Mammography Uptake Research Articles

Mammogram uptake and barriers among Palestinian women attending primary health care in North Palestine

Background Breast cancer affects women's lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers. Objectives Our study aims to assess mammography screening uptake and barriers among women attending primary healthcare centres (PHCs) in northern Palestine. Methods Using an interviewer administered questionnaire, we used a cross-sectional study design to determine mammography screening uptake, knowledge and barriers among 357 women attending PHCs in Northern Palestine between December 2018 and March 2019. Results The mean age was 50 years. The majority (69.2%) were considered to have adequate knowledge about breast cancer and mammography screening. Mammography screening uptake among the participants was 37%. Almost 85% of the women had a positive attitude towards breastfeeding as a prophylaxis factor against breast cancer, while the most frequent barrier to mammography screening was that the participants believed they did not have any symptoms (28.6%), followed by 22.1% of them who did not want to know if they had breast cancer. Conclusion The findings of this study highlighted the low mammography uptake among Palestinian women despite the adequate knowledge of those women and the fully accessible and free screening programme. Hence, interventional strategies should be implemented at several levels to enhance mammogram uptake.

Validity of self-reported mammography uptake in the Belgian health interview survey: selection and reporting bias.

BackgroundThe validity of self-reported mammography uptake is often questioned. We assessed the related selection and reporting biases among women aged 50–69 years in the Belgian Health Interview Survey (BHIS) using reimbursement data for mammography stemming from the Belgian Compulsory Health Insurance organizations (BCHI).MethodsIndividual BHIS 2013 data (n = 1040) were linked to BCHI data 2010–13 (BHIS–BCHI sample). Being reimbursed for mammography within the last 2-years was used as the gold standard. Selection bias was assessed by comparing BHIS estimates reimbursement rates in BHIS–BCHI with similar estimates from the Echantillon Permanent/Permanente Steekproef (EPS), a random sample of BCHI data, while reporting bias was investigated by comparing self-reported versus reimbursement information in the BHIS–BCHI. Reporting bias was further explored through measures of agreement and logistic regression.ResultsMammography uptake rates based on self-reported information and reimbursement from the BHIS–BCHI were 75.5% and 69.8%, respectively. In the EPS, it was 64.1%. The validity is significantly affected by both selection bias {relative size = 8.93% [95% confidence interval (CI): 3.21–14.64]} and reporting bias [relative size = 8.22% (95% CI: 0.76–15.68)]. Sensitivity was excellent (93.7%), while the specificity was fair (66.4%). The agreement was moderate (kappa = 0.63). Women born in non-EU countries (OR = 2.81, 95% CI: 1.54–5.13), with high household income (OR = 1.27, 95% CI: 1.02–1.60) and those reporting poor perceived health (OR = 1.41, 95% CI: 1.14–1.73) were more likely to inaccurately report their mammography uptake.ConclusionsThe validity of self-reported mammography uptake in women aged 50–69 years is affected by both selection and reporting bias. Both administrative and survey data are complementary when assessing mammography uptake.

Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal

BackgroundThe province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs.Purpose of the studyThe main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program.MethodsThe study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community.ResultsA mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources.ConclusionBarriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.

Trends in Breast Cancer Staging at Diagnosis Associated with Screening Campaigns in Lebanon.

Introduction: Mammography screening has been shown to improve early breast cancer (BC) detection, by shifting the disease at diagnosis to locally confined stages, offering lighter treatments and better prognoses. BC awareness campaigns calling for annual mammography screenings have been ongoing in Lebanon since 2002. Changes in BC staging at diagnosis as a consequence of documented improvements in mammography uptake remain to be described.Materials and Methods: We reviewed 2,822 BC cases identified by pathology reports in the American University of Beirut Medical Center between the years 1990 and 2015. After age stratification, we have trended the extracted stages versus time. Results were compared between the prescreening (1990–2001) and the postscreening period (2002–2015).Results: During the postscreening period, stage I represented 31%, stage II 47%, stage III 14%, and stage IV 8% of the cases. Stage I cases had more than doubled whereas stage III cases showed a mirror decrease compared with the years before the implementation of awareness campaigns. The increase in stage I was significantly more prominent in women aged 40 years and older (from 14% to 32%), compared with the younger group. Shifts in staging happened in parallel with a concurrent rise in reported uptake of mammography screening.Conclusions: Our findings demonstrate significant trends in earlier detection, which are likely associated with an increase in screening uptake and an awareness of BC as a public health issue. Staging data from hospitals all over Lebanon should be available for building national evidence. The Ministry of Public Health should require reporting of BC stage at diagnosis to the National Cancer Registry, as part of the annual cancer incidence reporting in Lebanon.

