[Barriers in the breast cancer screening and the role of nursing: an integrative review]

Factors associated with the proportion of abnormal results in screening mammograms: ecological study

OBJECTIVE

To analyze the factors associated with the proportion of abnormal results in screening mammograms.

METHODS

Ecological study, with data from DATASUS/SISCAN, Atlas Brasil do Desenvolvimento Humano, Fundação SEADE, and Sistema e-Gestor, from 2016 to 2019, of women aged 50 to 69 years in the 645 municipalities of São Paulo (Brazil). Independent variables were associated with the outcome: proportion of unsatisfactory coverage of abnormal test results (Breast Imaging Reporting and Data System - BI-RADS® 0, 4 and 5 proportion >10% of tests performed). Multiple Poisson regression was used.

RESULTS

Higher proportion of screening mammography (PR=1.20; 95%CI: 1.00;1.45), higher percentage of poor (PR=1.20; 95%CI: 1.07;1.36), low (PR=1.57; 95%CI: 1.38;1.78) and medium coverage of the Family Health Strategy (ESF) (PR=1.30; 95%CI: 1.09;1.52) were associated to the outcome.

CONCLUSION

Socioeconomic and FHS coverage factors mediate the proportion of mammograms with abnormal results in public health services. Therefore, they are important aspects in the fight against breast cancer.

Histórico familiar para câncer de mama em mulheres: estudo populacional em Uberaba (MG) utilizando o Family History Screen-7

RESUMO Objetiva-se determinar a prevalência de mulheres com risco de desenvolvimento de câncer de mama pelo histórico familiar em Uberaba (MG), e essa prevalência nas diferentes condições socioeconômicas e epidemiológicas. Pesquisa quantitativa, analítica, observacional e transversal de base populacional. Amostra com 1.520 mulheres a partir de 20 anos. Dados coletados por entrevistas domiciliares sobre informações socioeconômicas e epidemiológicas. A avaliação do risco hereditário de câncer de mama foi realizada pelo Family History Screen-7 (FHS-7). Como resultado, 28,6% da amostra apresentaram risco hereditário para câncer de mama. Houve associação significativa do risco de câncer quanto a: faixa etária, sendo nas mulheres com idade de 70 anos ou mais a maior proporção com risco (33,5%); etnia, sendo a maior proporção entre mulheres de etnia branca (31,2%); renda familiar, com maior ocorrência para renda per capita > 2,5 salários-mínimos (31,6%); prática de exames preventivos (30,6%); e alterações benignas na mama (46,7%). Conclui-se que, a partir do histórico familiar pelo FHS-7, o risco de as mulheres desenvolverem câncer mostrou-se significativamente associado com maior faixa etária, etnia branca e maior renda per capita, com a prática de exames preventivos em dia e alterações benignas na mama. Tais resultados possibilitam melhores direcionamentos de políticas públicas.

Actions for early detection of breast cancer in two municipalities in the Western Amazon

OBJECTIVE

to assess the implementation of actions for early detection of breast cancer in Primary Care and to verify the adequacy of these actions with the Ministry of Health recommendations.

METHOD

a cross-sectional study conducted from September 2017 to March 2018 with 736 women registered in Basic Health Units in two municipalities in Acre. For data collection, a validated questionnaire was used. In statistical analysis, the chi-square test or Fisher's exact test was applied.

RESULTS

the frequency of mammography was 42%. Of the women at standard risk for breast cancer, only 5,8% underwent mammography properly.

CONCLUSION

there was a low compliance of early detection actions to the Ministry of Health recommendations; thus, the need to adopt measures to increase professionals' adherence to government proposals is highlighted, as well as continuous actions assessments.

Detection of Breast Cancer: Knowledge, Attitude, and Practice of Family Health Strategy Women

In rural area, control of breast cancer is related to health promotion and early diagnosis, which includes knowledge, awareness, and stimulating behavioral change, emphasizing screening for disease. The present study was developed to assess the knowledge, attitude, and practice of rural women about early detection of breast cancer in the Primary Health Care Centre. This is a cross-sectional study in a Primary Health Care Centre with 243 rural women participating in the public health service. Data collection was made by a self-administered questionnaire which included sociodemographic characteristics, questions on breast cancer risk factors, screening, and diagnostic methods. Marks were attributed to each question and calculated for each section. Participants fell in three categories of knowledge, attitude, and practice: appropriate, regular and inappropriate. Knowledge, attitude, and practice of early detection methods were considered especially appropriate for those rural women with education and higher economic level, but inadequate responses to such methods were still significant. It is noted that there is still a significant number of rural women who do not have basic knowledge regarding early detection methods of breast cancer, contributing to the non-realization of these methods, as its advocates.

