Breast Examination Rates Research Articles

An equity analysis of health examination service utilization by women from underdeveloped areas in western China.

ObjectiveThis study sought to examine the sources of inequity in health examination service utilization by women from underdeveloped areas in western China.MethodsBased on data from the 5th National Health Service Survey in Shaanxi province, women’s utilization of health examination services was examined according to gynecological, cervical smear, and breast examination rates. The equity of health examination service utilization by 15- to 64-year-old women and the factors contributing to inequity were determined using the health concentration index, decomposition of the concentration index, and the horizontal inequity index.ResultsThe examination rates for gynecological, cervical smear, and breast exams for 15- to 64-year-old women in Shaanxi province were 40.61%, 27.08%, and 24.59%, respectively. The horizontal inequity indices of gynecological, cervical smear, and breast examination rates were 0.0480, 0.0423, and 0.0764, respectively, and each examination rate was higher for wealthy individuals. The contribution rates of economic status to the inequalities in gynecological, cervical smear, and breast examination rates were 65.80%, 74.31%, and 56.49%, respectively. The contribution rates of educational status to the inequalities in gynecological, cervical smear, and breast examination rates were 21.01%, 14.83% and 30.00%, respectively. The contribution rates of age to the inequalities in gynecological, cervical smear, and breast examination rates were 25.77%, 26.55%, and 18.40%, respectively.ConclusionsWomen’s health examination rates differed between populations with different socio-demographic characteristics. There is pro-wealth inequality in each examination rate. This study found that financial status, age, and education level were the main reasons for the unequal utilization of health examination services.

Healthcare access and mammography screening in Michigan: a multilevel cross-sectional study.

BackgroundBreast cancer screening rates have increased over time in the United States. However actual screening rates appear to be lower among black women compared with white women.PurposeTo assess determinants of breast cancer screening among women in Michigan USA, focusing on individual and neighborhood socio-economic status and healthcare access.MethodsData from 1163 women ages 50-74 years who participated in the 2008 Michigan Special Cancer Behavioral Risk Factor Survey were analyzed. County-level SES and healthcare access were obtained from the Area Resource File. Multilevel logistic regression models were fit using SAS Proc Glimmix to account for clustering of individual observations by county. Separate models were fit for each of the two outcomes of interest; mammography screening and clinical breast examination. For each outcome, two sequential models were fit; a model including individual level covariates and a model including county level covariates.ResultsAfter adjusting for misclassification bias, overall cancer screening rates were lower than reported by survey respondents; black women had lower mammography screening rates but higher clinical breast examination rates than white women. However, after adjusting for other individual level variables, race was not a significant predictor of screening. Having health insurance or a usual healthcare provider were the most important predictors of cancer screening.DiscussionAccess to healthcare is important to ensuring appropriate cancer screening among women in Michigan.

The effectiveness of a nurse-delivered breast health promotion program on breast cancer screening behaviours in non-adherent Turkish women: A randomized controlled trial

Background Few studies have investigated breast health programs to promote rates of having a mammography, clinical breast examination and breast self-examination among non-adherent Turkish women. Objectives To determine the effectiveness of a breast health promotion program on mammography and clinical breast examination use, breast self-examination frequency and proficiency (breast self-examination skills and lump detection), breast health knowledge and health beliefs about breast cancer screening in a sample of Turkish women. Design Experimental (pretest–posttest control group). Setting A community-based setting in Istanbul, Turkey. Participants 190 Non-adherent women (intervention group = 97, control group = 93) aged 41 and older, residing in Istanbul, Turkey. Methods The intervention group ( n = 97) received a 120-min breast health promotion program based on health belief model including a breast health education, film, breast self-examination instruction, and a booklet, a calendar, a card designed specifically for the study. The control group ( n = 93) received general information except breast health. Data were collected before the program, immediately after the program, and at 3- and 6-month post-program. The outcome measures are the mammography, clinical breast examination, and breast self-examination frequency, breast self-examination proficiency, breast health knowledge, and health beliefs (perceived susceptibility to breast cancer, benefits to mammography and breast self-examination, barriers of mammography and breast self-examination, confidence in performing breast self-examination). Results The breast health promotion program significantly increased breast self-examination frequency and proficiency and breast health knowledge. No significant differences existed in mammography and clinical breast examination rates between the two groups at 6 months. The program was effective in increasing perceived susceptibility to breast cancer, perceived benefits of mammography and breast self-examination, and confidence of breast self-examination. No significant difference was found between the two groups for perceived barriers to mammography. Conclusions The breast health promotion program was effective in increasing breast self-examination frequency and proficiency in a sample of Turkish women. In addition, it appears to be useful in raising the knowledge of breast health, enhancing confidence in performing breast self-examination, and increasing most health belief levels.