Inclusion of Evidence-Based Breast Cancer Control Recommendations and Guidelines in State Comprehensive Cancer Control Plans.

IntroductionEach US state, territory, and tribe/tribal organization is supported by the Centers for Disease Control and Prevention to develop and implement a comprehensive cancer control (CCC) plan. The objective of this study was to inform areas for improvement of those plans.MethodsTo show how CCC plans can be improved, we used the example of breast cancer, which has a long public health history and an established, broad spectrum of prevention and control activities. We evaluated the inclusion of evidence-based breast cancer prevention topics as provided by guidelines from the Centers for Disease Control and Prevention (CDC) and recommendations of the US Preventive Services Task Force (USPSTF) in each state’s CCC plan. From January through March 2019, we downloaded CCC plans from each state and the District of Columbia and abstracted and quantified the content of plans for 1) discussion of data on breast cancer mortality, breast cancer incidence, uptake of mammography; 2) statement of objective to reduce the burden of breast cancer; and 3) review of CDC guidelines and USPSTF recommendations.ResultsThe discussion of breast cancer–relevant topics and specification of objectives was incomplete. Of 51 plans, data on breast cancer mortality and incidence and uptake of mammography were reported in 53% (n = 27) to 76% (n = 39) of plans. CDC and USPSTF recommendations for breast cancer–specific interventions were discussed in only 6% (n = 3) to 37% (n = 19) of plans. Discussion of general cancer prevention topics relevant to breast cancer ranged from 10% (n = 5) to 61% (n = 31) of plans.ConclusionOur findings inform areas for quality improvement of state CCC plans and may contribute to other areas of public health planning.

Factors associated with receipt of mammogram among caregivers: a comparison with non-caregivers

Backgroundcaregiving responsibilities significantly impact females’ decisions on adhering to preventive mammography. The purpose of this study is to examine (1) the levels of mammogram receipt, (2) the role of caregiving factors on the receipt of mammogram in caregiving group, and (3) the role of cancer beliefs on mammogram screening in caregivers and non-caregivers.Methodsthe 2017 Health Information National Trends Survey (HINTS) provides samples of 1228 women aged 40 to 75 years old for this secondary analysis. By using Andersen’s Behavioral Model of Health Services Use, a binomial logistic regression model was used to analyze associations between mammography and socioeconomic factors, caregiving factors, and cancer belief factors.Resultscaregivers who provided more caregiving hours per week (OR = 0.749, 95% CI = 0.564–0.94) and caregivers who had the belief of rather not knowing the likelihood of getting cancer (OR = 0.673, 95% CI = 0.496–0.914) were less likely to use mammogram. However, caregivers who believed cancer is more common than heart disease (OR = 1.490, 95% CI = 1.302–2.151) were more likely to use a mammogram. Non-caregivers who worried about getting cancer (OR = 1.158, 95% CI = 0.793–1.691) were more likely to use mammogram, but non-caregivers who had the belief of rather not know the likelihood of getting cancer (OR = 0.825, 95% CI = 0.713–0.955) were less likely to use mammogram.Conclusionsto support caregivers’ breast cancer prevention, caregiving-related policies based on caregiving hours should be developed. Particularly, effort to promote breast cancer screening education and care support among older primary caregivers will likely increase their adherence to preventive mammography uptake. The development of targeted cancer prevention interventions on specific cancer beliefs held by both groups are also urgently needed to promote mammography.

