Breast Cancer Screening Practices Research Articles

Breast Cancer Screening Practices Among Hong Kong Chinese Women

Although the incidence rates of breast cancer have been increasing remarkably in Hong Kong over the last 2 decades, little is known on breast cancer screening practices among this group of women. This study aimed to report breast cancer screening practices among Hong Kong Chinese women and to examine the relationship between (1) demographic factors and (2) the modified Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and women's breast screening behaviors. A descriptive and cross-sectional method was used. Both English and Chinese versions of the modified CBCSB were administered. Of 946 Hong Kong Chinese women older than 18 years and invited to participate in the study, 753 (79.6%) completed and returned the questionnaire. The majority of participants (70%-90%) had heard of breast self-examination (BSE), clinical breast examination (CBE), and mammograms. Only 33.3% performed a BSE monthly; 37.8% and 32.7% of women within the targeted age group had a CBE annually and had a mammogram every 2 years, respectively. Being married and part-time employment were positively associated with women who performed BSE as recommended. In terms of modified CBCSB score, women who had BSE, CBE, and mammogram as recommended had significantly higher scores on the subscale attitudes to health check-up. Attitudes toward health check-up was influential in compliance with breast cancer screening practices among Chinese-Australian women. Effort should be focused on specific subgroups of Hong Kong Chinese women, to fully understand the barriers involved in participating in breast cancer screening practices.

Knowledge, Attitude and Practice of Breast Cancer Screening among Female General Practitioners in Riyadh, Saudi Arabia

Background: Breast cancer has been ranked as the 1st cancer in women in Kingdom of Saudi Arabia. Screening, early detection and proper treatment of Breast Cancer was associated with more chances of better prognosis and long-term survival. The role general practitioner’s role is to provide professional knowledge, skills and support for patients as well as their caregiver about screening and prevention. This study aimed to investigate the level of knowledge of Breast Cancer risk factors, beliefs, diagnosis and practice of Breast Self Examination, Clinical Breast Examination and mammography among female General Practitioners who are currently working in primary health care center in Riyadh city, Kingdom of Saudi Arabia. Methods: A cross-sectional study was conducted using a self-administered questionnaire among female physicians, currently working as General Practitioners in Primary Health Care centers were invited. Descriptive statistics: mean, standard deviation, frequencies, percentage were calculated. Results: The majority (90%) of the respondents believed that Breast Cancer is a major health problem and 96% were aware of the importance of mammography as a screening method. But only 19% of the studied physicians requested mammogram as screening tool for women aged 40 years or more. Conclusion: The current study demonstrated that knowledge about breast cancer screening was satisfactory and highlighted the need for the provision of continuing medical education programs to improve the general practitioners' practice on cancer screening tools.

Breast Cancer Knowledge, Beliefs, and Screening Practices among Women Seeking Care at District Hospitals in Dar es Salaam, Tanzania.

BACKGROUNDLimited disease awareness among women may impact breast cancer stage-at-diagnosis in Tanzania, reducing survival. This study assessed breast cancer knowledge, screening practices, and educational preferences among outpatients at Tanzanian government-supported hospitals.METHODSA convenience sample of women was surveyed regarding (1) knowledge/beliefs of breast cancer etiology, risk factors, symptoms, treatment, (2) early detection knowledge/practice, and (3) educational preferences.RESULTSAmong 225 respondents, 98.2% knew of breast cancer; 22.2% knew someone affected by breast cancer. On average, 30% of risk factors and 51% of symptoms were identified. Most accepted one or more breast cancer myths. Among 126 aware of breast self-exam, 40% did not practice it; only 0.9% underwent regular clinical breast examinations despite 68% being aware of the procedure. Among treatments, 87% recognized surgery, 70% radiation, and fewer systemic therapy. Preferred educational sources were group sessions, television/radio, and meetings with breast cancer survivors.CONCLUSIONSThis work reveals incomplete breast cancer awareness among Tanzanian women and promises to inform development of user-focused educational resources.

Beliefs and attitudes about breast cancer and screening practices among Arab women living in Qatar: a cross-sectional study

