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Quintal C, Antunes M. Picturing Prevalence and Inequalities in Cancer Screening Attendance to Population-Based Programs in Portugal. ACTA MEDICA PORT 2023; 36:577-587. [PMID: 37339163 DOI: 10.20344/amp.19443] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 04/28/2023] [Indexed: 06/22/2023]
Abstract
INTRODUCTION Screening is effective in reducing cancer-related morbidity and mortality. The aim of this study was to analyze the level of, and income-related inequalities in, screening attendance, in Portugal for population-based screening programs. METHODS Data from the Portuguese Health Interview Survey 2019 was used. Variables included in the analysis were self-reported: mammography, pap smear test, fecal occult blood test. Prevalence and concentration indices were computed at national/regional level. We analyzed: up-to-date screening (within recommended age/interval), under-screening (never or overdue screening), and over-screening (due to frequency higher than recommended or screening outside target group). RESULTS Up-to-date screening rates were 81.1%, 72%, and 40%, for breast, cervical and colorectal cancer, respectively. Never-screening was 3.4%, 15.7%, and 39.9%, for breast, cervical, and colorectal cancer, respectively. Over-screening related with frequency was highest for cervical cancer; in breast cancer, over-screening was observed outside recommended age, affecting one third of younger women and one fourth of older women. In these cancers, over-screening was concentrated among women with higher income. Never-screening was concentrated among individuals with lower income for cervical cancer and higher income for colorectal cancer. Beyond the recommended age, 50% of individuals never underwent screening for colorectal cancer and 41% of women never underwent screening for cervical cancer. CONCLUSION Overall, screening attendance was high, and inequalities were low in the case of breast cancer screening. The priority for colorectal cancer should be to increase screening attendance.
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Affiliation(s)
- Carlota Quintal
- Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra; Centro de Estudos e Investigação em Saúde da Universidade de Coimbra (CEISUC). Coimbra. Portugal
| | - Micaela Antunes
- Centre for Business and Economics Research (CeBER). Faculdade de Economia. Universidade de Coimbra. Coimbra. Portugal. Portugal
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Health inequities in mammography: A scoping review. Eur J Radiol 2023; 160:110693. [PMID: 36640712 DOI: 10.1016/j.ejrad.2023.110693] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 12/30/2022] [Accepted: 01/07/2023] [Indexed: 01/11/2023]
Abstract
OBJECTIVE The objective of this scoping review is to chart the existing evidence on health inequities related to mammography and identify existing knowledge gaps to guide future research. METHODS This scoping review followed guidelines from the Joanna Briggs Institute and the PRISMA extension for scoping reviews. In July 2022, we searched PubMed and Ovid Embase for published articles on mammography screening, published between 2011 and 2021, written in English, and examining at least one health inequity as defined by the NIH. Screening and charting were both performed in a masked, duplicate manner. Frequencies of each health inequity examined were analyzed and main findings from each included study were summarized. RESULTS Following screening, our sample consisted of 128 studies. Our findings indicate that mammography screening was less likely in historically marginalized groups, patients who live in rural areas, and in women with low income status and education level. Significant research gaps were observed regarding the LGBTQ + community and sex and gender. No trends between inequities investigated over time were identified. DISCUSSION This scoping review highlights the gaps in inequities research regarding mammography, as well as the limited consensus across findings. To bridge existing research gaps, we recommend research into the following: 1) assessments of physician knowledge on the LGBTQ + community guidelines, 2) tools for health literacy, and 3) culturally competent screening models.
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Araujo JM, Gómez AC, Jongh WZD, Ausejo J, Córdova I, Schwarz LJ, Bretel D, Fajardo W, Saravia-Huarca LG, Barboza-Meca J, Morante Z, Guillén JR, Gómez H, Cárdenas NK, Hernández L, Melo W, Villarreal-Garza C, Caglevic C, Palacio C, García H, Mejía G, Flores C, Vallejos C, Pinto JA. A nationwide pilot study on breast cancer screening in Peru. Ecancermedicalscience 2023; 17:1494. [PMID: 36816782 PMCID: PMC9937072 DOI: 10.3332/ecancer.2023.1494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Indexed: 01/11/2023] Open
Abstract
Introduction A high prevalence of advanced breast cancer (BC) is a common scenario in Latin America. In Peru, the frequency of BC at Stages III/IV is ≈50% despite implementation of a programme for breast cancer screening (BCS) along the country. We carried out a study to assess the feasibility and develop an instrument to evaluate the knowledge, barriers and perception about BCS in a nationwide pilot study in Peru among candidates for BCS. Methods We conducted a systematic review of 2,558 reports indexed in PubMed, Scopus, Web of Science, Medline-Ovid and EMBASE, regarding to our study theme. In total, 111 were selected and a 51-items survey was developed (eight items about sociodemographic characteristics). Patients were recruited in public hospitals or private clinics, in rural and urban areas of nine departments of Peru. Results We surveyed 488 women from: Lima (150), Cajamarca (93), Ica (59), Arequipa (56), Loreto (48), Ancash (38), Junín (15), Puerto Maldonado (15) and Huancavelica (14); 27.9% of them were from rural areas. The mean of age was 53.3 years (standard deviation ± 9.1). Regarding education level, 29.8% had primary, 33.2% secondary and 37.0% higher education. In total, 28.7% of women did not know the term 'mammogram' and 47.1% reported never receiving a BCS (36.9% from urban and 73.5% from rural population). In women that underwent BCS, only 67% knew it is for healthy women. In total, 54.1% of patients had low levels of knowledge about risk factors for BC (i.e. 87.5% of women respond that injuries in the breast produce cancer). Cultural, economic and geographic barriers were significantly associated with having a mammogram where 56.9% of participants considered a cost ≤ 7 USD as appropriate. Mammogram was perceived as too painful for 54.9% of women. In addition, women with a self-perception of low-risk for BC and a fatalistic perception of cancer were less likely to have a BCS. Conclusion We found that it is feasible to conduct a large-scale study in Peru. The results of this pilot study highlight an urgent need of extensive education and awareness about BCS in Peru.
