Breast Cancer Screening Intentions Research Articles

What Breast Cancer Screening Program do Rural Women Prefer? A Discrete Choice Experiment in Jiangsu, China.

Chinese rural women aged 35-64 years are encouraged to complete breast cancer screening (BCS) free of charge. However, it is challenging to reach a satisfying BCS uptake rate. In this study, rural women's preferences and preferences heterogeneity were measured for the development of strategies to enhance participation in BCS. A cross-sectional survey with a discrete choice experiment (DCE) was conducted via convenience sampling via face-to-face interviews in Jiangsu, China. Six DCE attributes were identified through a systematic literature review; our previous study of Chinese rural women's BCS intentions; a qualitative work involving in-depth interviews with rural women (n = 13), medical staff (n = 4), and health care managers (n = 2); and knowledge of realistic and actionable policy. The D-efficient design was generated using Ngene 1.3.0. A mixed logit model (MXL) in Stata 18.0 was used to estimate the main effect of attribute levels on rural women's preferences. The relative importance and willingness to utilize BCS services (WTU) were also estimated. The heterogeneous preferences were analyzed by a latent class model (LCM). Sociodemographic status was used to predict the characteristics of class membership. The WTU for different classes was also calculated. A total of 451 rural women, aged 35-64 years, were recruited. The MXL results revealed that the screening interval (SI) was the most important attribute for rural women with regard to utilizing BCS services, followed by the level of screening, the attitude of medical staff, ways to get knowledge and information, people who recommend screening, and time spent on screening (TSS). Rural women preferred a BCS service with a shorter TSS; access to knowledge and information through multiple approaches; a shorter SI; a recommendation from medical staff or workers from the village or community, and others; the enthusiasm of medical staff; and medical staff with longer tenures in the field. Two classes named "process driven" and "efficiency driven" were identified by the preference heterogeneity analysis of the LCM. There is a higher uptake of breast cancer screening when servicesare tailored to women's preferences. The screening interval was the most important attribute for rural women in China with a preference for a yearly screening interval versus longer intervals.

The triad of knowledge, regular medical consultation, and recommendations for enhanced breast cancer screening intention in Morocco

Purpose The low rate of breast cancer screening in Morocco is linked to delayed diagnosis and increased mortality rates. Furthermore, there is a lack of research on the association between screening intention and knowledge levels. Our objective was to assess the level of knowledge regarding breast cancer and screening, identify the determinants of this knowledge, and determine predictive factors for screening intention.MethodsA cross-sectional analytical study was conducted on 1014 women in the city of Essaouira, Morocco, during the years 2018–2020. A stepwise logistic regression analysis was performed to identify the predictors using SPSS software.ResultsWe found an above-average level of knowledge (67%). These knowledge levels were associated with several personal characteristics. Moreover, these knowledge levels proved to be powerful predictive factors for the intention to undergo screening, along with regular medical consultations and recommendations to undergo screening.ConclusionWomen had a high level of knowledge about breast cancer and its characteristics. These knowledge levels were strongly associated with the intention to undergo screening. However, despite this, the low participation rate encourages the reinforcement of research to align knowledge, intention, and screening practices.

Celebrity Identification and Reasoned Action: An Integrative Model of the Relationship Between Media Use and Breast Cancer Screening Intention

ABSTRACT This study investigates the relationship between media use and breast cancer screening intentions by integrating the celebrity identification model and the theory of reasoned action. It tests an integrative model with survey data from 315 U.S. adult women. The study found that media use for breast cancer information was positively associated with parasocial interaction (PSI) and identification with celebrities who have or have had breast cancer; PSI was positively associated with attitudes, descriptive and injunctive norms in breast cancer screening, while identification with celebrities was positively associated with descriptive norms; attitudes, injunctive norms and descriptive norms were positively associated with breast cancer screening intentions. The study supports the mediating effect of PSI, identification, attitudes, and descriptive and injunctive norms on the association between media use and breast cancer prevention intentions.

Predicting Rural Women's Breast Cancer Screening Intention in China: A PLS-SEM Approach Based on the Theory of Planned Behavior.