Sức Khỏe là Hạnh Phúc (Health is Happiness): promoting mammography and pap test adherence among Vietnamese nail salon workers

ABSTRACT Vietnamese nail salon workers have low cancer screening rates and confront multiple socioeconomic disparities as immigrants to the US. The Sức Khỏe là Hạnh Phúc (Vietnamese for “Health is Happiness”) program was adapted to the cultural and work needs of this population and implemented at nail salons to increase cancer screening adherence. A total of 186 study participants were recruited from 59 nail salons in a neighborhood with mostly Asian population. After being pretested, workers were enrolled in a cancer education session delivered by Vietnamese lay health workers. Non-adherent cases were offered navigation to cancer screening services to a local federally qualified health center. Participants completed a posttest survey five months, on average. At posttest, navigated non-adherent participants were more likely to report a recent Pap test compared to cases not navigated (83.8% vs. 50.0%), an effect not observed for mammography uptake (77.3% vs. 71.4%). Time in the US, marital status, insurance status, having a primary care provider and/or a gynecologist were significantly associated with cancer screening adherence. Low rates of adherence to cancer screening among Vietnamese nail salons workers can be improved by community based programs addressing cultural and work-related barriers confronted by this population.

Moderate psychological distress as a barrier to breast cancer screening among women

Objective: To examine the relationship between Breast Cancer Screening (BCS) and Moderate Psychological Distress (MPD). Also, to assess the effect of aggregating women with No Psychological Distress (NPD) and MPD into one group, as done in prior studies when evaluating the relationship between BCS and Psychological Distress (PD).Methods: The study population comprised of 34,565 women aged 50-74 years who participated in the National Health Interview Survey from 2013 to 2017. The Kessler-6 PD index score (0-24) was dichotomized (0-12: NPD; > 13: Severe Psychological Distress SPD) and trichotomized (0-5: NPD; 5-12: MPD; > 13 SPD). Two multivariate logistic regressions were conducted for the dichotomous and trichotomous PD categories. Andersen’s Behavioral Model of Health Services Use guided the choice of covariates. Data analysis was conducted using SAS version 9.4.Results: Our study showed 4.6% had SPD, and 17.9% had MPD. The latter group (MPD) was included in the NPD group in the dichotomous analysis. In the dichotomous analysis, women with SPD (adjusted Odds Ratio (aOR) = 0.71, 95% CI = 0.63, 0.81, p < .00001) were less likely to have received a mammogram than those with NPD. In the trichotomous model, women with SPD (aOR = 0.76, 95% CI = 0.67, 0.87, p = .0001) and MPD (aOR = 0.84, 95% CI = 0.78, 0.91, p <.00001) were both less likely to have had a mammogram than those with NPD.Conclusions: Prior studies that included individuals with MPD among those with NPD overestimated the effect of SPD on mammography and minimized the importance of targeting women with MPD along with those that have SPD to enhance the uptake of mammography.

Impact of Phone-Call and Access-Enhancing Intervention on Mammography Uptake among Primary Care Patients at an Urban Safety-Net Hospital: A Randomized Controlled Study

Our urban safety-net hospital (SNH) has very low screening mammogram rates within its primary care clinics. Despite Commission on Cancer (CoC) accreditation, we see ~ 3 × more late-stage breast cancer diagnoses than other CoC sites across the country, and recently showed this to be strongly associated with lack of screening (Ahmadiyeh et al. in J Health Care Poor Underserved, in press, 2020). Here we study whether a two-step intervention (phone calls and assistance scheduling mammograms) increases uptake over usual care. Randomized controlled study of 890 women aged 50-65years who were due for biennial screening mammograms and who were established within one of five primary care clinics at an urban SNH. Each patient in the intervention group was called with overdue status (up to three times, voicemail left if needed) and offered assistance scheduling mammogram appointment. Mammography uptake at 3 and 6months was analyzed. Intervention significantly increased uptake compared with usual care at both timepoints (18% versus 6% at 3months; χ2 = 27.597, p < 0.0001; 23% versus 12% at 6months; χ2 = 18.0, p < 0.0001), with scheduling component driving effectiveness. Of those who were successfully contacted, uptake was significantly greater among those who scheduled appointments versus those who did not (47% versus 9%, χ2 = 95, p < 0.0001), and uptake was no different between contacted but not scheduled patients and usual care controls. Phone call with access-enhancing intervention (facilitating mammogram appointments) increased screening mammogram uptake among primary care patients in an urban safety-net setting and may be applicable to other urban SNHs around the country.

Geographic Inequalities in Breast Cancer in Italy: Trend Analysis of Mortality and Risk Factors.