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Affiliation(s)
- Jhajaira M Araujo
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru,Escuela Profesional de Medicina Humana, Universidad Privada San Juan Bautista, Chorrillos, Lima 15067, Peru
| | - Andrea C Gómez
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru
| | - Winston Zingg-De Jongh
- Department of Molecular and Cellular Medicine, Texas A&M University, TX 77843, E.E.U.U., USA
| | - Jhon Ausejo
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Iván Córdova
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Luis J Schwarz
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Denisse Bretel
- Grupo de Estudios Clínicos Oncológicos Peruano (GECOPERU), Santiago de Surco, Lima 15038, Peru
| | - Williams Fajardo
- Servicio de Medicina Interna, Hospital Nacional Dos de Mayo, Lima 15003, Peru
| | | | | | - Zaida Morante
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru
| | - Juan R Guillén
- Hospital Félix Torrealva Gutiérrez- ESSALUD, Ica 11001, Peru
| | - Henry Gómez
- Grupo de Estudios Clínicos Oncológicos Peruano (GECOPERU), Santiago de Surco, Lima 15038, Peru
| | - Nadezhda K Cárdenas
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Lady Hernández
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Walter Melo
- Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
| | - Cynthia Villarreal-Garza
- Centro de Cáncer de Mama, Hospital Zambrano Hellion, Tecnológico de Monterrey, 66278 San Pedro Garza García, Monterrey, México
| | - Christian Caglevic
- Cancer Research Department, Fundacion Arturo Lopez Perez, Santiago de Chile 7500921, Chile
| | - Carolina Palacio
- Departamento de Oncología Clínica, Instituto de Cancerología Las Américas - AUNA, Medellín 050022, Colombia
| | - Héctor García
- Facultad de Medicina, Universidad de Antioquia, Medellín 050010, Colombia
| | - Gerson Mejía
- Departamento de Oncología Médica, Hospital Clínico VIEDMA, Cochabamba 0304, Bolivia
| | - Claudio Flores
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru
| | - Carlos Vallejos
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru
| | - Joseph A Pinto
- Centro de Investigación Básica y Traslacional, AUNA-Ideas, Guardia Civil 571, San Borja, Lima 16036, Peru,Escuela Profesional de Medicina Humana-Filial Ica, Universidad Privada San Juan Bautista, Ica 11004, Peru
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Esna-Ashari F, Saffari N, Parsapour H, Rezapur-Shahkolai F. Factors Associated with Breast Cancer Mammographic Screening Behavior among Iranian Women. Asian Pac J Cancer Prev 2022; 23:4073-4078. [PMID: 36579987 PMCID: PMC9971457 DOI: 10.31557/apjcp.2022.23.12.4073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Indexed: 12/30/2022] Open
Abstract
Breast cancer is one of the most common diseases of women, which can increase the survival of patients with its early diagnosis. Despite the existence of relatively sensitive methods of early detection of breast cancer, such as mammography, statistics show that a small number of women perform mammography according to the recommended clinical guidelines. Using the health belief model, this study aims to determine the factors affecting mammography among women teachers in Hamedan. METHODS This study was conducted on 458 female teachers aged 40 years and older of Hamadan city, in western part of Iran, during October to December of 2019. The participants were asked about the factors affecting mammography based on the health belief model. Questionnaires were completed by self-reported method and analyzed by SPSS software at 95% confidence interval. RESULTS The average age of the study participants was 46±4.1 years. Among the participants, about 41.5% had performed mammography at least once. In univariate analysis, the constructs of the health belief model generally predicts performing mammography between 35 and 49 percent. In multivariate analysis, age 46 to 50 years, having supplementary insurance, history of breast disease, perceived barriers with odds ratio of 3.4, 3.4, 10.6 and .89, respectively, were significantly related to mammography. CONCLUSIONS Female teachers over 45 years of age with a history of breast disease, if they do not have financial or other barriers to do mammography, perform breast cancer screening.
