0027-9684(15)31297-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To examine how family history of cancer influences the mammography screening behaviors of asymptomatic African-American women. METHODS Using the National Health Interview Survey's 2000 Cancer Control Module, the authors performed bivariate analyses and multivariate logistic regressions with SAS/SUDAAN due to the complex sampling design. RESULTS Of the 1,531 African-American women in the final sample, 38% had a family history of cancer. Women with a family history of cancer were 39% more likely to have a recent mammogram compared to women with no family history of cancer (OR = 1.39; 95% CI: 1.06-1.81; p < 0.05). Eighty-five percent of African-American women aged > 40 with a family history of cancer indicated having a mammogram in the past compared to nearly 70% of African-American women without a family history of cancer. CONCLUSION Family history of any cancer independently and positively predicted mammography screening behaviors among asymptomatic African-American women. This suggests that African-American women with a history of cancer in their family are more likely (and perhaps more motivated) to engage in early cancer detection practices.
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Lower adherence to screening mammography guidelines among ethnic minority women in America: a meta-analytic review. Prev Med 2008; 46:479-88. [PMID: 18295872 PMCID: PMC2920292 DOI: 10.1016/j.ypmed.2008.01.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2007] [Revised: 12/30/2007] [Accepted: 01/08/2008] [Indexed: 11/22/2022]
Abstract
OBJECTIVE This study investigates the association between ethnic minority status and receiving a screening mammogram within the past 2 years among American women over 50. METHOD The findings from 33 studies identified from interdisciplinary research databases (1980 to 2006) were synthesized. Separate pooled analyses compared white non-Hispanics to African Americans (28 outcomes), Hispanics (18 outcomes), and Asian/Pacific Islanders (10 outcomes). RESULTS Using the random effects model, results showed that African Americans were screened less than white non-Hispanics at a marginal level (OR 0.87, 95% CI 0.75, 1.00). Larger and significant discrepancies were observed for Hispanics (OR 0.65, 95% CI 0.50, 0.85) and Asian/Pacific Islanders (OR 0.63, 95% CI 0.39, 0.99) compared to white non-Hispanics. However, among studies controlling for socioeconomic status, ethnic differences in mammography screening were no longer significant for African Americans (OR 1.05, 95% CI 0.71, 1.76), Hispanics (OR 1.08, 95% CI 0.64, 1.93), or Asian/Pacific Islanders (OR 1.08, 95% CI 0.64, 1.93). Subgroup analyses further showed that geographical region, sampling method, and data collection strategy significantly impacted results. CONCLUSIONS This study found evidence that ethnic minority-screening mammography differences exist but were impacted by socioeconomic status. Implications for interpreting existing knowledge and future research needs are discussed.
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Goyal V, Levison S, Bavendam T, Gillen D, Stehman-Breen C. Preventive Care in African American Women with End-Stage Renal Disease. ACTA ACUST UNITED AC 2008. [DOI: 10.1002/dat.20206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Marinho LAB, Cecatti JG, Osis MJD, Gurgel MSC. Knowledge, attitude and practice of mammography among women users of public health services. Rev Saude Publica 2008. [DOI: 10.1590/s0034-89102008005000006] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE: To evaluate knowledge, attitude and practice related to mammography among women users of local health services, identifying barriers to its performance. METHODS: A total of 663 women were interviewed at 13 local health centers in a city of Southeastern Brazil, in 2001. Interviewees were randomly selected at each center and they were representative from different socioeconomic conditions. The number of interviewees at each center was proportional to monthly mean appointments. For data analysis, answers were described as knowledge, attitude, practice and their respective adequacies and then they were correlated with control variables through the chi-square test. RESULTS: Only 7.4% of the interviewees had adequate knowledge on mammography, while 97.1% of women had an adequate attitude. The same was seen for the practice of mammography that was adequate in 35.7% of the cases. The main barrier to mammography was lack of referral by physicians working at the health center (81.8%). There was an association between adequacy of attitude and five years or more of education and being married. There was also an association between adequacy of mammography practice and being employed and family income up to four minimum wages. CONCLUSIONS: Women users of local health services had no adequate knowledge and practice related to mammography despite having an adequate attitude about this exam.