We calculated time trends of standardised mortality rates and risk factors for breast cancer (BC) from 1990 to 2016 for all women resident in Italy. The age-standardised mortality rate in Italy decreased from 4.2 in 1990 to 3.2 (×100,000) in 2016. While participation in organised screening programmes and age-standardised fertility rates decreased in Italy, screening invitation coverage and mammography uptake, the prevalence of women who breastfed and mean age at birth increased. Although southern regions had favourable prevalence of protective risk factors in the 1990s, fertility rates decreased in southern regions and increased in northern regions, which in 2016 had a higher rate (1.28 vs. 1.32 child per woman) and a smaller increase in women who breastfed (+4% vs. +30%). In 2000, mammography screening uptake was lower in southern than in northern and central regions (28% vs. 52%). However, the increase in mammography uptake was higher in southern (203%) than in northern and central Italy (80%), reducing the gap. Participation in mammographic screening programmes decreased in southern Italy (−10%) but increased in the North (6.6%). Geographic differences in mortality and risk factor prevalence is diminishing, with the South losing all of its historical advantage in breast cancer mortality.

Women's views about breast cancer prevention at mammography screening units and well women's clinics.

Women attending mammography screening units (msus) and well women's clinics (wwcs) represent a motivated cohort likely to engage in interventions aimed at primary breast cancer (bca) prevention. We used a feasibility questionnaire distributed to women (40-49 or 50-74 years of age) attending msus and wwcs in Halifax, Nova Scotia, to examine■ women's views about bca primary prevention and sources of health care information,■ prevalence of lifestyle-related bca risk factors, and■ predictors of prior mammography encounters within provincial screening guidelines.Variables examined included personal profiling, comorbidities, prior mammography uptake, lifestyle behaviours, socioeconomic status, health information sources, and willingness to discuss or implement lifestyle modifications, or endocrine therapy, or both. A logistic regression analysis examined associations with prior mammography encounters. Of the 244 responses obtained during 1.5 months from women aged 40-49 years (n = 75) and 50-74 years (n = 169), 56% and 75% respectively sought or would prefer to receive health information from within, as opposed to outside, health care. Lifestyle-related bca risk factors were prevalent, and most women were willing to discuss or implement lifestyle modifications (93%) or endocrine therapy (67%). Of the two age groups, 49% and 93% respectively had previously undergone mammography within guidelines. Increasing age and marital status (single, separated, or divorced vs. married or partnered) were independent predictors of prior mammography encounters within guidelines for women 40-49 years of age; no independent predictors were observed in the older age group. Women attending msus and wwcs seem to largely adhere to mammography guidelines and appear motivated to engage in bca primary prevention strategies, including lifestyle modifications and endocrine therapy. Women's views as observed in this study provide a rationale for the potential incorporation of bca risk assessment within the "mammogram point of care" to engage motivated women in bca primary prevention strategies.

Mammography adherence among medically underserved women undergoing cancer genetic risk assessment.

1554 Background: Medically underserved women bear a disproportionate burden of breast cancer (BC) mortality. Early detection is vital for reducing BC deaths. Cancer genetic risk assessment (CGRA) provides an opportunity to identify women at highest risk so that risk-adapted screening can be implemented. The effect of CGRA on mammography adherence among underserved women is unknown. Methods: We conducted a study to test the feasibility of performing cancer genetic risk assessment (CGRA) as part of standard primary healthcare at two Federally Qualified Health Centers in Chicago, IL. Racial/ethnically diverse women age 25-69 without a personal history of BC underwent CGRA at the time of an annual well-visit and received the result from their PCP. Medical record review provided data on mammography adherence. Demographic data and measures of perceived BC risk, BC cultural beliefs, fatalism, and BC worry were collected with an enrollment survey. McNemar’s test compared the rate of adherence to screening mammography before and after implementation of CGRA, defined as completing a screening mammogram within 18 months prior to or following CGRA, resp., among women eligible for screening (age &gt; 40 at study enrollment). Logistic regression models tested for associations between mammography adherence and demographic characteristics/health beliefs. Results: Data was available for 90 participants with increased BC risk (IR) who were eligible for screening and 98 eligible, average risk (AR) participants (in total, 61% black and 37% Latina). Overall, adherence improved from 38% at baseline to 49% following CGRA (p = 0.03). Adherence increased from 35% to 51% among IR participants (p = 0.04), and from 40% to 47% among AR participants (p = 0.39). Data on predictors of adherence will be presented. Conclusions: Implementing CGRA as a standard component of primary healthcare improved adherence to screening mammography among racial/ethnically diverse underserved women. The effect was seen primarily in those with increased risk. This intervention could be used to improve uptake of mammography in the subgroup of underserved women who benefit the most from screening.