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Affiliation(s)
- Farzaneh Esna-Ashari
- Department of Community Medicine, School of Medicine and Research Center for Social Determinants of Health, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Narges Saffari
- General Physician, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Hamideh Parsapour
- Department of Obstetrics and Gynecology, Fatemieh Hospital, Hamadan University of Medical Sciences, Hamadan, Iran.
| | - Forouzan Rezapur-Shahkolai
- Department of Public Health, School of Public Health and Research Center of Health Sciences, Hamadan University of Medical Sciences, Hamadan, Iran.,For Correspondence:
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Factors associated with locoregional and metastatic breast cancer at diagnosis in a Southern Portuguese registry in the period 2005-2012. Eur J Cancer Prev 2018; 28:492-499. [PMID: 30407215 DOI: 10.1097/cej.0000000000000492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Breast cancer (BC) is the most frequent malignancy in Portuguese women, and more than half of the registered cases live in the south of the country. The main of this study was to characterize patients with locoregional and metastatic incident BC living in the Southern Portuguese and Madeira regions in 2005-2012 according to demographic, clinical and contextual characteristics. Additionally it aimns to find the associations and relative influences of these factors with locoregional or metastatic disease at diagnosis. After a descriptive approach, binary logistic regression models were used to estimate factors related to the presence of metastatic disease at diagnosis. A final multiple regression model was developed and presented graphically as a nomogram. The median age at diagnosis was 60.84 years, being statistically lower in locoregional cases (P < 0.001). Most patients presented a locoregional disease (78.4%) of unspecified location (44.5%) and had a ductal carcinoma (73.1%). The Lisbon region represented 50.5% of the analyzed cases. Metastatic disease significantly decreased over the period under analysis ( ≈ 7%/year). Demographic (age at diagnosis ≥ 50 years), clinical (lobular and 'other' morphologies, unspecified location) and contextual (residence in Portalegre) characteristics were statistically correlated with the presence of metastatic disease at the time of BC diagnosis in univariate logistic regression, with all but the last maintaining their significance in a multivariate model. Cases with metastatic BC disease at diagnosis are decreasing; however, additional information on their characteristics can improve the alignment of public health strategies, thus strengthening this trend, and contributing to the development of a graphically tailored screening tool.
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Costa L, Dias S, Martins MDRO. Fruit and Vegetable Consumption among Immigrants in Portugal: A Nationwide Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15102299. [PMID: 30347692 PMCID: PMC6210251 DOI: 10.3390/ijerph15102299] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 10/12/2018] [Accepted: 10/17/2018] [Indexed: 12/25/2022]
Abstract
This study aims to compare adequate fruit and vegetable (F&V) intake between immigrants and natives in Portugal, and to analyse factors associated with consumption of F&V among immigrants. Data from a population based cross-sectional study (2014) was used. The final sample comprised 17,410 participants (≥20 years old), of whom 7.4% were immigrants. Chi-squared tests and logistic regression models were conducted to investigate the association between adequate F&V intake, sociodemographic, anthropometric, and lifestyle characteristics. Adequate F&V intake was more prevalent among immigrants (21.1% (95% CI: 19.0–23.4)) than natives (18.5% (95% CI: 17.9–19.1)), (p = 0.000). Association between migrant status and adequate F&V intake was only evident for men: immigrants were less likely to achieve an adequate F&V intake (OR = 0.67, 95% CI = 0.66–0.68) when compared to Portuguese. Among immigrants, being female, older, with a higher education, and living in a low urbanisation area increased the odds of having F&V consumption closer to the recommendations. Adjusting for other factors, length of residence appears as a risk factor (15 or more years vs. 0–9 years: OR = 0.52, 95% CI = 0.50–0.53), (p = 0.000) for adequate F&V intake. Policies aiming to promote adequate F&V consumption should consider both populations groups, and gender-based strategies should address proper sociodemographic, anthropometric, and lifestyle determinants.
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Affiliation(s)
- Liliane Costa
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal.
| | - Sónia Dias
- Escola Nacional de Saúde Pública, Centro de Investigação em Saúde Pública, Universidade NOVA de Lisboa & Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, 1600-560 Lisboa, Portugal.
| | - Maria do Rosário O Martins
- Global Health and Tropical Medicine, GHTM, Instituto de Higiene e Medicina Tropical, IHMT, Universidade Nova de Lisboa, UNL, Rua da Junqueira 100, 1349-008 Lisboa, Portugal.
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