Perceptions Of Mammography Research Articles

Abstract C127: Strategies to improve breast cancer screenings among uninsured individuals post COVID-19

Abstract MD Anderson Cancer Center at Cooper (Cooper) is located in Camden, NJ, one of the poorest cities in the nation. The Camden County Cancer Screening Project (CCCSP) is a state and federally funded program out of Cooper which provides breast, cervical, prostate and colorectal cancer screening at no cost for uninsured and underinsured individuals. This target group is particularly difficult to screen due to a variety of social determinants of health and other barriers. Like other national sites, routine screenings stopped at Cooper for approximately four months in 2020. This quality improvement project focused on several initiatives to return insured and uninsured vulnerable patients back to mammography screening over the past two years. We also looked to understand barriers to screening prevalent in the community. Cooper undertook a multi-level approach to return our communities to their routine mammography screening. These included opportunities during the pandemic when screenings froze, opportunities when screenings resumed, outreach efforts through CCCSP, and special events with community partners. Efforts included screening postcards, advertisements, letters and phone calls to current patients, email blasts, virtual education, opening evening and weekend hours for mammograms, promoting screenings at vaccine sites, and in-reach to women who were due for screening. In 2020, mammography screenings decreased to 11% less for all of Cooper patients and to 37% for CCCSP compared to 2019 (pre-pandemic levels). In 2021, screenings increased higher than pre-pandemic levels at Cooper by 15% but stayed 25% lower for CCSP. In 2022, screenings increased higher than pre-pandemic levels at Cooper by 25% but stayed 22% lower for CCSP. A survey of 367 Camden community women 40 and older on barriers to screening noted that of the women who never had been screened (25) or had not gotten screened in over 2 years (118), health insurance, perceptions of mammography and transportation were the top barriers to screening. Institutional efforts at Cooper to return women to breast cancer screenings were successful for insured individuals but did not return to the pre-pandemic screening rate for uninsured individuals. A recent internal study noted that fear of screening, compounded by the pandemic, is a major reason for lack of screening for this community. A survey of our community noted insurance, beliefs and transportation as major barriers. As such, as we continue to encourage women back to screening, efforts need to focus on resources to support our underserved community’s concerns. Citation Format: Evelyn Robles-Rodriguez, Plyshette Wiggins, Tondalya DeShields. Strategies to improve breast cancer screenings among uninsured individuals post COVID-19 [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr C127.

Abstract P3-15-03: Imaging and invasive lobular carcinoma: A survey study conducted by the lobular breast cancer alliance

Abstract Background: The Lobular Breast Cancer Alliance (LBCA) is an advocacy organization guided by an expert advisory board. Since it launched in 2017, LBCA has been committed to raising awareness of the distinct aspects of invasive lobular carcinoma (ILC) and promoting ILC research. While ILC is the second most common histological breast cancer type representing 15% of breast cancer diagnoses in the United States annually, it is understudied compared to the more common invasive ductal carcinoma (IDC). ILC tumor cell density and lack of desmoplastic stromal reaction can pose challenges to detection by physical examination and mammography. Many studies have shown decreased accuracy of breast imaging tools for ILC, and those with ILC are often diagnosed at later stages and require more extensive surgery. We sought to hear from members of the LBCA community with ILC about their experiences with detection of their tumors. Methods: LBCA conducted an anonymous survey online. A link to the survey on the SurveyMonkey platform was made available for two weeks in June. It was sent to LBCA newsletter subscribers and posted to the LBCA website and ILC social media groups. The survey questions included stage and size of tumors at initial diagnosis and after surgery, and questions related to imaging for advanced ILC. It specifically asked whether and what type of mammogram initially detected the ILC. Results: Within 24 hours over 1,000 people responded, and a total of 1,476 people previously diagnosed with ILC responded by survey close. The majority of participants, 1,052 (72%), were from the US, followed by participants from 35 additional countries. 170 (12%) reported having metastatic ILC. 1,035 (70%) of respondents were under 60 at diagnosis. Of respondents reporting tumor size and stage, 936 (67%) of respondents indicated having a tumor larger than 2cm at diagnosis, and 897 (63%) reported stage 2 or higher, including 73 (5%) reporting stage 4 at initial diagnosis. In the subset of participants initially diagnosed with stage 2 or higher, 410 (46%) of respondents reported the tumor was not detected by mammogram. In the subset of participants who noticed changes in their breasts prior to the diagnosis, 521 (79%) had tumors larger than 2cm, and 490 (74%) were diagnosed at stage 2 or higher. Of the 1,241 respondents who had no preoperative therapy, 531 (43%) had tumors larger than initially seen on imaging and/or 321 (26%) had more tumors than initially found on imaging. Discussion: To the best of our knowledge this represents the largest survey seeking to understand patients’ experience with imaging to diagnose or visualize ILC. The results from this community survey of patients diagnosed with invasive lobular carcinoma confirmed patients’ perceptions of mammography as an imperfect screening tool to detect ILC. Of note were the findings that mammography failed to visualize 46% of ILC cases at stage 2 or higher, and the majority of respondents had tumors diagnosed/detected at stage 2 or higher and at sizes greater than 2cm. Moreover, participants often reported that the actual tumor size on the final pathology specimen was larger than seen on diagnostic imaging, and a significant number of respondents were diagnosed de novo metastatic. In summary, our findings affirm patients’ perception about the limitations of diagnostic and monitoring imaging of ILC. Our impressively large response also demonstrates the urgent need from patients’ perspectives for more research on better methods for detecting and monitoring ILC to improve outcomes for patients diagnosed with lobular disease. Citation Format: Laurie B Hutcheson, Janice Axelrod, Colleen L Fitzwater, Maxine S Jochelson, Gitte H Joergensen, Theresa Langdon, Julia K Levine, Otto Metzger, Mason Mitchell-Daniels, Barbara F Neilsen. Imaging and invasive lobular carcinoma: A survey study conducted by the lobular breast cancer alliance [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-15-03.

