1
|
Gold N, Christensen RAG, Arneja J, Aminoleslami A, Anderson GM, Brooks JD. Screening behaviours, demographics, and stage at diagnosis in the publicly funded Ontario Breast Screening Program. Breast Cancer Res Treat 2023; 198:523-533. [PMID: 36800117 PMCID: PMC10036268 DOI: 10.1007/s10549-022-06848-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 12/01/2022] [Indexed: 02/18/2023]
Abstract
PURPOSE The Ontario Breast Screening Program (OBSP) offers free screening mammograms every 2 years, to women aged 50-74. Study objectives were to determine demographic characteristics associated with the adherence to OBSP and if women screened in the OBSP have a lower stage at diagnosis than non-screened eligible women. METHODS We used the Ontario cancer registry (OCR) to identify 48,927 women, aged 51-74 years, diagnosed with breast cancer between 2010 and 2017. These women were assigned as having undergone adherent screening (N = 26,108), non-adherent screening (N = 6546) or not-screened (N = 16,273) in the OBSP. We used multinomial logistic regression to investigate the demographic characteristics associated with screening behaviour, as well as the association between screening status and stage at diagnosis. RESULTS Among women with breast cancer, those living in rural areas (versus the largest urban areas) had a lower odds of not being screened (odds ratio [OR] 0.73, 95% confidence interval [CI] 0.68, 0.78). Women in low-income (versus high-income) communities were more likely not to be screened (OR 1.42, 95% CI 1.33, 1.51). When stratified, the association between income and screening status only held in urban areas. Non-screened women were more likely to be diagnosed with stage II (OR 1.91, 95% CI 1.82, 2.01), III (OR 2.96, 95% CI 2.76, 3.17), or IV (OR 8.96, 95% CI 7.94, 10.12) disease compared to stage I and were less likely to be diagnosed with ductal carcinoma in situ (DCIS) (OR 0.91, 95% CI 0.84-0.98). CONCLUSIONS This study suggests that targeting OBSP recruitment efforts to lower income urban communities could increase screening rates. OBSP adherent women were more likely to be diagnosed with earlier stage disease, supporting the value of this initiative and those like it.
Collapse
Affiliation(s)
- Nicholas Gold
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Rebecca A G Christensen
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Jasleen Arneja
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
| | - Arian Aminoleslami
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Geoffrey M Anderson
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jennifer D Brooks
- Dalla Lana School of Public Health, University of Toronto, 155 College St. HSB 676, Toronto, ON, M5T 3M7, Canada.
| |
Collapse
|
2
|
Affiliation(s)
- Jianxia Gong
- School of Economics and Management, Southeast University, No.2 Sipailou, Nanjing 210096, China
| | | | - Qingxia Kong
- Rotterdam School of Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam 3062 PA, The Netherlands
| | - Wolfert Spijker
- Dutch Foundation of Population Screening Region South-West, Maasstadweg 124, Rotterdam 3079DZ, The Netherlands
| |
Collapse
|
3
|
Shimoda A, Saito Y, Ooe C, Kondo N. Income-based inequality in nationwide general health checkup participation in Japan. Public Health 2021; 195:112-117. [PMID: 34087670 DOI: 10.1016/j.puhe.2021.01.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 11/25/2020] [Accepted: 01/28/2021] [Indexed: 01/28/2023]
Abstract
OBJECTIVE In Japan, it is mandatory for employers to provide general health checkup opportunities to employees. Although many companies have subsidized checkups for employees' dependent family members, their participation is low. We assessed income-based inequality in the participation of employees' dependents in the general health checkup. STUDY DESIGN This is a cross-sectional descriptive study. Annual participation rate in general health checkup and various factors including income, age, and sex were collected and analyzed to examine the income-based inequality of participation rate in general health checkup. METHODS The data for the present study were sourced from the Fukuoka Branch of the Japan Health Insurance Association, a large medical insurer in Japan. We extracted data of 196,057 dependents aged 40-74 years. We conducted a multiple logistic regression analysis using participation from April 2015 to March 2016 as dependent variable and income category ranging from 1 (lowest) to 4 (highest) between April and June 2015 as independent variable (adjusted for sex and age). We computed slope index of inequality (SII) and relative index of inequality (RII) based on income category. RESULTS Higher the income, the more likely were dependents to participate in the general health checkup. SII for the participation rate of general health checkup ranged between -0.02 (95% confidence interval [CI]: -0.07 to 0.03) and 0.06 (0.03-0.09) for men; 0.03 (0.01-0.06) and 0.10 (0.09-0.11) for women. RII for the participation rate of general health checkup ranged between -0.19 (95% CI: -0.66 to 0.29) and 0.88 (0.15-1.61) for men; 0.22 (0.05-0.39) and 0.68 (0.60-0.76) for women. The highest inequality existed for men in their 50s and 60s and women in their 50s; the lowest inequality was among men and women aged 70-74 years. CONCLUSION There was income-based inequality in participation in the general health checkup among dependents (family members) of the insured persons. The degree of inequality differed with age group. It cannot be explained solely by financial barrier among low-income group, rather it may reflect Japanese unique context in medical insurance system.
Collapse
Affiliation(s)
- A Shimoda
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - Y Saito
- Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan
| | - C Ooe
- Planning and Administration Group, Fukuoka Branch of Japan Health Insurance Association, Hakata Mitsui Building, Gofukucho 10-1, Hakata-ku, Fukuoka City, Fukuoka, Japan
| | - N Kondo
- Department of Health Education and Health Sociology, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
| |
Collapse
|
4
|
Reece JC, Neal EFG, Nguyen P, McIntosh JG, Emery JD. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review. BMC Cancer 2021; 21:373. [PMID: 33827476 PMCID: PMC8028768 DOI: 10.1186/s12885-021-08100-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/23/2021] [Indexed: 01/07/2023] Open
Abstract
Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08100-3.
Collapse
Affiliation(s)
- Jeanette C Reece
- Colorectal Cancer Unit, Centre for Epidemiology and Biostatistics and Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 207 Bouverie Street, Parkville, VIC, 3010, Australia. .,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Eleanor F G Neal
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Peter Nguyen
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer G McIntosh
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Software Systems and Cybersecurity, Faculty of Information Technology, Monash University, VIC, Clayton, Australia
| | - Jon D Emery
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
5
|
Li J, Cornacchi SD, Farrokhyar F, Johnston N, Forbes S, Reid S, Hodgson N, Lovrics S, Lucibello K, Lovrics P. Relation between socioeconomic variables and surgical, systemic and radiation treatment in a cohort of patients with breast cancer in an urban Canadian centre. Can J Surg 2019; 62:83-92. [PMID: 30697993 DOI: 10.1503/cjs.009217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background Studies have shown an association between socioeconomic status and breast cancer treatment. We examined the relation between socioeconomic status and the treatment of breast cancer (surgical, systemic and radiation) in a universal health care system. Methods Data from a single urban Canadian centre were collected for consecutive patients who received a diagnosis of breast cancer from January 2010 to December 2011. Variables included patient and disease factors, surgery type, systemic and radiation treatment, and breast reconstruction. Socioeconomic variables were obtained from 2006 Canadian census data. We used multivariable logistic regression to identify predictors of breast cancer treatment. Results A total of 721 patients were treated for breast cancer during the study period. Socioeconomic variables were not related to type of breast surgery for breast cancer. Age less than 50 years, having a first-degree relative with breast cancer and income status were predictors of breast reconstruction. Employment status was a consistent predictor of systemic and radiation treatment. Conclusion Employment consistently predicted systemic and radiation treatment, and age and income were predictors of breast reconstruction in a universal health care system. Further research is required to determine precisely how socioeconomic
factors affect care and to minimize possible disparities in delivery of health care services.
Collapse
Affiliation(s)
- Jennifer Li
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sylvie D. Cornacchi
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Forough Farrokhyar
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Neil Johnston
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Shawn Forbes
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Susan Reid
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Nicole Hodgson
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Sarah Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Kristen Lucibello
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| | - Peter Lovrics
- From the Department of Surgery, McMaster University, Hamilton, Ont. (Li, Cornacchi, Farrokhyar, Forbes, Reid, Hodgson, Lucibello, Lovrics); the Department of Surgical Oncology, Hamilton Health Sciences and Juravinski Hospital and Cancer Centre, Hamilton, Ont. (Forbes, Rid, Hodgson, Lovrics); the Department of Surgery, St. Joseph’s Healthcare, Hamilton, Ont. (Lovrics); and the Department of Medicine, McMaster University, Hamilton, Ont. (Johnston)
| |
Collapse
|
6
|
Abstract
Breast cancer is the most commonly diagnosed type of cancer in women and the primary cause of death by cancer in women globally. Early diagnosis and treatment can be achieved through screening, mainly mammographic; however, international experience has shown that women do not attend mammographic screening adequately. The aim of the present study was to investigate and assess the factors that affect demand for mammography by women to improve and enhance the use of mammography by women in Greece, especially those in the 50-70 age group. The data used in the analysis were extracted from the National Health Survey of 2009, conducted by the Hellenic Statistical Authority. The sample for the analysis included 2294 women aged 30-70 years. To investigate the factors that affect mammography use, binary logistic regression models were constructed for women in the 30-39, 40-49 and 50-70 age groups. 61.70% of the sample had ever undergone a mammogram, 46.80% of which were during the last 12 months. Factors associated with mammography use in at least one of the binary logistic regression models were pap-test, blood cholesterol test, level of education, income level and country of birth. In the 50-70 age group, income level [odds ratio (OR)=1.164; 95% confidence interval (CI)=1.038, 1.305], blood cholesterol test ever (OR=6.096; 95% CI=2.498, 14.872) and pap-test (OR=20.148; 95% CI=11.264, 36.040) were found to be statistically significant predictors of mammography uptake. As mammography utilization in Greece is mostly opportunistic, it is necessary to organize screening provision to cover the majority of the population through nationally organized screening programmes, with a focus on women 50-70 years of age.