BackgroundDespite rising breast cancer incidence and mortality rates, breast cancer screening (BCS) rates among women in Qatar remain low. Previous studies indicate the need to better understand the many complex beliefs, values, and attitudes that influence Arab women’s health seeking behavior for the development of culturally appropriate and effective intervention strategies to address breast cancer in the Middle East. This study investigates beliefs, attitudes, and BCS practices of Arabic-speaking women in Qatar.MethodsA multicenter, cross-sectional quantitative survey of 1,063 (87.5% response rate) Arabic-speaking female Qatari citizens and non-Qatari residents, 35 years of age or older, was conducted in Qatar from March 2011 to July 2011. Associations between beliefs and BCS practice were estimated using chi-square tests and multivariate logistic regression analyses. Participants who adhered to BCS guidelines (BCS practice = Yes) were compared to those who did not (BCS practice = No).ResultsIn addition to low levels of awareness and low participation rates in BCS, one quarter of the participants stated their doctors talked to them about breast cancer, and less than half of the women interviewed believed breast cancer can be prevented. Women who engaged in BCS practice were more likely to have a doctor who talked to them about breast cancer, to believe they were in good–excellent health, that cancer can be prevented, or that cancer might be hereditary. The majority wanted to know if they had cancer and felt their health care needs were being met. The main reasons given for not planning BCS were lack of a doctor’s recommendation, fear, and embarrassment.ConclusionsThese findings indicate that a variety of channels (health care providers, media, breast cancer survivors, community leaders) should be utilized to create culturally appropriate breast cancer intervention programs and increased awareness of breast cancer, BCS, and the benefits of early detection of breast cancer. Employment of these measures will reduce breast cancer mortality rates among Arabic-speaking women living in the State of Qatar.

Abstract B55: Digoxin use and risk of invasive breast cancer: Evidence from the Nurses' Health Study

Abstract Background: Digoxin, a cardiac glycoside derived from Digitalis purpurea, has been used for centuries to treat heart failure and atrial fibrillation. Early evidence suggested that digoxin attenuates breast tumor aggressiveness and could become an antineoplastic drug. Two recent Danish studies did not support this hypothesis, showing an approximately 30% increased rate of breast cancer in digoxin users. One of these studies noted a stronger association with incidence of estrogen receptor (ER)-positive breast cancer than with incidence of ER-negative disease. Neither Danish study could account for mammography usage or for potential confounding by lifestyle-related breast cancer risk factors such as adiposity, postmenopausal hormone usage, and reproductive history, all of which hampers a causal interpretation of their findings. To address this evidence gap, we estimated the association between digoxin use and breast cancer incidence in the Nurses' Health Study (NHS) cohort. Methods: The NHS began in 1976 with the enrollment of 121,700 female U.S. registered nurses, who have completed biennial questionnaires to update demographic characteristics, lifestyle, dietary, and pharmaceutical exposures, and newly diagnosed illnesses. The current study followed cancer-free postmenopausal participants from 1994 (the year in which digoxin was first ascertained) until the end of 2010. Incident breast cancers were reported on questionnaires and confirmed by medical record review. We fit multivariable Cox proportional hazards models to estimate associations between time-varying digoxin use and breast cancer incidence. Competing risks models were used to assess heterogeneity of associations by tumor ER status. We conducted a secondary analysis to evaluate possible confounding by indication through use of an alternative reference group, comprised of digoxin-unexposed women who took other cardiac drugs (e.g., beta blockers). Results: Our study included 90,202 postmenopausal women who contributed approximately 1.05 million person-years of observation. There were 4,876 women who reported using digoxin during the follow-up period, among whom 144 cases of invasive breast cancer were diagnosed. Compared with non-users, digoxin users had lower average BMI, were more likely to have undergone regular screening mammograms, and were more likely to take aspirin, beta blockers and lipid lowering drugs. The exposed and unexposed groups were similar with respect to reproductive history, alcohol consumption, and use of postmenopausal hormones. Current digoxin use of greater than four years' duration was associated with a 49% increase in breast cancer incidence compared with never use (HRadj=1.49, 95% CI: 1.16, 1.91). This association was somewhat stronger for ER-positive breast cancer (HRadj=1.52, 95% CI: 1.14, 2.02) than for ER-negative breast cancer (HRadj=1.13, 95% CI: 0.53, 2.41). Current users with four or fewer years of exposure had a 31% higher incidence of ER-positive breast cancer (HRadj=1.31, 95% CI: 1.01, 1.69), and former users had about the same breast cancer risk as never users. The association was robust to adjustment for lifestyle-related breast cancer risk factors and to restriction to women who underwent regular screening mammograms. Furthermore, we saw no evidence of confounding by indication. Conclusions: This study confirms previously reported associations between current digoxin use and the incidence of breast cancer. We demonstrate that this association is not attenuated when lifestyle-related breast cancer risk factors and screening practices are accounted for. The considerable worldwide prevalence of digoxin use and the availability of alternative drugs may present an opportunity for primary prevention of a substantial number of breast cancer cases. Citation Format: Thomas P. Ahern, Rulla M. Tamimi, Bernard A. Rosner, Susan E. Hankinson. Digoxin use and risk of invasive breast cancer: Evidence from the Nurses' Health Study. [abstract]. In: Proceedings of the Twelfth Annual AACR International Conference on Frontiers in Cancer Prevention Research; 2013 Oct 27-30; National Harbor, MD. Philadelphia (PA): AACR; Can Prev Res 2013;6(11 Suppl): Abstract nr B55.

