Breast Cancer Screening Practices Research Articles

Keeping healthy! Whose responsibility is it anyway? Vietnamese Canadian women and their healthcare providers’ perspectives

Understanding how healthcare responsibility is distributed will give insight on how health-care is delivered and how members of a society are expected to practice health-care. The raising cost of health-care has resulted in restructuring of the existing Canadian healthcare system toward a system that controls costs by placing more healthcare responsibility on the individual. This shift might create more difficulty for immigrants and refugees to obtain equitable health-care and put blame on them when they experience illness. This paper is drawn from the results of a larger qualitative study exploring Vietnamese Canadian women's breast cancer and cervical cancer screening practices. Interview data were gathered from 15 Vietnamese Canadian women and six healthcare providers. We will demonstrate that (a) despite the strong influence of individualism, Vietnamese women and their healthcare providers value both individual liberty and the interrelationship between individual and society; (b) limited funding and unequal distribution of healthcare resources impacted how immigrant and refugee women practice health-care. Thus, motivating and fostering immigrant and refugee women's healthcare practice require both individual and institutional effort. To foster immigrant and refugees' healthcare practices, healthcare policy makers and providers need to consider how to distribute healthcare resources that meet immigrants' and refugees' healthcare needs in the most equitable way.

Are Tri-Ethnic Low-Income Women with Breast Cancer Effective Teachers of the Importance of Breast Cancer Screening to Their First-Degree Relatives? Results from a Randomized Clinical Trial

The purpose of this study was to determine the efficacy of women with breast cancer as teachers of the importance of breast cancer screening to their first-degree female relatives. The sample was restricted to low-income working age women recruited from four hospitals. The study design was a randomized clinical trial. At each hospital, breast cancer patients (probands) were randomized into one of two study groups: (i) intensive, individual educational training on breast cancer screening or (ii) standard clinic education on breast cancer screening. The probands were instructed to teach at least one of their first-degree female relatives (21+ years of age) about breast cancer screening techniques. Three to six months after the enrollment of the probands, their relatives were contacted by telephone to determine breast cancer screening practices. A total of 79 probands and 96 relatives participated in the study. Relatives in the education group when compared with the control group were: 1.25 times more likely to have clinical breast examination (p = 0.005), 2.83 times more likely to have scheduled a clinical breast examination (p = 0.046), and, 1.36 times more likely to have been told about performing breast self-examination (p = 0.05). Additionally, relatives in the education group were more likely to have received a pamphlet on breast cancer screening (RR = 1.58, p = 0.009) and have discussed the importance of breast cancer screening (RR = 1.33, p = 0.020) from the proband. Special education training did not impact mammography utilization of the relatives. From these findings, a tri-ethnic group of low-income women with breast cancer can be effective teachers of breast cancer screening practices, at least for promoting clinical breast examination and transmitting messaging for performance of breast self-examination if given the adequate training.

Breast cancer screening behaviors among African American women with a strong family history of breast cancer

Background. Despite the importance of breast cancer screening to reduce morbidity and mortality, limited information is available on screening practices among African American women with a family history that is suggestive of hereditary breast cancer. Objectives. To describe adherence to breast cancer screening recommendations among African American women with a family history that is suggestive of hereditary disease. Methods. Participants were unaffected African American women ( n = 65) who had a family history of cancer that was suggestive of hereditary breast cancer. Breast cancer screening practices were evaluated by self-report. The study was conducted at the University of Pennsylvania in Philadelphia, PA. Women were recruited to participate in the study from February 2003–December 2005. Results. Most women were adherent to recommendations for mammography (75%) and CBE (93%). A sizeable minority of women (41%) also performed excessive BSE. Being older than age 50 was associated significantly with mammography adherence (FET < 0.05). Employment had a significant independent association with BSE; unemployed women were most likely to perform excessive BSE (OR = 3.28, 95% CI: 1.05, 10.21, p < 0.05). Conclusions. The results of this study suggest a complex pattern of breast cancer screening practices among African American women at increased risk for hereditary breast cancer.