BackgroundIt was reported that the incidence of breast cancer (BC) was the highest among cancers worldwide. The breast cancer screening (BCS) program is regarded as an effective preventive measure. However, rural women's willingness to participate in the BCS program is relatively low. To provide measures to prevent BC, it is necessary for the government to identify the influencing factors of rural women's BCS intention.MethodsA cross-sectional study was conducted among 3,011 rural women by a convenience sampling method through face-to-face interviews on a self-designed questionnaire based on the theory of planned behavior (TPB). The partial least square structural equation model (PLS-SEM) was conducted to determine the predictors of BCS intention, and a multi-group analysis (MGA) of age was performed to identify if there were differences in all hypotheses between different age groups.ResultsThere were still rural women who have not been screened for BC in five years (41.7%). The research model of rural women's intention to accept this prevention against BC was rational. All of the hypotheses are supported. Especially, subjective norm (SN) (β = 0.345, p < 0.001) is found to be the strongest predictor followed by the perceived behavioral control 1 (PBC 1) (personal factors, including distance, transportation, busyness, etc.) (β = 0.165, p < 0.001), attitude (β = 0.152, p < 0.001), past behavior (PB) (β = 0.150, p < 0.001), knowledge (β = 0.121, p < 0.001), and perceived behavioral control 2 (PBC 2) (pain and cultural-social factors including embarrassment from a physician, etc.) (β = 0.042, p < 0.05). The advocacy and education (A&E), medical level and service attitude (ML&SA) of township health centers and village clinics can affect behavior intention (BI) via attitude, SN, and PBC. The results of MGA of age indicate that there are significant differences among rural women of different ages regarding the relationship between A&E and PBC 2 (p < 0.01) and the effect of PB on BI (p < 0.001).ConclusionThe TPB with the addition of PB, knowledge, ML&SA, and A&E can provide the theoretical basis for the policy intervention that aims to enhance the rural women's BCS willingness. MGA of age is conducive to promoting the implementation of the BCS policy. The findings are of great significance to improve rural women's health levels.

Determinants of Intention to Participate in Breast Cancer Screening among Urban Chinese Women: An Application of the Protection Motivation Theory.

Despite the significance of early detection of breast cancer through screening, the screening uptake in China remains relatively low. Protection motivation theory (PMT) suggested by Rogers is one of the theories concerning threat appeal. This study aimed to apply the protection motivation theory (PMT) in predicting breast cancer screening intention. In this cross-sectional study, a sample of Chinese urban women was recruited using the convenient sampling method from five communities in Wuhan. Data were collected using a self-report questionnaire that included demographic variables, knowledge about breast cancer, six PMT subconstructs, and screening intention. We used the structural equation modeling (SEM) to identify the predictor factors associated with screening intention. Of the total sample (n = 412), 86.65% had intention to participate in screening. Our data fit the hypothesized SEM model well (Goodness of fit index (GFI) = 0.91, adjusted GFI (AGFI) = 0.89, comparative fit index (CFI) = 0.91, root mean square error of approximation (RMSEA) = 0.05, standardized root mean residual (SRMR) = 0.06, and Chi-square/df = 2.01). Three PMT subconstructs (perceived severity, response cost, and self-efficacy) were significantly associated with screening intention. Knowledge, social status, and medical history had significantly indirect associations with screening intention through the mediating effect of PMT subconstructs. Considering the utility of PMT, intervention programs might be more effective based on the subconstructs of PMT, especially to improve self-efficacy, perceived severity, and knowledge, reduce response cost, as well as targeting specific demographic groups.

Factors associated with breast cancer screening intention in Kathmandu Valley, Nepal.