Arab Women's Breast Cancer Screening Practices: A Literature Review

Breast cancer incidence and mortality rates are increasing in the Arab world and the involved women are often diagnosed at advanced stages of breast cancer. This literature review explores factors influencing Arab women's breast cancer screening behavior. Searched databases were: Medline, PubMed, Cochrane Database of Systematic Reviews, CINAHL Plus, Google Scholar, Index Medicus for WHO Eastern Mediterranean, and Asian Pacific Journal of Cancer Prevention. Breast cancer screening participation rates are low. Screening programs are opportunistic and relatively new to the region. Knowledge amongst women and health care providers, professional recommendation, socio-demographic factors, cultural traditions, beliefs, religious, social support, accessibility and perceived effectiveness of screening influence screening behavior.

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. 1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. 36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.

Knowledge and Perspectives of Breast and Cervical Cancer Screening Among Female African Immigrants in the Washington D.C. Metropolitan Area

Black women in the USA have both a higher percentage of late-stage diagnoses as well as the highest rates of mortality from breast cancer when compared to women of other ethnic subgroups. Additionally, Black women have the second highest prevalence of cervical cancer. Many reports evaluating the cancer outcomes of Black women combine data on African-born immigrants and US-born Blacks. This categorization ignores subtle yet important cultural differences between the two groups, which may ultimately affect breast and cervical cancer screening practices. Therefore, this study investigated knowledge and awareness levels of breast and cervical cancer screening practices among female African-born immigrants to the USA residing in the Washington D.C. metropolitan area. Data were collected from 38 participants through key informant interviews, focus group sessions, and a sociodemographic questionnaire over a 3-month study period. Results suggest that fatalism, stigma, and privacy are among the major factors that affect the decision to seek preventative screening measures for breast and cervical cancer among this population. Additionally, the study implies that cervical cancer awareness is significantly lower among this population when compared to breast cancer. This study highlights differences between women of African descent residing in the USA and the need for continued research to increase understanding of the manner in which immigrant status affects health-seeking behavior. This information is critical for researchers, physicians, and public health educators aiming to design culturally appropriate interventions to effectively reduce the prevalence of breast and cervical cancer among female African immigrants living in the USA.

Screening for breast cancer among young Jordanian women: ambiguity and apprehension

The goal of this study was to understand young Jordanian women's attitudes towards breast cancer screening practices in order to improve young women's uptake of screening and early detection. The incidence of breast cancer is increasing annually among younger Jordanian women; however, little is known about their attitudes towards breast cancer and associated screening practices. Young women's attitudes towards breast cancer must be taken into account when designing screening strategies and interventions specifically for this age group. Screening strategies must also acknowledge young women's cultural context; however, little is known about how culture shapes their understandings and practices. A qualitative interpretive approach was utilized to interview 45 young educated women about their breast cancer views and screening practices. Data were analysed thematically. Four overlapping themes emerged: (i) young women should not think about it, (ii) absence of a role model, (iii) cultural shame of breast cancer, and (iv) cancer means death and disability. The study found high levels of apprehension and ambiguity related to breast cancer. This was associated with the perceived impact of a cancer diagnosis on a young woman's social status and family role. Family support was perceived to be a necessary prerequisite for seeking treatment or screening. Understanding young women's perception about screening and early detection of breast cancer is essential for policy makers and healthcare providers to design culturally appropriate and age-appropriate health promotion campaigns and services.

Breast cancer knowledge and practices among D/deaf women

BackgroundLimited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices. Objective/hypothesisTo assess baseline breast cancer knowledge and practices among a sample of D/deaf women recruited into a randomized controlled trial of a breast cancer education program developed for this population. MethodsA written and signed (American Sign Language) survey was administered to a racially/ethnically diverse sample of 209 D/deaf women, 40+ years old, with lower levels of education, recruited in California between October 2008 and May 2009. ResultsThere were misconceptions about breast cancer risk factors, screening, and treatment; only 64.2% of respondents correctly identified the purpose of mammography. Mammography in the prior 2 years was reported by 57.3% of the sample, by 69.8% of White women, and by 43.5% of women from other racial/ethnic groups. Rates also varied by education, having seen a physician in the prior year, and type of insurance. ConclusionsThis study underscores significant gaps in breast cancer screening knowledge and practices, communication issues in health care settings, and unmet needs for tailored health information and materials in this population. Challenges faced in conducting the research needed to develop and test such programs are noted.