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Calvocoressi L, Sun A, Kasl SV, Claus EB, Jones BA. Mammography screening of women in their 40s: impact of changes in screening guidelines. Cancer 2008; 112:473-80. [PMID: 18072258 DOI: 10.1002/cncr.23210] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND : In March 1997, the American Cancer Society (ACS) updated its recommended mammography screening interval for women ages 40-49 years from once every 1 to 2 years to once every year. At the same time, the National Cancer Institute (NCI), which had previously not recommended routine screening of women in their 40s, began recommending screening at 1 to 2-year intervals. These events occurred during the data collection phase of a prospective study of mammography screening and, thereby, provided an unexpected opportunity to examine the potential influences of changing guidelines on women's beliefs about how frequently they should obtain screening exams. METHODS : This analysis included 1451 African American and white women ages 40-79 years, who obtained an "index" screening exam between October 1996 and January 1998. In baseline and 2-year follow-up telephone interviews, respondents provided information on demographic, socioeconomic, health history, medical care, behavioral and psychosocial factors, and on how frequently they believed women of their age should obtain screening mammograms. RESULTS : After the ACS and NCI announcements of new screening guidelines for women in their 40s, a significant increase in endorsement of annual screening among women ages 40-49 years was observed, consistent with the ACS recommendation for annual screening in that age group. No increase in endorsement of annual screening among women ages 50 years and older was evident during the same time period. CONCLUSIONS : Women's beliefs about how frequently they should obtain mammography screenings appear to change in response to changes in recommendations of high-profile health organizations, particularly when those recommendations call for an increase in screening.
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Affiliation(s)
- Lisa Calvocoressi
- Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06510, USA.
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Bartle-Haring S, Toviessi P, Katafiasz H. Predicting the use of individualized risk assessment for breast cancer. Womens Health Issues 2008; 18:100-9. [PMID: 18319147 PMCID: PMC2276320 DOI: 10.1016/j.whi.2008.01.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 01/11/2008] [Accepted: 01/11/2008] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate the decision to obtain individualized risk assessment (IRA) after a breast cancer education session. METHODS A sample of both African American and Caucasian women was used to determine if there were differences by race/ethnicity in uptake of the assessment and differences in the variables that were most predictive of uptake. The sample included 166 women between the ages of 18 and 80. Sixty-two percent of the sample were African American women. KEY FINDINGS The results suggested that African American women and Caucasian women used different factors and used other factors differently to decide whether or not to obtain an IRA. CONCLUSIONS AND IMPLICATIONS These results are discussed within the context of health disparities among ethnic minority and Caucasian women with implications for breast cancer control programs. The results of this study suggest that knowledge alone does not lead to opting for a personalized risk assessment, and that African American and Caucasian women use different pieces of information, or information differently to make decision about getting more personalized information about risk.
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Affiliation(s)
- Suzanne Bartle-Haring
- Department of Human Development and Family Science, College of Education and Human Ecology, The Ohio State University, Columbus, Ohio 43210, USA.
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Magai C, Consedine N, Neugut AI, Hershman DL. Common psychosocial factors underlying breast cancer screening and breast cancer treatment adherence: a conceptual review and synthesis. J Womens Health (Larchmt) 2007; 16:11-23. [PMID: 17324093 DOI: 10.1089/jwh.2006.0024] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In this paper, we review the literature on psychosocial influences on breast cancer screening and treatment adherence with an eye to identifying common cognitive, emotional, and social network factors that may lead to poor screening adherence and suboptimal treatment in the case of diagnosed breast cancer. Nonadherence to breast cancer screening and treatment guidelines can significantly and negatively impact the prospects for prevention and control of breast cancer. Psychosocial factors are an especially important focus for research, inasmuch as belief structures and psychosocial characteristics (such as patterns of emotion regulation and the quality of social relations) are modifiable and are, thus, eminently suitable to intervention.
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Affiliation(s)
- Carol Magai
- Department of Psychology, Long Island University, Brooklyn, New York 11201, USA.