Breast cancer burden is increasing in low-income countries (LICs). Increasing incidence and delayed presentation of breast cancer are mainly responsible for this burden. Many women do not participate in breast cancer screening despite its effectiveness. Moreover, studies are limited on the barriers associated with low utilization of breast cancer screening in LICs. This study identified breast cancer screening behavior and factors associated with breast cancer screening intention among women in Kathmandu Valley, Nepal. A cross-sectional study was conducted among 500 women living in five municipalities of Kathmandu Valley, Nepal. Data were collected from July to September 2018, using a structured questionnaire. Interviews were conducted among women selected through proportionate random household sampling. This study was conceptualized using the theory of planned behavior, fatalism, perceived susceptibility, and perceived severity. The outcome variables included: the intention to have mammography (MMG) biennially, the intention to have clinical breast examination (CBE) annually, and the intention to perform breast self-examination (BSE) monthly. Analysis was conducted separately for each outcome variable using partial proportional odds model. Out of 500 women, 3.4% had undergone MMG biennially, 7.2% CBE annually, and 14.4% BSE monthly. Women with a positive attitude, high subjective norms, and high perceived behavioral control were more likely to have the intention to undergo all three screening methods. Similarly, women were more likely to have intention to undergo CBE and MMG when they perceived themselves susceptible to breast cancer. Conversely, women were less likely to have intention to undergo CBE when they had high fatalistic beliefs towards breast cancer. Women in this study had poor screening behavior. The practice of breast self-examination was comparatively higher than clinical breast examination and mammography. Multidimensional culturally sensitive interventions are needed to enhance screening intentions. Efforts should be directed to improve attitude, family support, and fatalistic belief towards cancer. Furthermore, the proper availability of screening methods should be ensured while encouraging women to screen before the appearance of symptoms.

Association between Breast Cancer Screening Intention and Behavior in the Context of Screening Cessation in Older Women.

Breast cancer is the most common life-threatening cancer in women and mammography screening is an important intervention that can reduce breast cancer-related mortality and morbidity.1 Not surprisingly, numerous studies have aimed at promoting the adoption of breast cancer screening.2–7 Based on the Theory of Planned Behavior, which posits that intention is the most important and proximal predictor of behavior,8 studies have found moderate association between breast cancer screening intention and receipt of screening,2,3 and a number of interventions have targeted screening intention as the outcome.4–7 All of these studies focused on increasing screening rates. More recently, there is growing recognition that among women aged 75 and older, the harms and burdens of routine mammography screening may outweigh the benefits.9–11 Therefore, the National Cancer Institute and others have called for interventions to reduce overuse and address screening cessation in older women.12 Screening cessation after decades of participation is likely different than the decision to initiate screening and it is not known how older women’s screening intentions relate to screening behavior in the context of de-implementing screening. Given that it can take years and significant resources to learn if an intervention leads to a reduction in overuse of mammography screening in older women, we aimed to examine among women aged 75 and older if lower intentions to be screened predicts lower screening rates in the context of screening cessation.

Impact of Awareness of Breast Density on Perceived Risk, Worry, and Intentions for Future Breast Cancer Screening among Korean Women.

PurposeThis study sought to examine perceived risk and concerns for breast cancer according to awareness of breast density and states thereof among Korea women and to identify the impact of such awareness on screening intentions.Materials and MethodsThis study was based on the 2017 Korean National Cancer Screening Survey of a nationally representative and randomly selected sample of Koreans. Ordinal logistic regression was conducted to examine associations for awareness of and knowledge on breast density in relation to psychological factors. Multivariate logistic regression analyses were conducted to investigate significant factors associated with intentions to undergo breast cancer screening.ResultsAmong a total of 1,609 women aged 40-69 years, 62.0% were unaware of their breast density, and only 29.7% had good breast density knowledge. Awareness of one’s breast density and knowledge about breast density were positively associated with perceptions of absolute and comparative risk and cancer worry. Women aware of their breast density (adjusted odds ratio [aOR], 1.35 for women aware of having a non-dense breast; aOR, 4.17 for women aware of having a dense breast) and women with a good level of breast density knowledge (aOR, 1.65) were more likely to undergo future breast cancer screening.ConclusionBreast density awareness and knowledge showed positive associations with psychological factors and breast cancer screening intentions. However, the majority of Korean women were not aware of their breast density status and demonstrated poor knowledge about breast density. These results demonstrate a need for better health communication concerning breast density.

"You probably can't feel as safe as normal women": Hispanic women's reactions to breast density notification.