Collapse
|
7
|
Buchmueller TC, Goldzahl L. The effect of organized breast cancer screening on mammography use: Evidence from France. HEALTH ECONOMICS 2018; 27:1963-1980. [PMID: 30084221 DOI: 10.1002/hec.3813] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 05/07/2018] [Accepted: 07/01/2018] [Indexed: 06/08/2023]
Abstract
In 2004, France introduced a national program of organized breast cancer screening. The national program built on preexisting local programs in some, but not all, départements. Using data from multiple waves of a nationally representative biennial survey of the French population, we estimate the effect of organized screening on the percentage of women obtaining a mammogram. The analysis uses difference-in-differences methods to exploit the fact that the program was targeted at women in a specific age group: 50 to 74 years old. We find that organized screening significantly raised mammography rates among women in the target age range. Just above the lower age threshold, the percentage of women reporting that they had a mammogram in the past 2 years increased by over 10 percentage points after the national program went into effect. Mammography rates increased even more among women in their 60s. Estimated effects are particularly large for women with less education and lower incomes, suggesting that France's organized screening program has reduced socioeconomic disparities in access to mammography.
Collapse
Affiliation(s)
- Thomas C Buchmueller
- Ross School of Business, University of Michigan, Ann Arbor, Michigan
- NBER, Cambridge, Massachusetts
| | - Léontine Goldzahl
- Manchester Centre for Health Economics, School of Health Sciences, University of Manchester, Manchester, UK
- EDHEC Business School, Roubaix, France
| |
Collapse
|
8
|
Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A. Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract 2018; 72:e13202. [PMID: 29920875 DOI: 10.1111/ijcp.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Screening programmes are well established in cancer, and are now being implemented in other conditions. An effective screening programme leads to early disease detection and improved outcomes but its impact is dependent on the quality of the test and the proportion of the target population participating. A further consideration is that uptake of screening by minority groups is low. PURPOSE To determine which interventions have successfully increased screening uptake amongst minorities. DATA SOURCES Medline, Cochrane database and the grey literature were searched from 1990 to 1st March 2016. STUDY SELECTION Fifty-five English language studies that assessed uptake of screening in any minority population in the country of study aged over 18 years and that included a comparison arm. DATA EXTRACTION Independent data extraction was undertaken by two researchers (CK and MP), using a predesigned data extraction form (DEF) which assisted retrieval of the core contents of each study and the organisation of material. DATA SYNTHESIS Evidence was organised by screening test and type of intervention. Two authors (CK and MP) extracted data into evidence tables to enable comparison of study characteristics and findings. The heterogeneity of methods precluded a meta-analysis thus results are descriptive. Evidence was also assessed, using the Cochrane Collaboration risk of bias tables. RESULTS This systematic review appraises data from international studies on a variety of minority groups, interventions and screening programmes providing a narrative review of their success and limitations.
Collapse
Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| |
Collapse
|
9
|
Lim LY, Ho PJ, Liu J, Chay WY, Tan MH, Hartman M, Li J. Determinants of breast size in Asian women. Sci Rep 2018; 8:1201. [PMID: 29352164 PMCID: PMC5775321 DOI: 10.1038/s41598-018-19437-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 01/02/2018] [Indexed: 12/26/2022] Open
Abstract
Breast size as a risk factor of breast cancer has been studied extensively with inconclusive results. Here we examined the associations between breast size and breast cancer risk factors in 24,353 Asian women aged 50 to 64 years old enrolled in a nationwide mammography screening project conducted between October 1994 and February 1997. Information on demographic and reproductive factors was obtained via a questionnaire. Breast size was ascertained as bust line measured at study recruitment and total breast area measured from a mammogram. The average bust line and total breast area was 91.2 cm and 102.3 cm2, respectively. The two breast measurements were moderately correlated (Spearman correlation coefficient = 0.65). Age, BMI, marital and working status were independently associated with bust line and total breast area. In the multivariable analyses, the most pronounced effects were observed for BMI (24.2 cm difference in bust line and 39.4 cm2 in breast area comparing women with BMI ≥30 kg/m2 to BMI <20 kg/m2). Ethnicity was a positive predictor for total breast area, but not bust line.
Collapse
Affiliation(s)
- Li Yan Lim
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Peh Joo Ho
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jenny Liu
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Min-Han Tan
- National Cancer Centre, Singapore, Singapore.,Institute of Bioengineering and Nanotechnology, Singapore, Singapore
| | - Mikael Hartman
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Jingmei Li
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore. .,Human Genetics, Genome Institute of Singapore, Singapore, Singapore.
| |
Collapse
|
10
|
Widdifield J, Ivers NM, Bernatsky S, Jaakkimainen L, Bombardier C, Thorne JC, Ahluwalia V, Paterson JM, Young J, Wing L, Tu K. Primary Care Screening and Comorbidity Management in Rheumatoid Arthritis in Ontario, Canada. Arthritis Care Res (Hoboken) 2017; 69:1495-1503. [DOI: 10.1002/acr.23178] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2016] [Revised: 12/07/2016] [Accepted: 12/13/2016] [Indexed: 12/12/2022]
Affiliation(s)
- Jessica Widdifield
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Noah M. Ivers
- Institute for Clinical Evaluative Sciences, University of Toronto, and Women's College Hospital; Toronto Ontario Canada
| | - Sasha Bernatsky
- Research Institute of the McGill University Health Centre and McGill University; Montreal Quebec Canada
| | - Liisa Jaakkimainen
- Institute for Clinical Evaluative Sciences and University of Toronto; Toronto Ontario Canada
| | - Claire Bombardier
- University of Toronto and University Health Network; Toronto Ontario Canada
| | - J. Carter Thorne
- University of Toronto, Toronto, Ontario, Canada, and Southlake Regional Health Centre; Newmarket Ontario Canada
| | | | - J. Michael Paterson
- Institute for Clinical Evaluative Sciences and University of Toronto, Toronto, Ontario, Canada, and McMaster University; Hamilton Ontario Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Laura Wing
- Institute for Clinical Evaluative Sciences; Toronto Ontario Canada
| | - Karen Tu
- Institute for Clinical Evaluative Sciences, University of Toronto, Sunnybrook Health Sciences Centre, and University Health Network; Toronto Ontario Canada
| |
Collapse
|
11
|
Hayek S, Enav T, Shohat T, Keinan-Boker L. Factors Associated with Breast Cancer Screening in a Country with National Health Insurance: Did We Succeed in Reducing Healthcare Disparities? J Womens Health (Larchmt) 2017; 26:159-168. [DOI: 10.1089/jwh.2016.5835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Samah Hayek
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Teena Enav
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Tamy Shohat
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Keinan-Boker
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
| |
Collapse
|
12
|
Preliminary effectiveness of breast cancer screening among 1.22 million Chinese females and different cancer patterns between urban and rural women. Sci Rep 2016; 6:39459. [PMID: 27995968 PMCID: PMC5171648 DOI: 10.1038/srep39459] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022] Open
Abstract
To determine the preliminary effectiveness of breast cancer screening among Chinese females, 1226714 women aged 35–69 years first received clinical breast examinations. Urban women with suspected cancer received mammography followed by breast ultrasound (BUS), while rural suspected women underwent BUS followed by mammography. After one-year follow-up, 223 and 431 breast cancers were detected among urban and rural women (respectively), with overall detection rates of 0.56/1000 and 0.52/1000. Higher detection rates were significantly associated with older age at screening for both urban and rural women; additionally, urban women were at significantly higher risk if they had no job, no insurance, or were obese; additional risk factors specific to rural women included Han nationality, higher income, being unmarried, and having a family history of cancer (all P values < 0.05). Among screening-detected breast cancers in urban vs. rural women, 46.2% and 38.8% (respectively) were early stage, 62.5% and 66.3% were ≤2 centimeters, 38.0% and 47.3% included lymph-node involvement, and 14.0% and 6.0% were identified as carcinoma in situ. All abovementioned cancer characteristics were significantly better than clinic-detected cancers (all P values < 0.001). In conclusion, several important differences were found between urban and rural women in screening effectiveness and patterns of cancer distribution.