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McAlearney AS, Reeves KW, Tatum C, Paskett ED. Cost as a barrier to screening mammography among underserved women. ETHNICITY & HEALTH 2007; 12:189-203. [PMID: 17364901 PMCID: PMC4465254 DOI: 10.1080/13557850601002387] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Breast cancer is a troublesome health problem, particularly among underserved and minority women. Early detection through screening mammography can reduce the impact of this disease, yet it remains underused. Objective. We examined cost as a barrier to screening mammography and studied the accuracy of women's perceptions of the cost of a mammogram among a rural, low-income, tri-racial (white, Native American and African American) population in need of a mammogram. DESIGN We interviewed 897 women age 40 and older, asking about cost as a barrier to mammography and perceptions about the actual costs of a screening mammogram. Face-to-face interviews were conducted between 1998 and 2000 among women participating in a randomized, controlled study to evaluate a health education intervention to improve mammography screening rates in an underserved population. All data used in these analyses were from the baseline interviews. RESULTS Cost acted as a barrier to screening mammography for a majority of the participants (53%). More than half of these women (52%), however, overestimated the cost of a screening mammogram, and overestimation of the cost was significantly related to mentioning cost as a barrier (OR 1.56, 95% CI 1.04-2.33). Higher estimates of out-of-pocket costs were associated with reporting cost as a barrier to mammography (OR 2.25, 95% CI 1.43-3.52 for $1-50 and OR 12.64, 95% CI 6.61-24.17 for >$50). Factors such as race, income and employment status were not related to reporting cost as a barrier to screening mammography. CONCLUSIONS Among a group of tri-racial, low-income, rural women who were in need of a mammogram, cost was a common barrier. Overestimating the cost, however, was significantly and positively associated with reporting cost as a barrier. Providing information about the actual cost women have to pay for mammograms may lessen the role of cost as a barrier to mammography screening, especially for underserved women, potentially improving utilization rates.
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Affiliation(s)
- Ann Scheck McAlearney
- Division of Health Services, Management and Policy, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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Fowler BA, Rodney M, Roberts S, Broadus L. Collaborative Breast Health Intervention for African American Women of Lower Socioeconomic Status. Oncol Nurs Forum 2007; 32:1207-16. [PMID: 16270116 DOI: 10.1188/05.onf.1207-1216] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To describe all phases of a collaborative breast health intervention delivered by paraprofessionals or specially trained community health advisors (CHAs) for African American women designed to increase mammography screening. DESIGN Collaborative pretest, post-test breast health intervention. SETTING Large city in Ohio. SAMPLE 68 African American women with a median age of 57.8 (SD = 5.28) obtained mammography screening and participated in the breast health intervention. METHODS Specially trained CHAs used aggressive recruitment strategies to increase mammography screening and knowledge of breast health and mammography screening in African American women aged 50 and older. MAIN RESEARCH VARIABLES Knowledge scores of breast health and mammography screening. FINDINGS Ninety women (81%) met the inclusion criteria and were recruited into the intervention, but only 68 (76%) obtained mammography screening. The women demonstrated increased knowledge by change in pre- to post-test scores. Several questions were statistically significant. CONCLUSIONS Collaborative breast health interventions delivered by trained CHAs are effective in increasing screenings as well as knowledge of breast health and mammography screening in African American women. The unique role of the CHA is especially important in recruitment of hard-to-reach women and was vital to the success of the educational intervention. Most importantly, the women valued the individualized attention to their breast health and agreed to share the information with significant others. Further collaborative interventions designed to increase screenings and increase knowledge of breast health and mammography screening are needed to reduce the health disparities of later-stage detection and poorer survival of breast cancer in African American women. IMPLICATIONS FOR NURSING Oncology nurses should build on the findings and deliver further outreach programs to increase mammography screening and knowledge of breast health in a larger number of women of lower socioeconomic status. Future research is needed to determine the influence of reminder phone calls for mammography screening. Oncology nurses should incorporate evaluation strategies at baseline and periodically throughout an intervention to provide more comprehensive data and enhance the credibility of findings. To maximize success, oncology nurses should work collaboratively with other healthcare professionals such as certified x-ray technicians and influential people in the community to increase knowledge of breast health and mammography screening.
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Affiliation(s)
- Barbara A Fowler
- College of Nursing and Health, Wright State University, Dayton, OH, USA.
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Abstract
PURPOSE/OBJECTIVES To understand factors that influence the mammography experience and intention to receive mammography among Korean women using the Health Belief Model and subjective norm of the Theory of Reasoned Action. DESIGN Cross-sectional. SETTING Two university hospitals and one general hospital in Korea. SAMPLE A convenience sample of 310 women aged 30 years and older who visited participating hospitals during the data collection period. METHODS Self-administered questionnaire. MAIN RESEARCH VARIABLES Perceived susceptibility and severity, perceived benefits and barriers, self-efficacy, normative beliefs, and motivation to comply. FINDINGS Age, self-efficacy, and perceived susceptibility were significantly associated with participants' mammography experience, whereas knowledge, self-efficacy, perceived susceptibility, perceived barriers, subjective norm, and income were significant in predicting women's intention to receive mammography. CONCLUSIONS The combined model synthesizing the Health Belief Model and the Theory of Reasoned Action was more effective in predicting mammography intention than in explaining mammography experience. IMPLICATIONS FOR NURSING Tailored health education and health promotion programs to promote mammography screening among Korean women should be developed based on women's perceptions and norms.