Prevalence and Potential Consequences of Exposure to Conflicting Information about Mammography: Results from Nationally-Representative Survey of U.S. Adults

ABSTRACT As scientific evidence evolves and clinical guidelines change, a certain amount of conflicting health information in the news media is to be expected. However, research is needed to better understand the public’s level of exposure to conflicting health information and the possible consequences of such exposure. This study quantifies levels of public exposure to one paradigmatic case: conflicting information about breast cancer screening for women in their 40s. Using a nationally-representative survey of U.S. adults aged 18–59 in 2016, we implemented four distinct types of measures of exposure to conflicting mammography information: an ecological measure based on keyword counts of local news closed-captioning, an inferred exposure measure based on a series of knowledge questions, a thought-listing exercise where respondents described their perceptions of mammography without prompting, and an explicit measure of self-assessed exposure to conflict. We examined the relationship between these exposure measures and four outcomes: confusion about mammography, backlash toward mammography recommendations, and confusion and backlash about health information more generally. We found moderate amounts of exposure to conflicting information about mammography, more among women than men. Exposure to conflicting information – across multiple measures – was associated with more confusion about mammography, more mammography-related backlash, and general health information backlash, but not general confusion about health information. These observational findings corroborate experimental-based findings that suggest potentially undesirable effects of exposure to conflicting health information. More research is needed to better understand how to mitigate these possible outcomes, in the context of a media landscape that proliferates exposure to multiple scientific perspectives.

A web-based tailored educational intervention increases positive perceptions of mammography and intention to obtain mammography compared to standardised mammography brochures among Taiwanese women

A web-based tailored educational intervention increases positive perceptions of mammography and intention to obtain mammography compared to standardised mammography brochures among Taiwanese women

Inconsistent mammography perceptions and practices among women at risk of breast cancer following a pediatric malignancy: a report from the Childhood Cancer Survivor Study

Women treated with chest radiation for a pediatric cancer have low mammography screening rates despite their high risk for breast cancer. This study characterized the relationship between perceptions of mammography and screening practices. A cross-sectional survey was administered to 523 women in North America who were treated with chest radiation before 21years of age. Women with inconsistent mammography perceptions and practices were identified using the Pros and Cons of Mammography for perceptions and Transtheoretical Model stages of adoption for prior and intended screening practices. Classification and regression tree (CART) analysis was used to identify barriers to and facilitators of screening among women with positive and negative perceptions. Nearly one-third of the cohort had inconsistent perceptions and practices: 37.4% had positive perceptions and were not having mammograms; 27.6% had negative/neutral perceptions and were having mammograms. Regardless of perceptions, a recent physician's recommendation for mammography, age≥40, and interest in routine health care were universally associated with mammography practices. For women with positive perceptions and a physician's recommendation, barriers to screening included high acceptance coping, low active-planning coping, and high internal health locus of control. For women with negative perceptions, acknowledging the importance of asymptomatic screening was associated with mammography.

A Tailored Web-Based Intervention to Promote Women's Perceptions of and Intentions for Mammography

The Internet is rapidly becoming an accepted standard for disseminating and obtaining health information. However, health information presented on the Web frequently is neither tailored to patients' characteristics nor theoretically driven. This study used Prochaska's transtheoretical model to guide the design and evaluation of a tailored Web-based mammography educational program. This study used a pretest-posttest design to examine the impact of a tailored Web-based educational intervention on women's perceptions of and intentions to obtain a mammography. We hypothesized that a complete tailored intervention (CTI) would result in a significantly higher score than that of tailored message intervention (TMI) in terms of women's perceptions of mammography and intentions to receive a mammography. Both TMI and CTI have been found to have significantly higher scores in terms of women's perceptions of mammography and intentions to receive a mammography than those of the standard intervention (SI). One hundred eighty-five women were assigned randomly to one of three groups: CTI (n = 61), TMI (n = 63), or SI (n = 61). Online questionnaires were completed by participants at baseline and after completion of intervention. Study results supported the hypothesis of perceptions of mammography. The CTI group had significantly higher scores on intention to obtain a mammogram than those of the SI group. However, the differences between CTI and TMI groups and between TMI and SI groups were not significant. Results of the study validated the importance of utilizing theory for tailored intervention design to enhance individuals' positive perceptions of health behaviors. Additional studies should consider the effect of various processes and activities on women at different stages of acceptance of the need to obtain a mammogram to further determine outcomes and apply such to mammography screening behavior.

Assessing elements of women's decisions about mammography.

We investigated motivational and cognitive processes of behavior change with respect to mammography screening. One hundred forty-two women (ages 40 and older) recruited from three worksites answered a 41-item questionnaire consisting of statements based on constructs from the transtheoretical model of behavior change. Principal-components analysis identified two factors: a six-item component representing positive perceptions of mammography (Pros) and a six-item component representing avoidance of mammography (Cons). Analysis of variance showed that Pros, Cons, and a derived Decisional Balance measure (Pros minus Cons) were associated with stage of mammography adoption. Results are consistent with applications of the model to smoking cessation. The model is also discussed as it relates to other theories of behavior change and as a general strategy for analyzing perceptual data pertinent to health-related actions and intentions for behavioral change.