Factors related to non-adherence to mammography in a city of the Brazilian Amazonian area: A population-based study

OBJECTIVE

To assess the prevalence of mammography use and factors related to non-adherence in Boa Vista, capital of Roraima, Brazil.

METHOD

A cross sectional study, quantitative analysis, based on household survey was performed between June and August 2013, using a face-to-face interview with a pre-tested form. Target population was women between 40 and 69 years. The sample size target was 240 participants, and the sampling method was random cluster sampling. The study was approved by the Institutional Review Board of Federal University of Roraima.

RESULTS

241 women were included without refusals. The prevalence of non-use of mammography in the past two years was 55.6% (95CI 49.1-61.9). In univariate analysis, the risk factors for non-adherence to mammography were having low educational level, family income below three minimum wages, receiving government assistance, not having consulted with a doctor and no health insurance. In multivariate analysis, only low educational level and receiving government assistance remained as risk factors. Medical consultation or health worker visiting were protective factors.

CONCLUSION

Adherence to mammography is unsatisfactory in Boa Vista, Roraima, and has a predominantly opportunistic character. Low educational level is confirmed as an independent risk factor, but belonging to a family that receives government assistance can be interpreted as a social marker of families and/or areas lacking of government intervention to increase access to breast cancer control programs.

[Opportunistic screening actions for breast cancer performed by nurses working in primary health care]

OBJECTIVE

To identify opportunistic screening actions for breast cancer performed by nurses working in primary health care units in Ribeirão Preto, São Paulo.

METHOD

Cross-sectional study with 60 nurses from 28 units, who had been working for at least one year in the public municipal health care network. Data were collected between December 2013 and March 2014, by means of a questionnaire, using descriptive analysis and the software IBM SPSS version 20 and Microsoft Excel 2010.

RESULTS

The results showed that 71.7% of the participants questioned their female patients as for risk factors for breast cancer, mainly during nursing consultation; 70.0% oriented users about the age to perform clinical breast exam, whereas 30.0% did not due to lack of knowledge and time; 60.0% explained about the age to perform mammogram; 73.3% did not refer patients with suspicious breast exam results to the referral department, citing scheduling as the main obstacle to referral. Educational activities were not performed by 78.3% of participants.

CONCLUSION

Investment is needed in professional training and management of breast cancer screening.

Knowledge about breast cancer and hereditary breast cancer among nurses in a public hospital

OBJECTIVE:

To assess the knowledge of nurses involved in the care of oncology patients in a public university hospital, regarding breast cancer and hereditary breast cancer, and to verify the use of such knowledge in their daily practice.

METHODS:

This is a descriptive cross-sectional study. Data were obtained through a structured, self-administered questionnaire. Out of 154 nurses, 137 (88.9%) agreed to participate in the study. Two questionnaires were excluded such that 135 questionnaires were analyzed.

RESULTS:

The global percentage of correct answers was not associated with age (p=0.173) or degree/specialization (p=0.815). Questions were classified into categories. In categories involving knowledge of established breast cancer risk factors and indicators of hereditary breast cancer, the rate of correct answers was 65.8% and 66.4%, respectively. On the practice of genetic counseling, 40.7% of those interviewed were not sure about the definition of genetic counseling and 78.5% reported never having identified or referred a patient at genetic risk for specialized risk assessment. Practice of educational actions regarding this subject was reported by 48.5% of those interviewed.

CONCLUSION:

This study reinforces the need to develop qualifying actions for nurses, so that strategies to control breast cancer become effective in their health care practice.

Barriers related to non-adherence in a mammography breast-screening program during the implementation period in the interior of São Paulo State, Brazil

Mammography is the best exam for early diagnosis of breast cancer. Developing countries frequently have a low income of mammography and absence of organized screening. The knowledge of vulnerable population and strategies to increase adherence are important to improve the implementation of an organized breast-screening program. A mammography regional-screening program was implemented in a place around 54.238 women, aged 40–69 years old. It was proposed to perform biannual mammography free of cost for the women. We analyze the first 2 years of the implementation of the project. Mammography was realized in 17.964 women. 42.1% of the women hadn’t done de mammography in their lives and these women were principally from low socio-economic status (OR = 2.99), low education (OR = 3.00). The best strategies to include these women were mobile unit (OR = 1.43) and Family Health Program (OR = 1.79). The incidence of early breast tumors before the project was 14.5%, a fact that changed to 43.2% in this phase. Multivariate analysis showed that the association of illiterate and the mobile unit achieve more women who had not performed mammography in their lives. The strategies to increase adherence to mammography must be multiple and a large organization is necessary to overpass the barriers related to system health and education.