The ties that bind: Cancer history, communication, and screening intention associations among diverse families.

Breast and cervical cancers are screen-detectable; yet, challenges exist with ensuring uptake of mammography and Pap smear. Family, a central factor in developing knowledge to carry out health promotion behaviors, may be an asset to improving intention to screen among non-adherent women from underrepresented minority groups. We explored familial cancer; communication; and breast and cervical screening intention among non-adherent Black, Latina, and Arab women in the United States who participated in a randomized controlled trial of the Kin KeeperSM Cancer Prevention Intervention study. The intervention was a culturally-targeted breast and cervical cancer literacy tool for Black, Latina, and Arab women, consisting of two family-focused education sessions on the cancers, their screening guidelines, and risk-reducing health-related behaviors. For this secondary analysis, we assessed family cancer history, family communication, and screening intention for breast and cervical cancer in age-eligible, non-adherent participants. Descriptive statistics examined sample characteristics of the intervention and control groups. Odds ratios were estimated from logistic regression modeling to assess the intervention and sample characteristic effects on screening intention. Of the 516 participants, 123 and 98 were non-adherent to breast and cervical cancer screening, respectively. The intervention (OR = 1.95 for mammography; OR = 1.62 for Pap smear) and highly communicative (OR = 2.57 for mammography; OR = 3.68 for Pap smear) families reported greater screening intention. Family history of cancer only increased screening intention for mammography (OR = 2.25). Family-focused approaches supporting communication may increase breast and cervical cancer screening intention among non-adherent, underrepresented minority groups.

Mediation Effect of Health Beliefs in the Relationship Between Health Knowledge and Uptake of Mammography in a National Breast Cancer Screening Program in Taiwan.

Despite evidence that breast cancer screening effectively diagnoses and treats cancer through early detection, mammography use remains low in Taiwan. We applied the health belief model (HBM) and the knowledge-attitude-behavior (KAB) model as theoretical frameworks to examine factors associated with mammography uptake among women aged 45-69years in Taiwan. A cross-sectional survey January-July 2018 was conducted of women aged 45-69years in five southern Taiwan health institutions. Survey questionnaires included demographics, HBM constructs, and health knowledge regarding breast cancer and screening. Multivariable logistic regression models explored the mediation effects of HBM constructs between health knowledge and mammography use. The final analytical sample included 621 women; 67 did not receive mammography and 554 received mammography. When the regression model was adjusted only for demographic factors, women with adequate health knowledge were more likely to undergo mammography (AOR = 2.321, 95%CI = 1.141-3.809); in regression models including health knowledge and HBM constructs, the likelihood effect of health knowledge declined and became insignificant (AOR = 1.711, 95%CI = 0.985-2.972), indicating potential mediation effects between health knowledge and up-to-date mammography use. Overall, based on the HBM and the KAB theoretical framework, our data support that health belief played a substantial mediating role in the association between health knowledge and mammography uptake, in particular perceived barriers and cues to action in the HBM, which were modifying factors of health beliefs. Therefore, to improve mammography uptake, it may be helpful to design educational model-based interventions through tackling those modifiable perceived barriers and enhancing the intensity of external cues to action.

Reduction from 2011 to 2017 in adherence to breast cancer screening and non-improvement in the uptake of cervical cancer screening among women living in Spain