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Affiliation(s)
- Ok Kyung Ham
- College of Nursing at Kyungpook National University, Daegu, Korea.
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Wu TY, Bancroft J. Filipino American Women's Perceptions and Experiences With Breast Cancer Screening. Oncol Nurs Forum 2007; 33:E71-8. [PMID: 16858450 DOI: 10.1188/06.onf.e71-e78] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To determine information about Filipino American women's perceptions of breast cancer, the most frequently diagnosed cancer and number-one killer of Asian American women, and their experiences with screening. DESIGN A qualitative, exploratory approach with focus groups. SETTING Suburban Filipino American communities in the midwestern United States. SAMPLE 11 Filipino American women aged 45-80 years who shared their experiences with breast cancer screening. METHODS Focus groups were conducted, and the meetings were recorded on audiotape, transcribed, and analyzed using constant comparison techniques. MAIN RESEARCH VARIABLES Breast cancer screening, experiences, motivators, and barriers. FINDINGS Avoidance was the main theme for Filipino American women in dealing with a cancer diagnosis in the Filipino American culture. Facilitators of Filipino American women's screening practices were support from family members, recommendations from familiar physicians, health insurance reinforcement, and personal attributes of physical symptoms, family history, past diagnosis, and health literacy. Barriers identified were different mind-sets and healthcare systems in the Philippines in regard to early detection, unpleasant experiences with mammography, cultural beliefs, and difficulties accessing services. CONCLUSIONS Results of the focus group discussions provide useful information about facilitators and barriers that affect Filipino American women's screening practices. IMPLICATIONS FOR NURSING The findings of the study can be used to develop tailored interventions for addressing culturally specific barriers and promoting screening practices in the Filipino American community.
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Affiliation(s)
- Tsu-Yin Wu
- School of Nursing, Eastern Michigan University, Ypsilanti, USA.
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Lengacher CA, Bennett MP, Kip KE, Gonzalez L, Jacobsen P, Cox CE. Relief of Symptoms, Side Effects, and Psychological Distress Through Use of Complementary and Alternative Medicine in Women With Breast Cancer. Oncol Nurs Forum 2007; 33:97-104. [PMID: 16470237 DOI: 10.1188/06.onf.97-104] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE/OBJECTIVES To identify use of complementary and alternative medicine (CAM) for relief of symptoms and side effects among women diagnosed with breast cancer and to identify demographic and clinical factors associated with the use of CAM in these patients. DESIGN A descriptive, cross-sectional survey. SETTING Clinics and community groups in the Tampa Bay area and community groups in a rural midwestern area. SAMPLE A convenience sample of 105 predominantly Caucasian women (mean age = 59 years) with a diagnosis of breast cancer was recruited from the Tampa Bay area and a rural midwestern area. METHODS The instrument used to gather the data was the Use of Complementary Therapies Survey. The reasons for choosing 33 individual CAM treatments were tabulated. The frequency of use was calculated according to four reasons: (a) to reduce physical symptoms or side effects, (b) to reduce psychological distress, (c) to gain a feeling of control over treatment, or (d) because of dissatisfaction with traditional medical care. Least-squares regression models were fit to identify independent demographic and clinical predictors of CAM therapy use. MAIN RESEARCH VARIABLES Use of CAM for relief of physical and psychological distress. FINDINGS Patients used all categories of CAM therapies to reduce physical symptoms and side effects. The most frequently cited reason for use of CAM was to reduce the symptom of psychological distress, whereas the lowest frequency of CAM use was because of dissatisfaction with traditional medical care. Traditional and ethnic medicines frequently were used to reduce physical symptoms and side effects, followed by diet and nutritional supplements. The most frequently used CAM therapy category cited for gaining a feeling of control over treatment was use of diet and nutritional supplements. Previous chemotherapy and having more than a high school education were associated with more frequent use of diet and nutritional supplements and stress-reducing techniques. CONCLUSIONS Frequency of specific use according to type of CAM was higher and more specific than reported in other studies. Patients who had undergone chemotherapy were most likely to use CAM. IMPLICATIONS FOR NURSING Oncology nurses are in a key position to identify which symptoms or side effects patients are experiencing and which CAM therapies may be helpful to relieve patients' symptoms related to treatment and psychological distress related to their cancer.