Collapse
|
13
|
Hulme J, Moravac C, Ahmad F, Cleverly S, Lofters A, Ginsburg O, Dunn S. "I want to save my life": Conceptions of cervical and breast cancer screening among urban immigrant women of South Asian and Chinese origin. BMC Public Health 2016; 16:1077. [PMID: 27733161 PMCID: PMC5062908 DOI: 10.1186/s12889-016-3709-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 09/23/2016] [Indexed: 11/13/2022] Open
Abstract
Background Breast and cervical cancer screening rates remain low among immigrant women and those of low socioeconomic status. The Cancer Awareness: Ready for Education and Screening (CARES) project ran a peer-led multi-lingual educational program between 2012 and 2014 to reach under and never-screened women in Central Toronto, where breast and cervical cancer screening rates remain low. The objective of this qualitative study was to better understand how Chinese and South Asian immigrants – the largest and most under-screened immigrant groups according to national and provincial statistics - conceive of breast and cervical cancer screening. We explored their experiences with screening to date. We explicitly inquired about their perceptions of the health care system, their screening experiences with family physicians and strategies that would support screening in their communities. Methods We conducted 22 individual interviews and two focus groups in Bengali and Mandarin with participants who had attended CARES educational sessions. Transcripts were coded through an iterative constant comparative and interpretative approach. Results Themes fell into five major, overlapping domains: risk perception and concepts of preventative health and screening; health system engagement and the embedded experience with screening; fear of cancer and procedural pain; self-efficacy, obligation, and willingness to be screened; newcomer barriers and competing priorities. These domains all overlap, and contribute to screening behaviours. Immigrant women experienced a number of barriers to screening related to ‘navigating newness’, including transportation, language barriers, arrangements for time off work and childcare. Fear of screening and fear of cancer took many forms; painful or traumatic encounters with screening were described. Female gender of the provider was paramount for both groups. Newly screened South Asian women were reassured by their first encounter with screening. Some Chinese women preferred the anonymous screening options available in China. Women generally endorsed a willingness to be screened, and even offered to organize women in their community hubs to access screening. Conclusions The experience of South Asian and Chinese immigrant women suggests that under and never-screened newcomers may be effectively integrated into screening programs through existing primary care networks, cultural-group specific outreach, and expanding access to convenient community -based screening.
Collapse
Affiliation(s)
- Jennifer Hulme
- Emergency Department, University Health Network, University of Toronto, Toronto, Canada. .,Department of Family and Community Medicine, University of Toronto, Toronto, Canada.
| | - Catherine Moravac
- Postgraduate Medical Education, University of Toronto, Toronto, Canada
| | - Farah Ahmad
- Faculty of Health, School of Health Policy and Management, York University, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley Cleverly
- Postgraduate Medical Education, University of Toronto, Toronto, Canada.,Centre for Health Promotion, Department of Public Health Sciences, University of Toronto, Toronto, Canada
| | - Aisha Lofters
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada.,Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Department of Family and Community Medicine, St. Michael Hospital, Toronto, Canada
| | - Ophira Ginsburg
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, Canada.,Department of Medicine, University of Toronto, Toronto, Canada
| | - Sheila Dunn
- Women's College Research Institute, Toronto, Canada.,Women's College Hospital, Toronto, Canada
| |
Collapse
|
14
|
Mungrue K, Chase H, Gordon J, Knowles D, Lockhart K, Miller N, Morley T, Sealey L, Turner B. Breast Cancer in the Bahamas in 2009-2011. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:45-52. [PMID: 27127408 PMCID: PMC4841291 DOI: 10.4137/bcbcr.s32792] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 10/15/2015] [Accepted: 10/19/2015] [Indexed: 01/13/2023]
Abstract
BACKGROUND Breast cancer is the most common form of cancer affecting women in the Bahamas, which consists of many islands. This is the first attempt to identify which island has the highest occurrence of breast cancer. OBJECTIVE The aim of this study was to describe the sociodemographical and spatial features of breast cancer in the Bahamas in 2009-2011. METHODS A review of the medical records of all women with a confirmed diagnosis of breast cancer during the period January 1, 2009-December 31, 2011, was undertaken. Data were first obtained from the National Oncology Board of the Bahamas and validated by a review of the medical records. The patient address was geocoded and mapped using ArcGIS 10.0 Environmental Systems Research Institute (ESRI) to satellite images obtained from The Nature Conservancy in the Bahamas. RESULTS We recruited 270 patients who satisfied the entry criteria. The cumulative incidences of breast cancer for the years 2009-2011 were 51.4, 45.4, and 51.4, respectively. Breast cancer occurred most often in women of African origin with a mean age at diagnosis of 56.6 ± 13.8 years. Ductal carcinoma was the most common histological type observed with most cancers occurring in Grade II or higher and presenting as late stage (≥ Stage II). Surgery was the preferred method of treatment with modified radical mastectomy being the procedure of choice. Spatial distribution of cases across the Bahamas revealed one cluster, which is present on the island of New Providence. Further analysis of New Providence showed a consistently skewed kernel density in the central and eastern regions, compared with a scattered distribution in the southern and western regions. CONCLUSION The island of New Providence had the highest occurrence of breast cancer among all the islands of the Bahamas. The increasing incidence of breast cancer in young women is likely to impose a significant burden on the future of Bahamian health care.
Collapse
Affiliation(s)
- K Mungrue
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - H Chase
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - J Gordon
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - D Knowles
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - K Lockhart
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - N Miller
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - T Morley
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - L Sealey
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| | - B Turner
- Department of Para-Clinical Sciences, Faculty of Medical Sciences, University of the West Indies, St. Augustine, Trinidad
| |
Collapse
|
15
|
Fortune ML. The Influence of Social Determinants on Late Stage Breast Cancer for Women in Mississippi. J Racial Ethn Health Disparities 2016; 4:104-111. [PMID: 26902946 DOI: 10.1007/s40615-016-0207-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Revised: 01/11/2016] [Accepted: 01/13/2016] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Breast cancer is the most common diagnosed cancer in women exacting an emotional and economic hardship for them and their families. There are no known causes of breast cancer, but there are certain genetic, social, and environment risk factors that pre-dispose women to this disease. Also, diagnosis at later stages of disease has been shown to have adverse outcomes for many as compared to early stages. The social determinants researched to examine their influence on breast cancer outcomes were race, health insurance, and income. The results of this study confirmed that race and health insurance were the two major factors that negatively impacted stages of breast cancer diagnoses. PURPOSE The purpose of this study was to investigate the influence that social determinants have on stage of breast cancer diagnoses. This research focused on three social determinants that research demonstrated had an influence on stages of breast cancer diagnoses (race, income, and lack of health insurance). METHODS Bivariate analyses were conducted to examine the relationships between race and income, race and health insurance, and race and stage of diagnosis. The findings confirmed what was suspected for Mississippians; more African Americans had lower incomes, had less health insurance coverage, and were diagnosed at later stages of breast cancer disease. RESULTS Only race and health insurance directly affected late stage diagnosis in analyses for this study. The influence of income on stage of breast cancer diagnosis was not statistically significant. The results of these analyses demonstrated that African American women in Mississippi were disproportionately diagnosed at late stage breast cancer as opposed to early stage. CONCLUSIONS An individual cannot alter the genetic factor of race, but some of the disparate health outcomes that appear to be associated with race may be behavioral or socio-economically based and can be addressed, which could impact health outcomes. Adequate health insurance could positively impact stage of breast cancer diagnoses, ultimately reducing health disparities and premature death.
Collapse
Affiliation(s)
- Melody L Fortune
- Health Care Administration, Division of Management, Marketing, and Business Administration, Delta State University, DSU Box 3275, 1003 West Sunflower Road, Cleveland, MS, 38733, USA.
| |
Collapse
|
16
|
Fernandes KA, Sutradhar R, Borkhoff CM, Baxter N, Lofters A, Rabeneck L, Tinmouth J, Paszat L. Small-area variation in screening for cancer, glucose and cholesterol in Ontario: a cross-sectional study. CMAJ Open 2015; 3:E373-81. [PMID: 26835437 PMCID: PMC4705009 DOI: 10.9778/cmajo.20140069] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Screening for cervical, breast and colon cancers, and elevations of cholesterol and glucose, reduces premature cause-specific mortality from these cancers and circulatory diseases. Despite primary care reforms and incentives, and promotion of cancer-screening programs among individuals, participation is suboptimal. We aimed to examine participation as of Dec. 31, 2011, by factors of deprivation, demographics and primary care at the small-area level. METHODS From health care administrative databases, we identified people eligible for each screening test, and their participation, in each dissemination area (referred to as small areas, n = 18 950) in Ontario. We calculated rates for each test among small areas (overall and stratified by demographic, socioeconomic and primary care descriptors) and stratified by sex for all tests combined. We loaded all data into a geographic information system. Funnel plots were generated showing the percentage of eligible people who completed screening for all tests by small area, stratified by sex. Overall and stratified screening prevalence ratios were calculated among small areas. RESULTS Among small areas, the mean and SD for participation in all tests combined was 31.6% (SD 11.0%) for women and 41.2% (SD 12.0%) for men. Screening prevalence among small areas, for each test and for all tests combined, overall and stratified by sex, declined with decreasing percentage with high school completion, decreasing socioeconomic quintile, and decreasing percentage with an identifiable primary care physician. INTERPRETATION Our results show that the rate of participation in all eligible screening tests among small areas is much lower than the rate of participation in any one particular test. This finding has implications for the design and implementation of strategies to improve rates of screening.