ObjectivesTo analyze the uptake of breast and cervical cancer screening according to the 2017 Spanish National Health Survey (SNHS), to compare uptake rates with those obtained in the previous SNHS 2011 and to identify predictors for the uptake for these two screening tests. Study designCross-sectional study. Main outcome measuresUptake rates of breast cancer and cervical cancer screening were analyzed for women aged 40–69 and aged 25–65 years, respectively. Independent variables included sociodemographic characteristics and factors related to health status and lifestyle. ResultsWe found that 66.8 % of women aged 40–69 years had undergone mammography in the previous two years. Positive predictors for mammography uptake were age (50–69 years); marital status (married); Spanish nationality; university education; one or more chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. We observed that 73.0 % of women aged 25–65 years had undergone cervical cytology screening in the previous three years. Positive predictors for uptake were age (25–52 years); marital status (married); Spanish nationality; middle-high educational level; no chronic diseases; no alcohol consumption; physical activity; body mass index <30 kg/m2; and not smoking. There was a significant decrease in the uptake rate for breast cancer screening from the previous SNHS 2011 (OR 0.89; 95 % CI 0.83–0.94). ConclusionsThe adherence rate for mammography in Spain in 2017 was below the recommended 70 % and was significantly lower than in 2011. The figures for cervical cancer screening were over 70 % and stable over time.

Mammography examination among women aged 40 years or older in Ghana: evidence from wave 2 of the World Health Organization’s study on global AGEing and adult health multicountry longitudinal study

ObjectiveTo determine the uptake of mammography among Ghanaian women aged 40 years or older and to examine critical risk factors that influence the uptake. Study designA cross-sectional survey. MethodsA nationally representative sample of 2787 women and 1948 men aged ≥18 years were surveyed in the Wave 2 (2014-2015) of the World Health Organization's multicountry study on AGEing and adult health in Ghana. Of the 2787 women aged ≥18 years, data on a total of 2301 women aged ≥40 years were included in this study. Univariable and multivariable logistic regression models were applied to examine critical risk factors for mammogram examination. ResultsOf the 2301 women sampled, only 83 (3.61%) ever had mammogram. The odds of mammogram examination were lower for women aged ≥70 years (odds ratio [OR] 0.42, 95% confidence interval [CI]: 0.19, 0.93), being self-employed (OR = 0.21, 95% CI: 0.11, 0.42) and being informal sector employee (OR = 0.26, 95% CI: 0.12, 0.57) in the multivariable analyses. Belonging to the Ewe ethnic group (OR=3.41, 95% CI:1.88, 6.16) compared to the Akan group was associated with increased odds of mammogram examination in the multivariable analysis. Women aged ≥70 years, being self-employed, being an informal employee and belonging to the Ewe ethnic group were independently associated with mammography examination. ConclusionThe prevalence of screening for breast cancer using mammography among Ghanaian women aged 40 years and older was 3.6%. Age, type of employer and ethnicity were associated with an older adult woman's likelihood to access mammography screening. Overall, our study provided critical data to encourage and promote good health-seeking behaviour in terms of breast cancer screening among older adult women. Further qualitative studies are warranted to explore why some of these factors influence mammography.

Mammography uptake among the female staff of King Saud University.

Background:Breast cancer is having a major impact on women's health worldwide. Early detection is the best defense against the associated morbidity and mortality of the disease.Objectives:To assess the level of mammography uptake among working Saudi women and identify the obstacles and barriers that negatively affect it. In addition, to identify the most effective sources of breast-cancer-related information and early detection screening.Method:We conducted a cross-sectional study of women employees of King Saud University aged 40 years and above on March–May 2015 using a self-report questionnaire.Results:A total of 229 participants were recruited from the female staff of King Saud University. Of the participants, 34% were aged 41 years or above, approximately 66% were married, 53.3% had a bachelor's degree, and 61.1% worked as administrators; further, 64.6% had a history of breastfeeding. The rate of mammography uptake was 51.5%. Univariate logistic regression indicated that age, education, and being single predict the rate of mammography uptake. However, multivariate logistic regression indicated that earlier age significantly predicts a higher risk of a low rate of mammography uptake. The main obstacle negatively affecting mammography uptake was ineligible criteria (21.8%). The main sources of information regarding breast cancer were awareness campaigns and television and radio (45.4% and 43.7%, respectively).Conclusion:The participants' rate of mammography uptake, awareness of mammograms, the risk factors, and signs of breast cancer were low. To improve breast-cancer mortality rates in Saudi Arabia, earlier detection of breast cancer through increasing awareness of mammograms is of paramount importance.

The Revised Champion's Health Belief Model Scale: Predictive Validity Among Brazilian Women.