Breast and Cervical Cancer Screening Among South Asian Women in New York City

The purpose of this paper is to document the breast and cervical cancer screening practices of a community sample of South Asian women living in the New York City area. A convenience sample of 98 women was engaged in face-to-face interviews regarding their socio-demographic characteristics and cancer screening utilization. Sixty-seven percent of women had ever had a Pap test; 54% had one in the last 3 years. Seventy percent of women over 40 had ever had a mammogram; 56% had one in the last 2 years. Sixty-six percent of women had knowledge of breast self-exam (BSE); 34% of women ever practiced BSE. Multiple logistic regression analysis indicated that insurance status was a significant predictor of ever having a Pap test or mammogram, receiving timely Pap tests, and ever practicing BSE. Education was a significant predictor of ever having a Pap test and having knowledge of BSE. Marital status was a predictor of receiving timely Pap tests, and having spent more time in the U.S. was a predictor of ever practicing BSE. The study concludes that increased educational efforts must be developed targeting immigrant South Asian women of low socioeconomic status with limited access to healthcare.

Breast Cancer Risk Assessment and Risk Perception on Nurses and Midwives in Bornova Health District in Turkey

Risk perception is a significant component of awareness of breast cancer risks. It can be helpful to reduce deaths of breast cancer via increasing awareness risk level. This study aimed to discuss the level of perceived and calculated breast cancer risk and to provide data on the practice of breast self-examination and use of mammography among 215 nurses and midwives working in the 23 primary healthcare centers in Turkey. Participants were asked to assess their personal lifetime breast cancer risk by a 4-item Likert scale ("no risk," "usual," "moderate," and "strong" risk), which determined "perceived breast cancer risk." Gail model was used to assess the "calculated breast cancer risk," which was calculated by the tool provided by the National Cancer Institute, version 7. Perceived and calculated risk levels were compared. The relation between sociodemographic and risk factors with "perceived risk" was examined. In addition, the influence of perceived risk on breast cancer screening practice was also assessed. The level of perceived risk of nurses and midwives was higher than that of calculated risk. Considering the fact that participants were healthcare professionals, the use of breast self-examination and mammography practices as a preventive behavior by nurses and midwives was lower than expected. Implications are discussed with regard to breast cancer risk and preventive behavior.

Breast Cancer Screening and Diagnosis Clinical Practice Guidelines

The lifetime risk of a woman developing breast cancer has increased over the past 5 years in the United States: of every 7 women, 1 is at risk based on a life expectancy of 85 years. An estimated 214,640 new cases (212,920 women and 1,720 men) of breast cancer and 41,430 deaths (40,970 women and 460 men) from this disease will occur in the United States in 2006. However, mortality from breast cancer has decreased slightly, attributed partly to mammographic screening. Early detection and accurate diagnosis made in a cost-effective manner are critical to a continued reduction in mortality. These practice guidelines are designed to facilitate clinical decision making. For the most recent version of the guidelines, please visit NCCN.org

Effectiveness of Academic Detailing on Breast Cancer Screening among Primary Care Physicians in an Underserved Community

Urban minority groups, such as those living in northern Manhattan and the South Bronx, are generally underserved with regard to breast cancer prevention and screening practices. Primary care physicians are critical for the recommendation of mammography and clinical breast examinations to their patients. Two medically underserved communities were matched and block randomized. The aim of the study was to assess the efficacy of academic detailing in increasing recommendations for breast cancer screening in community-based primary care physicians. Ninety-four primary care community-based (ie, not hospital-based) physicians in northern Manhattan were compared with 74 physicians in the South Bronx who received no intervention. INTERVENTION participants received multicomponent physician-directed education, academic detailing, using the American Cancer Society guidelines for the early detection of breast cancer. We administered interviews to ask about primary care physicians' recommendation of mammography and clinical breast examination. They were also queried about their knowledge of major risk factors and perceived barriers to breast cancer screening. We conducted medical audits of 710 medical charts 2 years before and after the intervention. Using a mixed models linear analysis, we found a statistically significant intervention effect on the recommendation of mammography and clinical breast examination (according to medical audit) by female patients age 40 and over. INTERVENTION group physicians correctly identified significantly more risk factors for breast cancer, and significantly fewer barriers to practice, than did comparison physicians. We found some evidence of improvement in breast cancer screening practices due to academic detailing among primary care physicians practicing in urban underserved communities.