Collapse
Affiliation(s)
- Kimberly A Fernandes
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Rinku Sutradhar
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Cornelia M Borkhoff
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Nancy Baxter
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Aisha Lofters
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Linda Rabeneck
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Jill Tinmouth
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| | - Lawrence Paszat
- Institute for Clinical Evaluative Sciences (Fernandes, Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Dalla Lana School of Public Health (Sutradhar, Borkhoff, Rabeneck, Paszat); St. Michael's Hospital (Baxter, Lofters); Institute of Health Policy, Management and Evaluation (Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); University of Toronto (Sutradhar, Borkhoff, Baxter, Lofters, Rabeneck, Tinmouth, Paszat); Cancer Care Ontario (Rabeneck); Sunnybrook Health Sciences Centre (Tinmouth), Toronto, Ont
| |
Collapse
|
17
|
Espey D, Castro G, Flagg T, Landis K, Henderson JA, Benard VB, Royalty JE. Strengthening breast and cervical cancer control through partnerships: American Indian and Alaska Native Women and the National Breast and Cervical Cancer Early Detection Program. Cancer 2014; 120 Suppl 16:2557-65. [PMID: 25099898 DOI: 10.1002/cncr.28824] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2014] [Revised: 04/28/2014] [Accepted: 04/29/2014] [Indexed: 11/05/2022]
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has played a critical role in providing cancer screening services to American Indian and Alaska Native (AI/ANs) women and strengthening tribal screening capacity. Since 1991, the NBCCEDP has funded states, tribal nations, and tribal organizations to develop and implement organized screening programs. The ultimate goal is to deliver breast and cervical cancer screening to women who do not have health insurance and cannot afford to pay for these services. The delivery of clinical services is supported through complementary program efforts such as professional development, public education and outreach, and patient navigation. This article seeks to describe the growth of NBCCEDP's tribal commitment and the unique history and aspects of serving the AI/AN population. The article describes: 1) how this program has demonstrated success in improving screening of AI/AN women; 2) innovative partnerships with the Indian Health Service, state programs, and other organizations that have improved tribal public health infrastructure; and 3) the evolution of Centers for Disease Control and Prevention work with tribal communities.
Collapse
Affiliation(s)
- David Espey
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | | | | | | | | |
Collapse
|
18
|
Cancer trends among the extreme elderly in the era of cancer screening. J Geriatr Oncol 2014; 5:408-14. [PMID: 25108886 DOI: 10.1016/j.jgo.2014.06.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 06/23/2014] [Accepted: 06/29/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND The extreme elderly (EE; >84 years) are among the fastest growing segments of the population and bear a substantial cancer burden. We examined cancer incidence and cancer specific mortality changes among the EE during the implementation of cancer screening from the 1980s to 2000s. METHODS We examined incidence and mortality rates for breast, colon, prostate, and lung cancer by age group between 1973 and 2009 in the SEER database. We compared incidence/mortality between EE and middle aged (MA; age 50-69) patients. RESULTS Prostate cancer incidence and mortality rose and then, in the early 1990s, declined (-3.61%/year and -2.91%/year, respectively) among EE. Prostate cancer incidence rose steadily throughout the study period for MA. Breast cancer incidence rose and then declined for both MA and EE, with the decline starting in 1990 for EE (-1.34%/year), and 1998 for MA (-1.24%/year). Both age groups experienced an increase and then decrease in colon cancer incidence. The decrease in colon cancer mortality over the last decade was profound for all patients (-2.88%/year MA, and -3.29%/year EE). Lung cancer incidence (+2.35%/year to 2005) and mortality (+1.25%/year from 1995) increased for EE. Lung cancer incidence and mortality increased and then decreased (-2.54%/year for mortality from 1990) for MA. CONCLUSION Recent trends in incidence and mortality for screened cancers (breast, colon, prostate) show substantial gains for the extreme elderly, likely due in part to the effect of screening. Incidence and mortality from lung cancer, with no recommended screening during the study period, have continued to worsen for the extreme elderly, despite improvements in younger patient populations.
Collapse
|
19
|
Chan W, Yun L, Austin PC, Jaakkimainen RL, Booth GL, Hux J, Rochon PA, Lipscombe LL. Impact of socio-economic status on breast cancer screening in women with diabetes: a population-based study. Diabet Med 2014; 31:806-12. [PMID: 24588332 DOI: 10.1111/dme.12422] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 11/14/2013] [Accepted: 02/19/2014] [Indexed: 12/28/2022]
Abstract
AIMS There is evidence to suggest that mammography rates are decreased in women with diabetes and in women of lower socio-economic status. Given the strong association between low socio-economic status and diabetes, we explored the extent to which differences in socio-economic status explain lower mammography rates in women with diabetes. METHODS A population-based retrospective cohort study in Ontario, Canada, of women aged 50 to 69 years with diabetes between 1999 and 2010 age matched 1:2 to women without diabetes. Main outcome measure is the likelihood of at least one screening mammogram in women with diabetes within a 36-month period, starting as of either 1 January 1999, their 50th birthday, or 2 years after diabetes diagnosis--whichever came last. Outcomes were compared with those in women without diabetes during the same period as their matched counterparts, adjusting for socio-economic status based on neighbourhood income and other demographic and clinical variables. RESULTS Of 504,288 women studied (188,759 with diabetes, 315,529 with no diabetes), 63.8% had a screening mammogram. Women with diabetes were significantly less likely to have a mammogram after adjustment for socio-economic status and other factors (odds ratio 0.79, 95% CI 0.78-0.80). Diabetes was associated with lower mammogram use even in women from the highest socio-economic status quintile (odds ratio 0.79, 95% CI 0.75-0.83). CONCLUSIONS The presence of diabetes was an independent barrier to breast cancer screening, which was not explained by differences in socio-economic status. Interventions that target patient, provider, and health system factors are needed to improve cancer screening in this population.
Collapse
Affiliation(s)
- W Chan
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | | | | | | | | | | | | |
Collapse
|
20
|
Shuaib W, Vijayasarathi A, Johnson JO, Salastekar N, He Q, Maddu KK, Khosa F. Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports. Emerg Radiol 2014; 21:373-9. [DOI: 10.1007/s10140-014-1209-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
|
21
|
Jacob R, Arnold LD, Hunleth J, Greiner KA, James AS. Daily hassles' role in health seeking behavior among low-income populations. Am J Health Behav 2014; 38:297-306. [PMID: 24629558 DOI: 10.5993/ajhb.38.2.15] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To adapt a daily hassles measure for a low-income population and assess the relationship between hassles and health seeking behavior. METHODS The mixed methods approach used cognitive interviews (N = 23) to inform an adapted measure of daily hassles. The adapted scale was then tested via surveys (N = 144) in community health centers; multivariate logistic regression models were used to assess relationships among variables. RESULTS Hassle concerning having enough money for emergencies (76.5%) and worrying about personal health (68.8%) were among the most common. Increased health-related hassles were associated with an increased likelihood to delay needed care. CONCLUSIONS Findings suggest daily hassles are unique among low-income populations and should be considered in health behavior interventions.
Collapse
Affiliation(s)
- Rebekah Jacob
- Washington University in Saint Louis, School of Medicine, Division of Public Health Sciences, St Louis, MO, USA.
| | - Lauren D Arnold
- Saint Louis University, College of Public Health & Social Justice, Department of Epidemiology, Kansas City, KS, USA
| | - Jean Hunleth
- Washington University in Saint Louis, School of Medicine, Division of Public Health Sciences, St Louis, MO, USA
| | - K Allen Greiner
- University of Kansas Medical Center, Department of Family Medicine, Kansas City, KS, USA
| | - Aimee S James
- Washington University in Saint Louis, School of Medicine, Division of Public Health Sciences, St Louis, MO, USA
| |
Collapse
|
22
|
Rondet C, Lapostolle A, Soler M, Grillo F, Parizot I, Chauvin P. Are immigrants and nationals born to immigrants at higher risk for delayed or no lifetime breast and cervical cancer screening? The results from a population-based survey in Paris metropolitan area in 2010. PLoS One 2014; 9:e87046. [PMID: 24466323 PMCID: PMC3899363 DOI: 10.1371/journal.pone.0087046] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2013] [Accepted: 12/17/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES This study aims to compare breast cancer screening (BCS) and cervical cancer screening (CCS) practices of French women born to French parents with those of immigrants and nationals born to immigrants, taking their socioeconomic status into account. METHODS The study is based on data collected in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For women with no history of breast or cervical cancer, multivariate logistic regressions and structural equation models were used to investigate the factors associated with never having undergone BCS or CCS. RESULTS We confirmed the existence of a strong gradient, with respect to migration origin, for delaying or never having undergone BCS or CCS. Thus, being a foreign immigrant or being French of immigrant parentage were risk factors for delayed and no lifetime screening. Interestingly, we found that this gradient persisted (at least partially) after adjusting for the women's socioeconomic characteristics. Only the level of income seemed to play a mediating role, but only partially. We observed differences between BCS and CCS which suggest that organized CCS could be effective in reducing socioeconomic and/or ethnic inequities. CONCLUSION Socioeconomic status partially explained the screening nonparticipation on the part of French women of immigrant origin and foreign immigrants. This was more so the case with CCS than with BCS, which suggests that organized prevention programs might reduce social inequalities.