IntroductionMammography screening is provided free of charge for the recommended target population in Brazil but participation rates have remained low, and breast cancer mortality has continued to increase. Thus, it is important to identify factors that are associated with poor participation in mammography screening so that service providers can target health promotion messages and screening programs more effectively. Objective: To evaluate the predictive validity of the Revised Champion’s Health Belief Model scale (RCHBMS) for identifying women at high risk of not adhering to national guidelines for mammography screening in Brazil. Methods: We used a longitudinal survey design with a 1-year follow-up data from 194 women living in northeastern Brazil, in the city of Fortaleza, Ceará, participants completed the RCHBMS at baseline, and mammography uptake was measured 1 year later. Hierarchical logistic regression was used to determine the predictive validity of the RCHBMS for identifying women who had not adhered to recommendations for mammography screening, after accounting for the women’s sociodemographic and clinical characteristics. The sensitivity and specificity of various cut-off points were calculated to determine the optimal cut-off point for identifying women at high risk of not adhering to mammography screening guidelines. Results: Two subscales of the RCHBMS uniquely predicted nonadherence: susceptibility and barriers, along with race and family history of cancer. The total scale score (with barriers reverse coded) was also highly predictive. For our sample, using only the RCHBMS with a cutoff of ≤ 3.67 (out of a total possible range of 1–5) yielded a high sensitivity and specificity for predicting nonadherence. Conclusion: Study findings support the validity and clinical utility of the RCHBM for identifying women at risk of not adhering to national guidelines for mammography screening in Brazil.

Pattern of Mammography Utilization by Women Attending Asokoro District Hospital, Abuja, Nigeria.

Introduction: Mammography is a major tool for the screening and diagnosis of breast cancer globally. Poor funding and lack of good public health education for mammography in resource-limited countries limit access to mammographic services. In these settings, patients bear the cost of breast cancer screening from out-of-pocket expenses. The aim of this study was to interrogate the pattern of utilization of mammography by women of childbearing age, who attended Asokoro District Hospital (ADH) for Healthcare, with the view to increase uptake.Materials and Methods: This was a 4-year retrospective, cross-sectional study of 534 women who attended ADH from July 2015 to June 2019 for screening or diagnostic mammography. Data were extracted from completed questionnaire by women who had mammography during the period under review. The data were entered into Statistical Package for the Social Sciences version 27 by IBM for analysis.Results: The mean age of the women was 47.8 years ± 7.7 with a range of 30–82 years. Most of the women, 525 (94.9%), were referred for mammography by health workers; only nine (5.1%) had mammography on self-referral. In all, 71% of the women paid for their mammography from their pockets, whereas 28.1% made payments through the National Health Insurance Scheme (NHIS). A total of 100% of women who reported for mammography on self-referral paid for the services from their pockets. The association between the funding options and mode of referral was statistically significant, P = 0.049.Conclusion: This study showed that referral for mammography by health workers was responsible for not only most of the mammograms conducted but also all the women who utilized NHIS to pay for this service. Resources should therefore be directed towards creating awareness among health workers, especially with the present level of NHIS coverage in the population, in order to increase the uptake of screening mammography in the population.

Developing a Culturally and Linguistically Targeted Breast Cancer Educational Program for a Multicultural Population.

Breast cancer is the most commonly diagnosed cancer among women in the USA. Despite the availability of screening mammograms, significant disparities still exist in breast cancer outcomes of racial/ethnic and sexual/gender minorities. To address these disparities, the Mount Sinai Mobile Breast Health Program in New York City collaborated with local organizations to develop culturally and linguistically appropriate breast cancer education programs aimed at increasing screening mammogram utilization. Literature review of the barriers to mammography screening formed the basis to allow us to draft a narrative presentation for each targeted cultural group: African American, African-born, Chinese, Latina, and Muslim women, as well as LGBTQ individuals. The presentations were then tested with focus groups comprised of gatekeepers and members from local community and faith-based organizations which served the targeted populations. Feedback from focus groups and gatekeepers was incorporated into the presentations, and if necessary, the presentations were translated. Subsequently, the presentations were re-tested for appropriateness and reviewed for consistency in message, design, educational information, and slide sequencing. Our experience demonstrated the importance of collaborating with community organizations to provide educational content that is culturally and linguistically appropriate for minority groups facing barriers to uptake of screening mammography.