Patient advocacy has led to state-level legislative mandates for the release of personal mammographic breast density information to women undergoing screening mammography. More research is needed to understand the impact of this information on women's perceptions and mammography screening behavior. Semistructured interviews were conducted in English and Spanish with 24 self-identified Hispanic women who had undergone at least 1 mammogram since breast density notification was enacted in New York State. The women ranged in age from 43 to 63years. Women were asked about their understanding and perceptions of the communication of New York State-mandated breast density information, and any actions they have taken or would take in response to this information. A content analysis of the qualitative data from the translated and transcribed interviews was conducted. The majority of participants had no prior knowledge of breast density and expressed confusion and apprehension regarding the meaning of dense breasts when presented with the notification information. Many participants understood having dense breasts to be a serious and abnormal condition, and reported feelings of worry and vulnerability. Participants mostly expressed a strong interest in learning about breast density and obtaining additional and more frequent breast cancer screening tests. These behavioral intentions were consistent with participants' overall favorable view of breast cancer screening and a belief that their faith, as well as regular screening, can help to protect them from breast cancer morbidity and mortality. Hispanic women conveyed proactive breast cancer screening intentions in response to breast density notification, despite inadequate comprehension of this information and negative emotional responses.

A Study of the Effects of Self-efficacy and Optimistic Bias on Breast Cancer Screening Intention: Focusing on the Health Belief Model(HBM)

A Study of the Effects of Self-efficacy and Optimistic Bias on Breast Cancer Screening Intention: Focusing on the Health Belief Model(HBM)

건강 정보 추구가 유방암 검진행동에 미치는 영향 연구: 건강신념모형과 자율적 동기를 중심으로

본 연구는 전세계적으로 여성암 발병률 1위로 꼽히는 유방암 검진을 활성화하여 질병을 예방하고 조기에 발견할 수 있는 인식개선 방안을 살펴보기 위해 진행되었다. 유방암 관련 인식을 살펴보기 위해 건강신념모형(HBM)을 활용하였다. 질병 위험 지각, 질병 예방 행동 평가가 질병 관련 정보 추구에 긍정적인 영향을 주고 이러한 정보 추구 행동이 결과적으로 유방암 건강 검진 의도를 강화할 것이라고 추측하였다. 여기에 개인의 가치와 관심에 의한 스스로의 행위 조절을 뜻하는 ‘자율적 동기’를 추가적으로 살펴보았다. 연구 결과, 유방암을 위험하다고 지각할수록 유방암과 관련한 정보를 보다 적극적으로 찾고 있었다. 유방암 검진을 수행함으로써 얻을 수 있는 이익을 높게 지각할수록 관련 정보를 추구하는 행동 역시 높게 나타났다. 또한 스스로의 행위 조절에 적극적일수록, 즉 자율적 동기가 높을수록 유방암 관련 정보 추구 행동이 강하게 나타났다. 이러한 정보 추구 행동은 다시 건강 검진의도에 긍정적인 영향을 미쳤다. 즉 유방암 관련 정보를 많이 찾아볼수록 검진을 하겠다는 의도가 높아짐을 확인할 수 있었다.

College Women’s Responses to a Celebrity Health Disclosure

ABSTRACTCelebrities can have a powerful influence on people’s health-related attitudes and behaviors, often by publicly disclosing their own personal health decisions. In May 2013, Angelina Jolie, an internationally recognized actress, director, and author, wrote an op-ed for the New York Times disclosing her decision to undergo a prophylactic double mastectomy to reduce her risk of breast cancer after learning that she carried the BRCA1 gene mutation. This cross-sectional study examined whether exposure to Angelina Jolie and her mastectomy disclosure and parasocial involvement (PSI) with Angelina Jolie were related to female college students’ perceived risk of breast cancer and breast cancer screening intentions. Participants were 198 female undergraduate college students. Data were collected anonymously via an online questionnaire and analyzed using bivariate correlations and hierarchical linear regression analyses. Neither exposure to Angelina and her disclosure nor PSI with Angelina Jolie was related to participants’ attitudes or behaviors related to breast cancer. However, having a family history of cancer was associated with more exposure to Angelina Jolie and her disclosure. Findings suggest that exposure to and PSI with a celebrity who has disclosed a health-related message may not be sufficient to motivate young women to change their health-related attitudes and behaviors. Future studies should explore how celebrities disclosing different types of health issues might influence the attitudes and behaviors of young women.