Collapse
Affiliation(s)
- Claire Rondet
- Perre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, INSERM, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
- Department of General Practice, School of Medicine, UPMC Univ Paris 06, Paris, France
- * E-mail:
| | - Annabelle Lapostolle
- Perre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, INSERM, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Marion Soler
- Perre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, INSERM, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Francesca Grillo
- Perre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, INSERM, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| | - Isabelle Parizot
- Centre Maurice Halbwachs, Research Team on Social Inequalities, CNRS, Paris, France
| | - Pierre Chauvin
- Perre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, INSERM, Paris, France
- Pierre Louis Institute of Epidemiology and Public Health, Department of social epidemiology, Sorbonne Universités, UPMC Univ Paris 06, Paris, France
| |
Collapse
|
23
|
The role of a lack of social integration in never having undergone breast cancer screening: results from a population-based, representative survey in the Paris metropolitan area in 2010. Prev Med 2013; 57:386-91. [PMID: 23811529 DOI: 10.1016/j.ypmed.2013.06.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 11/22/2022]
Abstract
OBJECTIVES This study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. METHODS The SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. RESULTS 6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. CONCLUSION This study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives.
Collapse
|
24
|
Interventions to increase the uptake of mammography amongst low income women: a systematic review and meta-analysis. PLoS One 2013; 8:e55574. [PMID: 23451028 PMCID: PMC3579869 DOI: 10.1371/journal.pone.0055574] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 01/03/2013] [Indexed: 11/30/2022] Open
Abstract
Background Two previous reviews found that access-enhancing interventions were effective in increasing mammography uptake amongst low-income women. The purpose of this study was to estimate the magnitude of the effect of interventions used to increase uptake of mammography amongst low-income women. Methods Searches were conducted in MEDLINE and EMBASE (2002–April 2012) using relevant MeSH terms and keywords. Randomised controlled trials which aimed to increase mammography use in an asymptomatic low-income population and which had as an outcome receipt of a mammogram, were eligible for inclusion. The primary outcome was the post-intervention difference in the proportion of women who had a mammogram in the intervention and control groups. The quality of the studies was assessed using the Cochrane risk of bias tool. We calculated summary estimates using random effects meta-analyses. Possible reasons for heterogeneity were investigated using sub-group analyses and meta-regression. Publication bias was assessed using Egger's test. Results Twenty-one studies met the inclusion criteria, including 33 comparisons. Interventions increased the uptake of mammography in low income women by an additional 8.9% (95% CI 7.3 to 10.4%) compared to the control group. There was some evidence that interventions with multiple strategies were more effective than those with single strategies (p = 0.03). There was some suggestion of publication bias. The quality of the included studies was often unclear. Omitting those with high risk of bias has little effect on the results. Conclusions Interventions can increase mammography uptake among low-income women, multiple interventions being the most effective strategy. Given the robustness of the results to sensitivity analyses, the results are likely to be reliable. The generalisability of the results beyond the US is unclear.
Collapse
|
25
|
De Maio FG, Linetzky B, Ferrante D. Changes in the social gradients for Pap smears and mammograms in Argentina: evidence from the 2005 and 2009 National Risk Factor Surveys. Public Health 2012; 126:821-6. [PMID: 23083845 DOI: 10.1016/j.puhe.2012.05.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Revised: 03/13/2012] [Accepted: 05/24/2012] [Indexed: 11/19/2022]
Abstract
OBJECTIVES To identify changes in the social gradients for Pap smears and mammograms in Argentina. STUDY DESIGN Secondary analysis of the 2005 and 2009 Argentine National Risk Factor Surveys. METHODS Logistic regression analysis was used to examine social gradients by income and education, adjusting for age and health insurance. RESULTS The proportion of women who received a Pap smear in the previous 2 years increased from 51.6% in 2005 to 60.5% in 2009 (χ(2) = 344.8, P < 0.001). A significant increase was also seen in the receipt of a mammogram in the previous 2 years by women aged ≥50 years, with an increase from 39.6% in 2005 to 52.6% in 2009 (χ(2) = 279.6, P < 0.001). In 2005, low-income women were most likely not to have received a Pap test [odds ratio (OR) = 3.27, 95% confidence interval (CI) = 2.70-3.98], followed by medium-income women (OR = 1.73, 95% CI = 1.41-2.12), compared with high-income women. The gradient by education was of a similar magnitude, and both income and education gradients remained stable from 2005 to 2009. Restricting the analysis to eight provinces that have been deemed to be high priority due to their high levels of mortality from cervical cancer reveals an increasing income-based gradient in Pap smears. In contrast, inequalities in mammography diminished across the country, with a significant reduction in the social gradient measured either by income or education. In contrast to high-income women, low-income women experienced higher odds of not having a mammogram, but the gap diminished over time [OR = 4.14 (95% CI = 2.96-5.78) in 2005 vs OR = 2.37 (95% CI = 1.81-3.11) in 2009]. CONCLUSION Social gradients in cancer screening are changing in Argentina. There are signs of a reduction in inequalities in mammograms, although this is attenuated by indications that inequalities in Pap smear utilization in priority provinces are growing. Surveillance of population indicators is needed to verify whether these short-term changes persist over time.
Collapse
Affiliation(s)
- F G De Maio
- Department of Sociology, DePaul University, 990 W. Fullerton Ave., Suite 1100, Chicago, IL 60614, USA.
| | | | | |
Collapse
|
26
|
Yamada Y, Ekmann A, Nilsson CJ, Vass M, Avlund K. Are acceptance rates of a national preventive home visit programme for older people socially imbalanced?: a cross sectional study in Denmark. BMC Public Health 2012; 12:396. [PMID: 22656647 PMCID: PMC3403897 DOI: 10.1186/1471-2458-12-396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2012] [Accepted: 06/01/2012] [Indexed: 11/28/2022] Open
Abstract
Background Preventive home visits are offered to community dwelling older people in Denmark aimed at maintaining their functional ability for as long as possible, but only two thirds of older people accept the offer from the municipalities. The purpose of this study is to investigate 1) whether socioeconomic status was associated with acceptance of preventive home visits among older people and 2) whether municipality invitational procedures for the preventive home visits modified the association. Methods The study population included 1,023 community dwelling 80-year-old individuals from the Danish intervention study on preventive home visits. Information on preventive home visit acceptance rates was obtained from questionnaires. Socioeconomic status was measured by financial assets obtained from national registry data, and invitational procedures were identified through the municipalities. Logistic regression analyses were used, adjusted by gender. Results Older persons with high financial assets accepted preventive home visits more frequently than persons with low assets (adjusted OR = 1.5 (CI95%: 1.1-2.0)). However, the association was attenuated when adjusted by the invitational procedures. The odds ratio for accepting preventive home visits was larger among persons with low financial assets invited by a letter with a proposed date than among persons with high financial assets invited by other procedures, though these estimates had wide confidence intervals. Conclusion High socioeconomic status was associated with a higher acceptance rate of preventive home visits, but the association was attenuated by invitational procedures. The results indicate that the social inequality in acceptance of publicly offered preventive services might decrease if municipalities adopt more proactive invitational procedures.
Collapse
Affiliation(s)
- Yukari Yamada
- Section of Social Medicine, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | | | | | | | | |
Collapse
|
27
|
Bilyalova Z, Igissinov N, Moore M, Igissinov S, Sarsenova S, Khassenova Z. Epidemiological Evaluation of Breast Cancer in Ecological areas of Kazakhstan - Association with Pollution Emissions. Asian Pac J Cancer Prev 2012; 13:2341-4. [DOI: 10.7314/apjcp.2012.13.5.2341] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
28
|
Cancer stage comparison between dual Medicare-Medicaid eligibles using Medicaid as a supplemental health insurance program and low-income nonduals. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2012; 17:479-91. [PMID: 21964357 DOI: 10.1097/phh.0b013e31821a3f8c] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Dual-eligibility status for both Medicare and Medicaid is associated with unfavorable cancer stage outcomes. However, given the reduced financial barriers, duals enrolled in Medicaid prior to cancer diagnosis-or those using Medicaid as a supplemental health insurance program (Dual/SHIP)-may have improved access to preventive services compared with low-income nonduals (LI/nondual), therefore, be more likely to be diagnosed at earlier stages of cancers amenable to screening. OBJECTIVES To compare breast, prostate, and colorectal cancer stage at diagnosis between Duals/SHIP and LI/nonduals, adjusting for sociodemographic variables, comorbidities, and nursing home status. RESEARCH DESIGN Cross-sectional study using a database developed by linking records from the Ohio Cancer Incidence Surveillance System with Medicare and Medicaid files, as well as US census data. SUBJECTS Fee-for-service, Ohio residents aged 65 years or older, and diagnosed with incident breast, prostate, or colorectal cancer in 1997-2001. MEASURES (1) Unknown stage/unstaged cancer and (2) distant-stage cancer at diagnosis. RESULTS Duals/SHIP were more likely than LI/nonduals to have unknown stage/unstaged breast cancer (adjusted odds ratio: 1.43, 95% Confidence Interval (CI): 1.02-2.0; P = .035). However, this difference was not seen in prostate or colorectal cancer. In prostate cancer patients, but not in breast or colorectal cancer patients, Dual/SHIP status was associated with distant-stage disease (adjusted odds ratio: 1.74, 95% CI: 1.12-2.70; P = .014). In colorectal cancer patients, dual status was not associated with cancer stage. CONCLUSION The findings show no benefit associated with Medicaid as SHIP. Rather, they indicate that for the most part, cancer stage is comparable between Duals/SHIP and LI/nonduals.