Utilization of mammography services among elderly rural and urban African American women

Purpose This study was a two-year educational intervention and research project aimed at increasing the awareness of breast cancer and the utilization of Clinical Breast Examination (CBE) services and Self-Breast Examination (SBE) among elderly rural and urban African American women who are Medicare beneficiaries. Design The study was implemented in four phases. In Phase 1, we obtained Center for Medicare and Medicaid Services (CMS) data collected for a one-year period and computed the annual mammography screening and clinical breast examination rates for elderly African American and Caucasian women who are participants in the Medicare programme. Phase 2 was conducted concurrently with Phase 1 to collect and analyze pertinent data. During Phase 3, the one-year educational intervention component of the project was implemented, in conjunction with the American Cancer Society's Sisters Alive programme, and with the Health Advisory Council. In Phase 4, we obtained the claims data from CMS to compute annual mammography rates to evaluate the impact of the intervention. Findings The results suggest the following: (1) one of the primary reasons elderly women do not utilize CBE services is because they do not consider it necessary when they experience no symptoms or pain; (2) elderly African American women have moderate awareness of the incidence and prevalence of breast cancer; and (3) they are generally aware of the benefi ts of CBE. Analysis of the pre- and post-tests data failed to provide evidence of the impact of this project on the utilization of CBE among elderly African American women.

The effect of comorbid illness on receipt of cancer screening by older people.

To identify associations between the type and number of diagnoses and receipt of screening for breast, cervical, and colorectal cancer by older people. Sixth annual follow-up of a community-based survey with 4,162 participants aged 65 and older at baseline in 1986. Piedmont area of North Carolina. Two thousand two hundred twenty-five subjects with a mean age of 79 who responded in 1992. Self-reported receipt of clinical breast examination, mammography, Papanicolaou (Pap) smear, and fecal occult blood testing (FOBT) within the 2 years before the survey. Hip fracture was associated with lower rates of mammography (odds ratio (OR) = 0.53, 95% confidence interval (CI) = 0.32-0.87) and cognitive impairment with lower rates of FOBT (OR = 0.71, 95% CI = 0.54-0.94). Hypertension was associated with higher rates of breast examination (OR = 1.56, 95% CI = 1.18-2.07), Pap smear (OR = 1.41, 95% CI = 1.09-1.83), and FOBT (OR = 1.37, 95% CI = 1.12-1.66) and a trend toward increasing rates of mammography (OR = 1.28, 95% CI = 0.98-1.69). The presence of three or more comorbid conditions was associated with an increased rate of mammography (OR = 1.35, 95% CI = 1.06-1.71), breast examination (OR = 1.46, 95% CI = 1.12-1.89), and Pap smear (OR = 1.31, 95% CI = 1.04-1.65). With few exceptions, the presence of comorbid conditions is not associated with a decreased rate of receipt of screening. In fact, hypertension and the presence of a higher number of comorbid conditions are associated with a higher rate of receipt of cancer screening. This finding may be due to an increase in the frequency of office visits increasing the opportunity for cancer screening.

Improving residents' performances of clinical breast examination.

Clinical breast examination and mammography are recommended as combined modalities for breast cancer screening. Rates of mammography are increasing; however, clinical breast examination rates are decreasing. Specific training in breast examination may be warranted. The authors developed an ambulatory rotation to teach breast cancer screening to medical residents. To assess whether this training improved screening performance, they compared clinical breast examination and mammography rates in residents' continuity clinics before and after training among residents who were assigned to the training program and residents who were not. 314 women patients were seen by 28 residents. The rates for annual clinical breast examination and mammography were 39% and 71%, respectively. Clinical breast examination rates increased by 18% among the residents assigned to the training program, whereas they dropped by 13% over than same period among the residents who had not received the training (p < 0.005). Female residents performed more clinical breast examinations than did their male counterparts (50% vs 34% p < 0.01). Mammography rates did not change with training, and were not associated with resident gender or career plans. Although the residents performed mammography at high rates, clinical breast examination rates were low. Short-term directed teaching about clinical breast examination increased the performance of this screening test, and is important to incorporate into teaching programs.

Socioeconomic Disparities in Preventive Care Persist Despite Universal Coverage

To compare the association of income and education with breast and cervical cancer screening in Ontario, Canada, and the United States. Survey using data from the Ontario Health Survey and the US National Health Interview Survey. A multistage random sample of women aged 18 years and older living in households in Ontario (N = 23,521) and the United States (N = 23,932) in 1990. Persons were considered screened if they reported a Papanicolaou test within the previous 2 years, a clinical breast examination within the previous year, or a mammogram within the previous year. Papanicolaou test and clinical breast examination rates were similar between countries, but mammography rates were two to three times higher in the United States across all age groups. Compared with women with less than a high school degree, college graduates were more likely to receive screening (odds ratio [OR], 1.5; 95% confidence interval [CI], 1.2 to 1.7) and there was no difference between countries. Across all procedures, women with higher incomes were more likely to receive screening. For Papanicolaou test and clinical breast examination, there was no difference between countries. Compared with the lowest income, the OR was 1.7 (95% CI, 1.3 to 2.1) in Ontario and 1.9 (95% CI, 1.6 to 2.2) in the United States for Papanicolaou test and 2.1 (95% CI, 1.6 to 2.8) in Ontario and 2.1 (95% CI, 1.8 to 2.6) in the United States for the clinical breast examination for women with income greater than $45,600 (US dollars). For mammography screening, the association of income with use was greater in the United States: the OR was 1.8 (95% CI, 1.3 to 2.6) in Ontario and 2.7 (95% CI, 2.3 to 3.2) in the United States for women with income greater than $45,600 (US dollars). Despite the long-time presence of universal insurance coverage in Ontario the disparities in the use of cancer screening procedures by the poor were similar to the United States. Universal coverage is not sufficient to overcome the large disparities in screenings across socioeconomic status demonstrated in both countries.