Breast and Cervical Cancer Control Among Pacific Islander and Southeast Asian Women: Participatory Action Research Strategies for Baseline Data Collection in California

No data exists on the breast and cervical cancer screening practices among Cambodian, Laotian, Thai, and Tongan women. In this article, we describe the efforts required to conduct a baseline survey among these non-English-speaking women using the participatory action research (PAR) approach. We tailored small population sampling techniques to each of the populations in partnership with Community Health Outreach workers. A total of 1825 surveys were successfully conducted in 8 communities. PAR and the culturally based techniques used to conduct the survey proved successful in maintaining scientific rigor, developing true community-researcher partnership, and achieving over 99% participation.

Effects of Mass and Interpersonal Communication on Breast Cancer Screening: Advancing Agenda-Setting Theory in Health Contexts

Drawing on components of agenda-setting theory and the two-step flow of information from mass media to news audiences, this study examines the effects of mass and interpersonal communication on breast cancer screening practices among college- and middle-aged women (n = 284). We theorized that screening behaviors among younger women would be influenced more by interpersonal sources of information while screening among middle-aged women would be more influenced by exposure to mass-mediated information. Findings supported anticipated patterns, revealing important and varying roles for both mass and interpersonal communication in the health behaviors of women. Implications for health practitioners and campaign planners, as well as recommendations for future research, are discussed.

Breast Cancer Screening and Health Behaviors among African American and Caribbean Women in New York City

A telephone-based survey regarding breast cancer screening practices among 300 African American and Caribbean women age 40 and over in New York City revealed that while U.S.-born women had significantly different sociodemographic profiles (in terms of insurance status, marital status, educational attainment), they were no more likely to have had a mammogram than the foreign-born women. Adjusting for insurance status and source of care, women with a provider recommendation were 8 times more likely ever to have had a mammogram (AOR 8.01, 95%CI: 3.74-17.14). Among foreign-born Caribbean women in the U.S. for less than half their lives, only 52% ever had a provider recommend a mammogram, compared with 77% of U.S.-born women. The findings confirm previous reports of the importance of physician recommendation in increasing mammography screening among urban Black women, and suggest that efforts to reach Caribbean-born women with breast cancer screening messages should emphasize the important role of providers.

Breast and Cervical Cancer Screening Practices for Low-Income Asian American Women in Ethnic-Specific Clinics

Introduction: Early detection and screening are the most effective means to reduce cancer mortality in all populations. Asian American (AA) women have among the lowest rates in aggregate for use of early detection, and screening practices of all ethnic populations. The only nationally disaggregated populationbased data on these ethnic groups at the time of the study was the 1993-1994 National Health Interview Survey (NHIS) of English speaking AA, but 70% of the AA population is non-English speaking. Our study presents heretofore unavailable data for cancer screening for monolingual AA women for a comparable time period in California between 1992 and 1994, prior to initiation of the state and Federal programs targeting this group of women. Methods: Retrospective chart reviews of randomly selected medical records were conducted for the breast and cervical cancer screening practices of low-income, non-English speaking Chinese, Korean, and Thai women attending ethnic specific community-based health clinics. All women seen in the clinics between 1992-1994 who were within the appropriate screening age categories were eligible. Results: Asian American women utilizing ethnic specific clinics had equal to or better screening rates for mammography and Pap tests than mainstream services for English-speaking AA women in a national survey. These screening rates, however, were still well below nationally recommended screening rates for breast and cervical cancer according to Healthy People 2000 or 2010 goals. Conclusion: These data support the effectiveness of Community Based Clinics (CBOs) to reach these hard to reach women and address the call for the elimination of health disparities. In addition, we compare our findings with national data to highlight within group variations.