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Thompson HS, Littles M, Jacob S, Coker C. Posttreatment breast cancer surveillance and follow-up care experiences of breast cancer survivors of African descent: an exploratory qualitative study. Cancer Nurs 2006; 29:478-87. [PMID: 17135822 DOI: 10.1097/00002820-200611000-00009] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Breast cancer survivors are at considerable risk for breast cancer recurrence and at higher risk of developing a new breast cancer compared with women never diagnosed. It is recommended that survivors undergo careful breast cancer surveillance as cancers detected early are more treatable. However, data indicate that surveillance among African American survivors, particularly mammography, is lower than that of white survivors. There is little published work focusing on general experiences of posttreatment breast cancer surveillance among survivors of African descent. In the current qualitative pilot study, key informant interviews were conducted in order to explore the following: (1) the extent of posttreatment surveillance information provided to or obtained by survivors of African descent; (2) the actual follow-up care received by survivors in the past year; and (3) factors that are either motivators of or barriers to care. Participants were 10 African American and African Caribbean breast cancer survivors. Survivors reported a number of factors that motivated them in obtaining follow-up care: a desire to maintain good health, concern about recurrence, support from healthcare providers, familial relationships, relationships with other survivors, and religious/spiritual faith. Survivors also reported barriers to care: fear of recurrence, low support from family and friends, lack of information about posttreatment follow-up care, and medical care costs. These results represent formative work that may inform similar studies examining factors in breast cancer surveillance and follow-up care in larger samples of survivors of African descent.
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Affiliation(s)
- Hayley S Thompson
- Department of Oncological Sciences, Division of Cancer Prevention and Control, Mount Sinai School of Medicine, One Gustave Levy Place, Box 1130, New York, NY 10029, USA.
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Rapkin BD, Massie MJ, Jansky EJ, Lounsbury DW, Murphy PD, Powell S. Developing a partnership model for cancer screening with community-based organizations: the ACCESS breast cancer education and outreach project. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2006; 38:153-64. [PMID: 17028998 DOI: 10.1007/s10464-006-9071-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
There is growing enthusiasm for community-academic partnerships to promote health in underserved communities. Drawing upon resources available at a comprehensive cancer center, we developed the ACCESS program to guide community based organizations through a flexible program planning process. Over a three-year period, ACCESS partnered with 67 agencies serving various medically underserved populations. Organizations included hospitals, parishes, senior centers, harm reduction programs, and recreational facilities. Program outcomes at the organizational level were quantified in terms of introduction of new cancer information, referral or screening programs, as well as organizational capacity building. ACCESS represents a viable model for promoting partnership to transfer behavioral health programs and adapt interventions for new audiences. Plans to further evaluate and enhance this model to promote cancer screening efforts are discussed. We argue that, ultimately, formation and development of community partnerships need to be understood as a fundamental area of practice that must be systematically integrated into the mission of major academic medical institutions in every area of public health.
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Affiliation(s)
- Bruce D Rapkin
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY, 10022, USA.
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Roscoe JA, Jean-Pierre P, Shelke AR, Kaufman ME, Bole C, Morrow GR. The role of patients' response expectancies in side effect development and control. Curr Probl Cancer 2006; 30:40-98. [PMID: 16516693 DOI: 10.1016/j.currproblcancer.2005.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Joseph A Roscoe
- Department of Radiation Oncology, University of Rochester, James P. Wilmot Cancer Center, Rochester, New York, USA
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Otero-Sabogal R, Stewart S, Shema SJ, Pasick RJ. Ethnic differences in decisional balance and stages of mammography adoption. HEALTH EDUCATION & BEHAVIOR 2006; 34:278-96. [PMID: 16891624 PMCID: PMC2939724 DOI: 10.1177/1090198105277854] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Behavioral theories developed through research with mainstream, English-speaking populations have been applied to ethnically diverse and underserved communities in the effort to eliminate disparities in early breast cancer detection. This study tests the validity of the transtheoretical model (TTM) decisional balance measure and the application of the TTM stages of change in a multiethnic, multilingual sample. A random sample of 1,463 Filipino, Latino, African American, Chinese, and White women aged 40 to 74 completed a phone survey of mammography beliefs and practices. Consistent with the TTM and independent of ethnicity, decisional balance was associated with mammography stage in all five ethnic groups when controlling for socioeconomic and other factors. In addition, having private insurance and a regular physician and being a long-time resident in the United States were positively associated with mammography maintenance. The application of the TTM for mammography is supported in a multiethnic and multilingual sample.
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Affiliation(s)
- Regina Otero-Sabogal
- Institute for Health and Aging, University of California-San Francisco, CA 94143-0646, USA.
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