Collapse
|
29
|
Hanson K, Montgomery P, Bakker D, Conlon M. Factors influencing mammography participation in Canada: an integrative review of the literature. ACTA ACUST UNITED AC 2011; 16:65-75. [PMID: 19862363 PMCID: PMC2768512 DOI: 10.3747/co.v16i5.359] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This integrative review critically examines quantitative and qualitative evidence concerning factors influencing the participation of Canadian women in mammography. Empirical studies published between 1980 and 2006 were identified and retrieved by searching electronic databases and references listed in published studies. Among the 1461 citations identified and screened, 52 studies met the inclusion criteria and were independently appraised by two researchers. Extracted data were categorized, summarized, compared, and interpreted within and across studies. The presentation of barriers and facilitators to mammography was guided by the Pender Health Promotion Model. Findings from this review showed that no published studies were specific to settings in Saskatchewan, Nova Scotia, Prince Edward Island, Newfoundland and Labrador, and the three Canadian territories. The most common barriers to screening were membership in an ethnic minority and concerns about pain, radiation, and embarrassment. The recommendation of a health care provider for mammography was found to be the most common facilitator for the engagement of women in this health behaviour. The targeting of specific strategies aimed at overcoming identified barriers and the enhancement of facilitators are essential to improving mammography participation rates throughout Canada.
Collapse
Affiliation(s)
- K Hanson
- School of Nursing, Laurentian University, Sudbury, ON
| | | | | | | |
Collapse
|
30
|
Sundmacher L, Busse R. The impact of physician supply on avoidable cancer deaths in Germany. A spatial analysis. Health Policy 2011; 103:53-62. [DOI: 10.1016/j.healthpol.2011.08.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/27/2011] [Accepted: 08/13/2011] [Indexed: 10/17/2022]
|
31
|
Perception of Neighborhood Disorder and Health Service Usage in a Canadian Sample. Ann Behav Med 2011; 43:162-72. [DOI: 10.1007/s12160-011-9310-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
32
|
Miller SJ, O'Hea EL, Lerner JB, Moon S, Foran-Tuller KA. The relationship between breast cancer anxiety and mammography: experiential avoidance as a moderator. Behav Med 2011; 37:113-8. [PMID: 22168327 DOI: 10.1080/08964289.2011.614291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β = .31, p < .01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R2 Δ = .04, p = .07), suggesting that a woman's level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations.
Collapse
Affiliation(s)
- Sarah J Miller
- Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
| | | | | | | | | |
Collapse
|
33
|
Hahm MI, Choi KS, Lee HY, Jun JK, Oh D, Park EC. Who participates in the gastric cancer screening and on-time rescreening in the National Cancer Screening Program? A population-based study in Korea. Cancer Sci 2011; 102:2241-7. [PMID: 21895871 DOI: 10.1111/j.1349-7006.2011.02090.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Gastric cancer (GC) screening is a major challenge in countries where the disease is highly prevalent. This study was conducted to identify the factors associated with participation in GC screening and on-time rescreening among the average-risk population in Korea. The study population was derived from the National Cancer Screening Program database. The population for this study was 22 913 618 individuals aged ≥40 years who had been invited to participate in a GC screening program from 2005 to 2006. We determined whether these individuals had attended the GC screening program and which method - an upper gastrointestinal series (UGIS) or endoscopy-they underwent. We followed the participants to determine whether they had a second GC screening after 2 years. The overall participation rate in the GC screening was 20.5%. More people underwent UGIS than endoscopy. Individuals who had been screened by endoscopy rather than UGIS were more likely to be younger, male, or those who were National Health Insurance (NHI) beneficiaries with a higher premium rate. Of those who underwent baseline screening, 59.4% participated in a rescreening program 2 years later. NHI beneficiaries with a higher premium rate were significantly more likely to be rescreened than medical aid recipients. The results from this study showed that the UGIS were more commonly used in organized GC screenings in Korea, and those who underwent UGIS were more likely to return for subsequent screening compared to those who underwent an endoscopy.
Collapse
Affiliation(s)
- Myung-Il Hahm
- Department of Health Administration and Management, College of Medical Science, Soonchunhyang University, Choongchungnam-do, Korea
| | | | | | | | | | | |
Collapse
|
34
|
Krzyzanowska MK, Barbera L, Elit L, Razzaq A, Saskin R, Yeritsyan N, Bierman AS. Identifying population-level indicators to measure the quality of cancer care for women. Int J Qual Health Care 2011; 23:554-64. [DOI: 10.1093/intqhc/mzr043] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
35
|
Use of evidence-based strategies to promote mammography among medically underserved women. Am J Prev Med 2011; 40:561-5. [PMID: 21496756 DOI: 10.1016/j.amepre.2010.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/01/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several web-based resources recommend effective intervention strategies to promote use of mammography but there is limited information on whether the strategies are used, particularly by organizations that serve medically underserved women. PURPOSE In 2010, data collected by the Avon Breast Health Outreach Program (BHOP) were analyzed to examine the diffusion of evidence-based intervention strategies among funded organizations. METHODS Data on intervention strategies were obtained from a 2009 survey of Avon BHOP organizations funded during 2006-2009. Self-reported use of mammography was reported from annual intake forms administered to medically underserved women aged ≥40 years, excluding those with a history of breast cancer or initial enrollees not exposed to the strategies. Strategies reflected interventions reviewed in the Guide to Community Preventive Services. Those recommended to increase demand and use of mammography included (1) client reminders; (2) small media; (3) one-to-one education; (4) removal of structural barriers to rescreening; and (5) group education-and one that lacked sufficient evidence to warrant a recommendation (6) client incentives. RESULTS Among 86 organizations, 96% used three or more intervention strategies. The most common strategies were group education (91%) and client reminders (83%). The overall crude-percentage of recent mammography use was 84%. This percentage was similar for clinical sites and nonclinical sites, despite the disproportionate enrollment of medically underserved women in nonclinical sites. CONCLUSIONS The wide use of evidence-based strategies among Avon BHOP-funded organizations and high percentage of recent mammography use among women exposed to the strategies suggests that medically underserved women are benefiting from effective interventions to increase use of mammography.
Collapse
|
36
|
Sprague BL, Trentham-Dietz A, Gangnon RE, Ramchandani R, Hampton JM, Robert SA, Remington PL, Newcomb PA. Socioeconomic status and survival after an invasive breast cancer diagnosis. Cancer 2010; 117:1542-51. [PMID: 21425155 DOI: 10.1002/cncr.25589] [Citation(s) in RCA: 116] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Revised: 06/28/2010] [Accepted: 07/20/2010] [Indexed: 01/22/2023]
Abstract
BACKGROUND Women who live in geographic areas with high poverty rates and low levels of education experience poorer survival after a breast cancer diagnosis than women who live in communities with indicators of high socioeconomic status (SES). However, very few studies have examined individual-level SES in relation to breast cancer survival or have assessed the contextual role of community-level SES independent of individual-level SES. METHODS The authors of this report examined both individual-level and community-level SES in relation to breast cancer survival in a population-based cohort of women ages 20 to 69 years who were diagnosed with breast cancer in Wisconsin between 1995 and 2003 (N = 5820). RESULTS Compared with college graduates, women who had no education beyond high school were 1.39 times more likely (95% confidence interval [CI], 1.10-1.76) to die from breast cancer. Women who had household incomes <2.5 times the poverty level were 1.46 times more likely (95% CI, 1.10-1.92) to die from breast cancer than women who had household incomes ≥5 times the poverty level. Adjusting the analysis for use of screening mammography, disease stage at diagnosis, and lifestyle factors eliminated the disparity by income, but the disparity by education persisted (hazard ratio [HR], 1.27; 95% CI, 0.99-1.61). In multilevel analyses, low community-level education was associated with increased breast cancer mortality even after adjusting for individual-level SES (HR, 1.57; 95% CI, 1.09-2.27 for ≥20% vs <10% of adults without a high school degree). CONCLUSIONS The current results indicated that screening and early detection explain some of the disparity according to SES, but further research will be needed to understand the additional ways in which individual-level and community-level education are associated with survival.
Collapse
Affiliation(s)
- Brian L Sprague
- University of Wisconsin Carbone Cancer Center, Madison, Wisconsin, USA.