Breast self-examination practices among women from six ethnic groups and the influence of cancer worry

Diverse samples of women (N = 1364) from Brooklyn, New York, were interviewed regarding their breast cancer screening practices. Of interest here is the relation between cancer worry and adherence to breast self-examination (BSE) guidelines among the six ethnic groups identified--European American, African American, Haitian, Dominican and English-speaking Caribbean women. There was a significant difference in cancer worry by ethnicity. Logistic regression analysis indicated that education, cancer worry, and perceived efficacy of BSE significantly predicted adherence. Furthermore, there were significant differences among women of African descent in BSE adherence and cancer worry. These differences reflect the emerging need for researchers to empirically and methodically investigate ethnic and cultural factors, as well as emotions and affect in preventive health behaviors.

521-S: Physician and Patient Characteristics Influencing Breast and Cervical Cancer Screening Practices

521-S: Physician and Patient Characteristics Influencing Breast and Cervical Cancer Screening Practices

An Integrative Review on Breast Cancer Screening Practice and Correlates Among Chinese, Korean, Filipino, and Asian Indian American Women

Breast cancer is the leading cancer diagnosed among Chinese, Filipino, and Korean women. Despite the efficacy of breast cancer screening, Asian American women have one of the lowest rates of mammography and clinical breast exam (CBE) of all U.S. ethnic groups. I provided a systematic overview to document factors related to three modalities of breast cancer screening (breast self-exam [BSE], CBE, and mammography) among four subgroups of Asian American women (i.e., Chinese, Korean, Filipino, and Asian Indian). Results showed that the existing studies provided evidence of demographic correlates to screening practice; however, fewer studies focused on cognitive and social–cultural correlates, and limited results were available with Filipino and Asian Indian groups.

Women with disabilities: General practitioners and breast cancer screening

Because they undergo breast cancer screening (BCS) relatively infrequently, women with physical or mental impairments may be at higher risk of late-stage breast cancer than women without impairments. A panel of 600 general practitioners (GPs) in Provence (southeastern France) provided information from which barriers potentially associated with BCS practices for women with disabilities were evaluated. In 2002, a telephone questionnaire collected data about GPs' personal and professional characteristics and their attitudes and practices regarding patients with disabilities. Analysis in 2003 used simple and multiple logistic regressions. More than a quarter of the GPs reported apparently inadequate BCS practices for people with disabilities. Feelings of discomfort when treating people with disabilities, lack of assistance, and communication difficulties were inversely associated with BCS for women with mental and physical impairments. General practitioners' information-seeking strategies were associated with BCS for women with mental impairments, and nursing home work experience was inversely associated with BCS for women with physical impairments. Appropriate training sessions should be made available to improve primary health care quality and prevention practices and to reduce GPs' misperceptions of people with disabilities.

Breast and Cervical Cancer Screening Practices and Interventions Among Chinese, Japanese, and Vietnamese Americans Frances

To review research on breast and cervical cancer screening practices among Chinese, Japanese, and Vietnamese Americans. MEDLINE and the Cumulative Index to Nursing and Allied Health Literature databases. Of the 28 studies reviewed, 19 (68%) were descriptive and 9 (32%) were interventions. Instruments were developed or translated into the native language. Inconsistent operational definitions for positive facilitators and negative barriers made comparisons across studies difficult. Research about breast and cervical cancer screening is limited in these groups. All of the studies reviewed indicated low adherence to cancer screening guidelines. Some interventions showed promising results. Poor awareness about cancer was reported; positive facilitators and negative barriers were identified. The rapidly increasing number of Asian Americans in the United States underscores the need for further research in this area. Future studies should focus on each population as a disaggregated subgroup. Cancer control interventions should be culturally competent.