Web-Based Study for Improving Mammography Among Korean American Women.

Web-based culture-specific interventions for Korean American (KA) women to improve mammography utilization are not available. An established intervention developed to improve mammography utilizations for Korean American (KA) women was tested via the Web for its efficacy, feasibility, and acceptability. A randomized controlled trial, with a pretest-posttest control group design, was conducted with 136 KA women and their spouses. Intention to have a mammogram within the next 12months increased significantly in the intervention group compare to controls. Among women whose mammograms had not been updated, 22% of women in the intervention and 13% of women in the control group obtained a mammogram at 2-month post-baseline, even though the difference was not statistically significant. The Web-based study educating couples was feasible and could improve KA women's breast cancer screening intention and behaviors. Combining off-line contact for recruitment/data collection with online intervention material could decrease the attrition rate in the future study because the attrition rate in this study was higher than the original study.

Abstract P1-11-12: Religion-related factors and breast cancer screening among American Muslims

Abstract Background: Cancer disparities research often overlooks the influence a shared religion may have across race and ethnicity, and thereby misses opportunities to leverage shared religious networks to promote screening. While American Muslims have low rates of mammography and their health behaviors are strongly influenced by religion, a description of such relationships is lacking in the literature. Our study fills this gap. Methods: We conducted a mixed-methods exploration of how religion-related factors impact breast cancer screening practices. We sampled an ethnically and racially diverse group of Muslim women frequenting mosques and community sites. A survey incorporated measures of fatalism, religiosity, religious discrimination, and Islamic modesty, while subsequent focus groups elicited perspectives on how religious beliefs, values and identity impact breast cancer screening intentions. Survey analyses involved logistic regression models, while focus groups were analyzed using a team-based framework content analysis approach. Results: Of 240 survey respondents, 72 were Arabs, 71 S. Asians and 59 African Americans. Seventy-five percent had insurance, while 85% had a PCP. 77% reported ever having a mammogram while only 37% a mammogram within the past 2 years. In multivariate models, positive religious coping (OR= 0.21;P &amp;lt;.05) and perceived religious discrimination in healthcare (OR=0.74;P &amp;lt;.05) were negatively associated with having a mammogram in the past two years, while having a primary care physician (OR=20;P&amp;lt;.01) was positively associated. Ever having a mammogram was positively associated with increasing age (OR=1.1;P&amp;lt;.05), years of US residency (10-20 yrs OR=11; 20 yrs OR=4.3;P&amp;lt;.05) and knowing someone with breast cancer (OR=3.5;P&amp;lt;.01). Importantly, ethnic/racial affiliation did not influence mammography rates. Of 50 focus group participants there were nearly equal numbers of S. Asians, Arabs, and African Americans, 74% reported ever having a mammogram, with 56% having a mammogram within the past two years. Focus group data revealed that family support and encouragement strongly impacted screening intentions, and that obtaining screening in a way that accommodated notions of religious modesty was paramount and prior experiences with such accommodations influenced subsequent intentions. Focus group participants believed that the mosque is a critical community venue for setting religious mores but is underutilized for health education and for motivating theological responses to illness. Participants expressed the need for mosque administration and religious leaders to openly discuss breast health and mammography screening among the Muslim community. Conclusions: Aspects of religion appear to influence cancer screening behaviors similarly across the socioeconomic, ethnic, and racial diversity of American Muslims. Promoting biennial mammography screening among American Muslims requires addressing ideas about religious coping as related to preventive cancer screening and empowering women to combat perceived religious discrimination. Mosques are underutilized in breast cancer screening interventions but are a ripe setting for religiously-tailored programming that can address barriers to screening and promote a culture of health in this community. Citation Format: Aasim Padela, S Murrar, S Mallick, Z Hosseinain, C Liao, C Ajax, F Marfani, M Peek. Religion-related factors and breast cancer screening among American Muslims [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P1-11-12.