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Hahm MI, Park EC, Choi KS, Lee HY, Park JH, Park S. Inequalities in adoption of cancer screening from a diffusion of innovation perspective: identification of late adopters. Cancer Epidemiol 2010; 35:90-6. [PMID: 20947463 DOI: 10.1016/j.canep.2010.08.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2009] [Revised: 08/30/2010] [Accepted: 08/31/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Although national-level organized cancer screening programs have reduced barriers to screening for people of low socioeconomic status, barriers to early screening remain. Our aim was to determine the diffusion pattern and identify the factors associated with early participation in stomach and breast cancer screening programs. METHODS The study population was derived from the Korean National Cancer Screening Survey, conducted in 2007. A stratified random sample of people aged 40 years and older from a nationwide population-based database was gathered in Korea (n=1,517) in 2007. Time of participation in early screening was defined as the number of years that had elapsed between the participant's 30th birthday and the age at first screening. RESULTS Significant differences were observed in the probability of adopting stomach and breast cancer screening in relation to education, household income, and job level. Results from Cox's proportional hazard model indicated that higher household income was significantly associated with an increased probability of adopting stomach cancer screening earlier (p<0.05), and people with high household incomes were more likely to adopt breast cancer screening earlier than were those with incomes under US$1,500 per month (p<0.01). When considered at a significance level of 0.1, we found that the most highly educated women were more likely than the least educated to be screened early. CONCLUSIONS Despite organized governmental screening programs, there are still inequalities in the early adoption of cancer screening. The results of this study also suggest that inequalities in early adoption may affect participation in regular screening.
Collapse
Affiliation(s)
- Myung-Il Hahm
- Department of Healthcare Management, College of Medical Science, Soonchunhyang University, Shinchang-myun, Asan-si, Choongchungnam-do 336-745, Republic of Korea
| | | | | | | | | | | |
Collapse
|
38
|
Rose G, Duerksen F, Trepman E, Cheang M, Simonsen JN, Koulack J, Fong H, Nicolle LE, Embil JM. Multidisciplinary treatment of diabetic foot ulcers in Canadian Aboriginal and non-Aboriginal people. Foot Ankle Surg 2010; 14:74-81. [PMID: 19083619 DOI: 10.1016/j.fas.2007.10.006] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Revised: 10/15/2007] [Accepted: 10/29/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diabetic foot ulcers are a major cause of morbidity and mortality. This study evaluated the clinical outcomes in Canadian non-Aboriginal and Aboriginal diabetic patients with foot ulcers managed at a multidisciplinary, tertiary care diabetic foot clinic. METHODS A retrospective review of medical records was done for 325 patients receiving care during a 2-year period. All patients were followed at least 1 year after the initial visit. RESULTS There were 224 (69%) non-Aboriginal and 101 (31%) Aboriginal patients with 697 foot ulcers. At the initial office visit, 204 (63%) patients had lesions in Wagner grades 2-4. At the most recent evaluation (average, 79+/-73 weeks after initial clinic visit), 190 (58%) patients were rated as having a good outcome (either healed or healing), but a poor outcome (static, progression, amputation, or death) was noted in 135 (42%) patients. At the most recent evaluation, the majority of the 697 ulcers that were noted at the initial or subsequent clinic visits were healed. Aboriginal patients had a shorter average time from initial clinic visit to major lower extremity amputation (Aboriginal, 50+/-64 weeks; non-Aboriginal, 62+/-56 weeks; P<0.01). Residence in a rural or reserve community also correlated with shorter average time from initial clinic visit to major lower extremity amputation (rural or reserve, 45+/-56 weeks; urban, 66+/-61 weeks; P<0.002). When controlled for non-urban residence, Aboriginal ethnicity was not associated with poorer clinical outcome. Earlier major lower extremity amputation was significantly associated with non-urban residence, Aboriginal ethnicity, and arterial insufficiency. Poor clinical outcome was significantly associated with being referred with a lesion present, age greater than 60 years, prior lower extremity amputation or revascularization, arterial insufficiency, more than one lesion on initial presentation, longer duration of type 2 diabetes, and a higher initial Wagner grade for the most advanced lesion. CONCLUSIONS A multidisciplinary diabetic foot clinic may be successful in treating diabetic foot ulcers in Aboriginal and non-Aboriginal people. However, the frequency of poor outcome is high, consistent with the high prevalence of associated significant risk factors in this population.
Collapse
Affiliation(s)
- Greg Rose
- Department of Medicine, Section of Infectious Diseases, University of Ottawa, Ottawa, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
López-de-Andrés A, Martin-Lopez R, Hernández-Barrera V, Carrasco-Garrido P, Gil-de-Miguel Á, Esteban y Peña MM, Jiménez-García R. Predictors of Breast and Cervical Cancer Screening in a Spanish Metropolitan Area. J Womens Health (Larchmt) 2010; 19:1675-81. [DOI: 10.1089/jwh.2009.1828] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
40
|
Sprague BL, Trentham-Dietz A, Burnside ES. Socioeconomic disparities in the decline in invasive breast cancer incidence. Breast Cancer Res Treat 2010; 122:873-8. [PMID: 20087648 PMCID: PMC2904433 DOI: 10.1007/s10549-010-0737-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 01/07/2010] [Indexed: 10/20/2022]
Abstract
Breast cancer incidence in the United States has declined dramatically since the year 2002. To improve our understanding of the underlying factors driving breast cancer trends, we explored potential socioeconomic disparities in the recent decline in incidence. We examined the decline in breast cancer incidence according to county-level socioeconomic indicators using data from the Surveillance, Epidemiology and End Results (SEER) program. Since socioeconomic status is associated with mammography screening, we also examined the relation between incidence of ductal carcinoma in situ (DCIS; a strong marker of mammography utilization) and the decline in invasive breast cancer. The reduction in invasive breast cancer incidence between 1998-2001 and 2003-2006 in the SEER 9 registries was greatest among women living in counties with higher median household income (-16% change for > or = $85,000 vs. -4% for <$35,000; P(trend) < 0.01) and a higher percentage of adults aged 25 years or older with a bachelor's degree (-13% change for > or = 40% vs. -8% for <15%; P(trend) < 0.01). Counties with higher DCIS incidence during 1985-2001 had a larger decrease in invasive breast cancer incidence (absolute decrease 1.7 percentage points greater per 5 per 100,000 increase in DCIS incidence; P = 0.01). This association was present for both ER-positive and ER-negative invasive cancers (P < 0.05). In summary, the decline in breast cancer incidence has been largest in areas with high socioeconomic status and high screening utilization rates. These results are consistent with the hypothesis that a saturation of screening mammography utilization contributed to the overall decline in breast cancer incidence.
Collapse
Affiliation(s)
- Brian L Sprague
- University of Wisconsin Carbone Comprehensive Cancer Center, 610 Walnut St., WARF Rm 307, Madison, WI 53726, USA.
| | | | | |
Collapse
|
41
|
Ashok M, Griffin P, Halpern M. Impact of Clinical and Non-Clinical Factors on the Choice of HER2 Test for Breast Cancer. Cancer Invest 2010; 28:735-42. [DOI: 10.3109/07357907.2010.496753] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
|
42
|
Kjellén M, von Euler-Chelpin M. Socioeconomic status as determinant for participation in mammography screening: assessing the difference between using women's own versus their partner's. Int J Public Health 2010; 55:209-15. [PMID: 20340039 DOI: 10.1007/s00038-010-0137-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Revised: 03/10/2010] [Accepted: 03/11/2010] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES Earlier research has shown that participation in mammography screening tends to vary across socioeconomic levels. We assessed the difference between using the woman's own socioeconomic status (SES) and using that of her household or partner as determinant of participation in mammography screening. METHODS Participation data from two mammography screening programs in Denmark were linked to a national SES classification system providing data for each citizen, their partner, and household. We calculated the odds ratio of non-participation across SES levels using the woman's own, the household's, and her partner's SES status, respectively. RESULTS When using the woman's own SES, the odds ratio of non-participation showed a clear U-shape across SES levels, in both programs. When using the partner's SES the difference in non-participation across SES levels was significantly smaller (p < 0.001). CONCLUSIONS To what extent SES was a determinant for screening participation strongly depended on whether using the woman's own SES or that of her partner. In a public health perspective it is important to take this into account when addressing the problem of non-attendance in screening.
Collapse
Affiliation(s)
- Malin Kjellén
- Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, opg B, 1014 Copenhagen K, Denmark
| | | |
Collapse
|
43
|
Amorim VMSL, Barros MBDA, César CLG, Carandina L, Goldbaum M. [Factors associated with lack of mammograms and clinical breast examination by women: a population-based study in Campinas, São Paulo State, Brazil]. CAD SAUDE PUBLICA 2009; 24:2623-32. [PMID: 19009142 DOI: 10.1590/s0102-311x2008001100017] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2007] [Accepted: 04/18/2008] [Indexed: 05/25/2023] Open
Abstract
This study analyzes the prevalence of mammograms and clinical breast examination according to socioeconomic, demographic, and health-related behavioral variables in women 40 years or older in Campinas, São Paulo State, Brazil. This was a cross-sectional population-based study (N = 290). Based on multivariate analysis, factors associated with not having a mammogram in the previous two years were: age (> or = 70 years), race/ethnicity (black or mixed-race), and low per capita family income. Lack of clinical breast examination in the previous year was associated with: marital status (single/widow/without partner) and low income. The Unified National Health System (SUS) performed 28.8% of reported mammograms and 38.2% of clinical breast examinations. According to the findings, lack of breast cancer screening is associated with social and racial inequity, and reduction in breast cancer mortality requires early detection of the disease, which in turn demands that health care facilities implement strategies to expand coverage of preventive practices, especially for more vulnerable social groups.