An Evaluation of Standardized Patients in Improving Clinical Breast Examinations for Military Women

There is a need to improve the quality of clinical breast examination (CBE) and breast cancer screening for women. The purpose of this study was to determine whether instructions from a standardized patient to military healthcare providers would increase the quality of CBE and breast cancer screening for military women. The study used a 2-group pretest and posttest experimental design with random assignment by study site. Before and after the intervention, the providers completed a 13-item survey to assess their current breast cancer screening practices and the standardized patient used an investigator-developed checklist to assess the providers' breast cancer screening performance. The survey of breast cancer screening practice scores and the interview and CBE performance scores were analyzed using analysis of covariance with the pretest scores as covariates. Results showed the experimental group made significantly more improvement than did the control group in their total scores on the observational checklist of interview and CBE skills (F = 19.18, P < .001, observed power = 0.99). In conclusion, this method of continuing education was effective with military healthcare providers.

Breast and cervical cancer knowledge, attitudes, and screening practices of Hispanic women diagnosed with cancer.

Cancer survivors' screening participation is important to prevent cancer recurrence and to maintain health for the growing number of Hispanic cancer survivors. Using a case comparison study design, data from a survey of Hispanic breast (n = 54) and cervical cancer (n = 58) survivors were analyzed by bivariate analysis. Knowledge of screening guidelines was low for all participants, especially regarding cervical cancer screening. Breast cancer survivors were most knowledgeable. Although survivors held positive cancer attitudes, participation in preventive cancer screening was low indicating the need for more effective cancer prevention communication processes. Hispanic cancer survivors need culturally sensitive cancer prevention education and the associated communication processes that acknowledges differences among the varying Hispanic subgroups.

The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening

Background. There is little research on medical mistrust as a barrier to breast cancer screening. This study investigated the psychometric properties of a new scale, the Group-Based Medical Mistrust Scale (GBMMS), and its association with cancer screening attitudes and breast cancer screening practices among African American and Latina women. Methods. Participants were 168 African American and Latina urban women who completed the GBMMS and measures of sociodemographics, cancer screening pros and cons, acculturation, breast cancer screening practices and physician recommendation of such screening. Results. A principal components analysis of GBMMS items revealed three factors that were analyzed as subscales: (1) suspicion, (2) group disparities in health care, and (3) lack of support from health care providers. Convergent validity of the GBMMS was supported by its negative association with perceived benefits of cancer screening and acculturation and positive association with perceived disadvantages of cancer screening. Results further showed that women who reported no previous mammogram or a long-term lapse in mammography participation (>5 years) had significantly higher total GBMMS scores ( P < 0.04) compared to women who were either adherent to mammography guidelines or nonadherent but reported a mammogram within the past 5 years. This analysis controlled for physician recommendation. Conclusions: Results support the validity of the GBMMS and its association with breast cancer screening adherence. The GBMMS may be used to further investigate medical mistrust as a barrier to screening for cancers for which ethnic group disparities have been observed.

Enhancing breast health in rural populations: clinical nurse specialist as the key.

Four clinical nurse specialists (CNSs) were funded for a project to increase breast cancer (BC) screening practices and the knowledge of BC risk factors for women in 4 medically underserved rural counties. The goal was to implement a program to increase knowledge of breast health practices, increase access to mammography, establish linkages among CNSs and community organizations, and increase resources for breast health education and screening. Phase I: A training program (focusing on breast health, breast cancer, and screening) was presented to public health nurses from each of the 4 counties. Phase II: Project and public health nurses teamed to provide an education and screening program for rural area women. The program involved making mammograms available at no cost through a mobile mammography unit that was brought to each county. Mammograms and educational programs were provided to 141 women. The project team was clearly able to function as both clinical experts and clinical leaders. The spheres of influence for these 4 CNSs included patient/client (rural women), nursing personnel (county health department nurses), and organization/network (state health department and governmental bodies). This project, based on the Logic Model, can serve as a framework for delivering care in underserved, rural populations.