Dense Breast Tissue Notification: Impact on Women’s Perceived Risk, Anxiety, and Intentions for Future Breast Cancer Screening

PurposeThe aim of this study was to explore how women respond to the wording of dense breast tissue notifications, which are increasingly required by state law after mammography. The specific aims were to (1) determine whether perceived lifetime risk for breast cancer and intentions to undergo mammography increase after reviewing a sample notification, (2) explore individual difference variables (eg, minority status, insurance coverage) that may influence intentions for additional ultrasound screening, and (3) assess whether anxiety mediates the relationship between perceived risk and screening intentions. MethodsA total of 184 women aged >40 years in the United States were recruited from Amazon Mechanical Turk to respond to a dense breast tissue notification as if they had personally received it. ResultsAfter reviewing a notification, women reported greater perceived risk (d = 0.67) and intentions to undergo mammography (d = 0.25) than before. Most women intended to undergo additional ultrasound screening, although to a lesser extent when ultrasound was covered by insurance than when it was not (d = 1.03). All screening intentions were lower in women with ambiguity aversion, a tendency to avoid tests without medical consensus, and those who preferred an active decision-making role. Anxiety mediated the relationship between perceived breast cancer risk and all screening intentions. ConclusionsWomen who receive dense breast tissue notifications may generally increase their breast cancer screening intentions; however, intention strength varies depending on internal (eg, ambiguity aversion) and external (eg, insurance for ultrasound) factors. Although perceived risk increases after notification, it is anxiety that drives women’s intentions for future screening.

Examining Asian Women’s Motivations to Undergo Breast Cancer Screening

Purpose: This study utilizes Protection Motivation Theory as a theoretical framework to predict women’s intentions to go for mammogram screening in Singapore, a country with the highest incidence of breast cancer in Asia. Materials and Methods: A questionnaire centered on the theoretical predictive model of early detection behavior was developed to examine the hypothesized relationships. Data was collected from Singaporean women between 40 to 69 years of age. The data was analyzed using hierarchical regression. Results: Amongst all predictors tested, we found that Perceived Severity influences protection motivation (Beta=.346, p=.033), whereas Perceived Vulnerability has little effect on protection motivation (Beta= .075, p=. 355). There is also a significant relationship between Self-Efficacy and protection intention (Beta= .373, p<.001). However, contrary to expectations, neither Response Cost (Beta=.136, p=.101) nor Physical Cost (Beta=-.051, p=-.036) was related to protection intention. Conclusions: Our findings indicate that coping appraisal variables are more significantly associated with protection motivation than threat appraisal variables. In particular, self-efficacy was found to be the strongest predictor of breast cancer screening intentions, whereas response cost and physical cost were found to have little effect. This implies that breast cancer screening motivators should communicate the ease of undergoing the procedure and other confidence building messages. Implications for health education and policy are discussed.

Why are Tailored Messages More Effective? A Multiple Mediation Analysis of a Breast Cancer Screening Intervention.

Past research has found that tailoring increases the persuasive effectiveness of a message. However, the observed effect has been small and the explanatory mechanism remains unknown. To address these shortcomings, a tailoring software program was created that personalized breast cancer screening pamphlets according to risk, health belief model constructs, and visual preference. Women aged 40 and older (N = 119) participated in a 2 (tailored vs. stock message) × 2 (charts/graphs vs. illustrated visuals) × 3 (nested replications of the visuals) experiment. Participants provided with tailored illustrated pamphlets expressed greater breast cancer screening intentions than those provided with other pamphlets. In a test of 10 different mediators, perceived message relevance was found to fully mediate the tailoring × visual interaction.

Predicting Breast Cancer Screening Intentions and Behavior with Emotion and Cognition

Abstract The present study applied the key elements of the Self-Regulation model to predicting breast cancer screening intentions. The participants in this study were women aged 18 to 73 years recruited from family members with breast cancer and through public announcements in local papers, all with a history of breast cancer. The women (n = 357) completed a baseline questionnaire. Participants' perceptions of their own risk relative to their medical risk varied widely. In contrast to the lack of relationship of beliefs and cognitions to overestimation of breast cancer risk estimates, several emotional variables were related to overestimation. Cancer worry and perceived risk increased significantly as risk overestimation increased. There were differences among the predictors of the breast cancer screening outcomes in the regression models, including perceived risk, cancer worry, and coping strategies. These data inform the literature on emotions, cognitions, and breast care.