Collapse
|
44
|
Donelle L, Hoffman-Goetz L. Functional health literacy and cancer care conversations in online forums for retired persons. Inform Health Soc Care 2009; 34:59-72. [DOI: 10.1080/17538150902779535] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
45
|
Von Wachenfeldt A, Brandberg Y, Johansson H, Fornander T. Socioeconomic status and quality of life of women with family history of breast cancer attending an oncogenetic counseling clinic: a comparison with general population. Acta Oncol 2009; 48:86-92. [PMID: 18759137 DOI: 10.1080/02841860802343182] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Women with high risk for breast cancer due to family history are offered genetic counseling and surveillance. The aim of this cross-sectional study was to characterize women at an oncogenetic counseling clinic in terms of socioeconomic status (SES) and health related quality of life (HRQOL) and to compare data with population based figures. MATERIAL AND METHODS All healthy women who had ever visited the Oncogenetic clinic, Department of Oncology, Sodersjukhuset, 1998-2004 were eligible. A total of 306 women consented to participate (82.5%). SES data were compared with official data for all women (n=277,783), in the same age, living in the same geographical area at the time the study was performed. HRQOL data (SF-36) were compared with Swedish normative data. RESULTS Significantly more women in the study group were cohabiting (74.2 vs. 43.8%), had the highest education level, (56.7 vs. 39.6%) and had the highest household income (36.9 vs. 12.9%) as compared to the reference population in the same catchment area. Study subjects report significant lower levels of HRQOL for subscales related to mental health and for general health compared to normative data, but similar levels on HRQOL subscales related to physical health. DISCUSSION Attendees at the oncogenetic clinic appears to have higher socioeconomic status and lower quality of life as compared to women living in the same area, although the genetic predisposition for breast cancer is considered to be evenly distributed in the population. Thus, efforts to reach women in lower socioeconomic groups should be elaborated.
Collapse
|
46
|
Abstract
OBJECTIVE To conduct a population-based study of incidence and screening rates for secondary breast and colorectal cancers after endometrial cancer and to assess implications for follow-up. METHODS This was a retrospective population-based study from administrative databases. The inception cohort included all women diagnosed with endometrial cancer in Ontario, Canada from 1996 to 2000, without a previous history of breast or colorectal cancer. We ascertained 5-year recurrence and overall survival rates and practitioner type during follow-up. Primary outcomes were age-standardized incidence and screening rates of breast and colorectal cancer during follow-up compared with the general female population. RESULTS There were 3,473 women in the cohort. The 5-year recurrence rate was 15.0% and overall survival was 79.3%. Family physicians were most often involved in follow-up care. Age-standardized incidence rates of breast and colorectal cancer were 0.5% and 0.7%, respectively, compared with 0.5% (P=.76) and 0.2% (P<.001) in the general population. Age-standardized screening rates for these cancers were 64.0% and 30.0%, respectively, compared with 31.0% (P<.008) and 15.0% (P<.001) in the general population. Women aged older than 70 years and those with the lowest income were least likely to have secondary cancer screening. CONCLUSION Women with endometrial cancer have a comparable risk of breast cancer but higher risk of colorectal cancer compared with the general population. Follow-up after endometrial cancer should include counseling and uptake of secondary cancer prevention strategies, which will contribute to maximizing long-term survivorship for these women. LEVEL OF EVIDENCE II.
Collapse
|
47
|
Sochocki MP, Verity S, Atherton PJ, Huntington JL, Sloan JA, Embil JM, Trepman E. Health related quality of life in patients with Charcot arthropathy of the foot and ankle. Foot Ankle Surg 2009; 14:11-5. [PMID: 19083605 DOI: 10.1016/j.fas.2007.07.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 07/09/2007] [Accepted: 07/17/2007] [Indexed: 02/04/2023]
Abstract
BACKGROUND Clinical observation suggests that Charcot arthropathy of the foot and ankle has major negative consequences on the quality of life of neuropathic patients, particularly those with diabetes. We hypothesized that the quality of life in patients with Charcot arthropathy may be aggravated by Aboriginal ethnicity and rural residence because of limited access to timely specialty healthcare. METHODS Sixty patients with Charcot arthropathy were interviewed with the Short Form 36 (SF-36) Health Survey. RESULTS Mean Physical Component Summary (PCS) score was 31+/-8 points and mean Mental Component Summary (MCS) score was 45+/-10 points. Mean PCS and MCS scores were not affected by gender, ethnicity, residence, or Charcot stage. Mean PCS score was significantly lower in non-employed (unemployed or retired) than employed patients and in patients who did not use alcohol than those who used alcohol; MCS score was not affected by employment status or alcohol use. CONCLUSIONS Charcot arthropathy has a major negative effect on quality of life. The SF-36 survey was sensitive to the physical effects, but not to mental effects, of Charcot arthropathy.
Collapse
|
48
|
Kim J, Jang SN. Socioeconomic disparities in breast cancer screening among US women: trends from 2000 to 2005. J Prev Med Public Health 2008; 41:186-94. [PMID: 18515996 DOI: 10.3961/jpmph.2008.41.3.186] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. Continued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Department of Environmental Health, Harvard School of Public Health, USA
| | | |
Collapse
|
49
|
Disparities in mammography use among US women aged 40-64 years, by race, ethnicity, income, and health insurance status, 1993 and 2005. Med Care 2008; 46:692-700. [PMID: 18580388 DOI: 10.1097/mlr.0b013e31817893b1] [Citation(s) in RCA: 102] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To examine current disparities in mammography use, and changes in disparities over time by race, ethnicity, income, insurance, and combinations of these characteristics. RESEARCH DESIGN Comparison of cross-sectional surveys of mammography use using the 1993 and 2005 National Health Interview Survey. SUBJECTS Women aged 40-64 (1993, n = 4167; 2005, n = 7434). MEASURES Mammogram within prior 2 years. RESULTS In 2005, uninsured women reported the lowest mammography use (38.3%). Though screening increased 6.9 percentage points among low-income, uninsured women, the overall disparity between insured and uninsured women did not change significantly between 1993 and 2005. Screening seems to have declined among middle-income, uninsured women, increasing the gap compared with middle-income, insured women. The lower mammography use in 1993 among American Indian/Alaska Native compared with white women was not present in 2005; however, lower use among Asian compared with white women emerged in 2005. We found no differences between African American and white women. Hispanic women were less likely than non-Hispanic women to report screening in 2005 (58.1% vs. 69.0%). CONCLUSIONS Although mammography use increased for some groups between 1993 and 2005, low-income, uninsured women continued to have the lowest screening rates in 2005 and the disparity for this group was not reduced. The gap in screening use for middle-income, uninsured women increased, resulting from possible declines in mammography even for uninsured women not in poverty. Asian women became less likely to receive screening in 2005. Continuing efforts are needed to eliminate disparities. Increased efforts are especially needed to address the large persistent disparity for uninsured women, including middle-income uninsured women.
Collapse
|
50
|
Webster TF, Hoffman K, Weinberg J, Vieira V, Aschengrau A. Community- and individual-level socioeconomic status and breast cancer risk: multilevel modeling on Cape Cod, Massachusetts. ENVIRONMENTAL HEALTH PERSPECTIVES 2008; 116:1125-1129. [PMID: 18709175 PMCID: PMC2516595 DOI: 10.1289/ehp.10818] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2007] [Accepted: 04/25/2008] [Indexed: 05/26/2023]
Abstract
BACKGROUND Previous research demonstrated increased risk of breast cancer associated with higher socioeconomic status (SES) measured at both the individual and community levels. However, little attention has been paid to simultaneously examining both measures. OBJECTIVES We evaluated the independent influences of individual and community SES on the risk of breast cancer using case-control data. Because our previous work suggests that associations may be stronger after including a latency period, we also assessed the effect of community-level SES assuming a 10-year latency period. METHODS We obtained individual education for cases and matched controls diagnosed between 1987 and 1993 on Cape Cod, Massachusetts (USA). We acquired community-level SES from census data for 1980 and 1990. Using SES data at diagnosis and 10 years earlier, we constructed models for breast cancer risk using individual-level SES only, community-level SES only, and a multilevel analysis including both. We adjusted models for other individual-level risk factors. RESULTS Women with the highest education were at greater risk of developing breast cancer in both 1980 and 1990 [odds ratio (OR) = 1.17 and 1.19, respectively]. Similarly, women living in the highest-SES communities in 1990 had greater risk (OR = 1.30). Results were stronger in the analyses considering a latency period (OR = 1.69). Adjusting for intragroup correlation had little effect on the analyses. CONCLUSIONS Models including individual- or community-level measures of SES produced associations similar to those observed in previous research. Results for models including both measures are consistent with a contextual effect of SES on risk of breast cancer independent of individual SES.
Collapse
Affiliation(s)
- Thomas F Webster
- Department of Environmental Health, Boston University Schoolof Public Health, Boston, Massachusetts 02118, USA.
| | | | | | | | | |
Collapse
|