The role of a lack of social integration in never having undergone breast cancer screening: Results from a population-based, representative survey in the Paris metropolitan area in 2010

ObjectivesThis study aims to investigate the association between social contact and social support and women's breast cancer screening (BCS) practices, taking their socioeconomic status (SES) into account. MethodsThe SIRS survey was conducted in 2010 in the Paris metropolitan area among a representative sample of 3000 French-speaking adults. For the 784 women aged 50years or older with no history of breast cancer, multivariate logistic regressions and bootstrap methods were used to analyze the factors associated with never having undergone BCS. Results6.5% of these women had never undergone BCS. In multivariate analysis, being older, having a low education level, having poor-quality health insurance, and having one or less than one social contact per 3-day period were significantly associated with never having undergone BCS during their lifetime, but the level of social support was not. The strength of the association with a low frequency of social contact tended to increase with age. ConclusionThis study analyzed the role of social contact in social inequalities in BCS practices in the Paris metropolitan area. Like SES, social integration and social isolation should be taken into consideration by public health professionals and practitioners when planning BCS programs and incentives.

Breast Cancer Risks and Screening Practices among Women Living in a Resource Poor Community in Tshwane, South Africa

To the Editor:Despite breast cancer being believed to be a diseaseof the developed world, the incidence is increasingespecially in the developing world, where 69% ofbreast cancer-related deaths occur (1). The averageage of women in sub-Saharan Africa at diagnosis isapproximately 10 years lower than that of breast can-cer patients in western nations (2). In South Africa,breast cancer is the most common cancer in white,colored, and Asian women, with Black women havingthe lowest incidence rates (3). Unfortunately only22% of Black female patients present with early stagesI and II breast cancer, in contrast to nearly 69% ofthe non-Black patients (4). Matatiele and Van denHeever (5) report an alarming increase in the inci-dence of breast cancer among young Black women ofless than 35 years of age and it appears as thoughthese young Black women are more likely to be diag-nosed with a more virulent form of the disease. Apf-felstaedt and Baatjes (6) do not paint a positivepicture of the care of South African women diagnosedwith breast cancer as only 2,000 of the 8,000 newlydiagnosed patients are treated in health care facilitiesoffering some state of the art diagnostic and treatmentservices. Early diagnosis is therefore of cardinalimportance. Early detection and treatment services inSouth Africa are lacking despite the fact that morethan 3,000 women annually die of a disease which, ifdetected early, has an excellent chance of being cured(7).The aim of our study was to determine the level ofknowledge of breast cancer among Black women liv-ing in a resource poor community in Tshwane, SouthAfrica, specific risks, and screening practices. Ourstudy was based on a cervical and breast cancer pre-vention and screening project situated in the specificcommunity. We conducted a quantitative survey usingstructured interviews with a self-developed question-naire as survey instrument. Sampling was convenience.All women in 18 years and older who reported at theproject between March and October 2008 and werewilling to participate were recruited for the study.Recruitment continued until the sample totaled 299(n = 299), and the participation rate was 100%.Descriptive statistics and Chi-squared test were usedto analyze the data.Our sample (n = 299) represented various culturalgroups and was primarily between the ages of 20 and39 (87.6%). Most (73.9%) were literate, unemployed(93.6%), and unmarried (71.3%). The mean age was30.7 years. The income of the sample was low as99.3% had no personal income or an income of lessthan 300USD per month. The majority (89.6%) of theparticipants reported they had given birth to at leastone child. The sample’s knowledge of the warningsigns of breast cancer was low as the greatest percent-age (80.6%) were unaware of any warning sign. Only18.4% identified a lump in the breast as warning signwhile less than 4% could identify one or more of theother warning signs. Dimpling of the skin was theleast known risk factor. Only two respondents wereable to identify all seven warning signs. Chi–squaredtest revealed a significant association between theknowledge of the warning signs and the level of liter-acy (v²=0.15; p = 0.01;df= 1).We found the sample (n = 299) had a largely protec-tive reproductive history as only a small percentage(4.7%) had started menstruating before the age of 12;the majority (89.3%) had their first child before the ageof 30, while less than 40% reported having used oralcontraceptives. Most (64.5%) of the women indicatedthat they have breast fed from 6 days to 72 months. Asthe sample was primarily young, only 5.7% were post-menopausal, 64.7% (n = 17) reported they had their

Breast Cancer Education for the Deaf Community in American Sign Language

To create and evaluate an educational video designed to increase breast cancer-related knowledge and screening behaviors among women who are deaf and use American Sign Language (ASL) as their preferred communication method. A test-retest survey was used to determine retained knowledge following an intervention with an ASL breast cancer education video. Deaf-friendly community settings in southern California. 122 women who were deaf with a preference for communicating via ASL. Participants completed a knowledge survey to determine their breast cancer screening practices and baseline breast cancer awareness. Participants then viewed a 30-minute video in ASL. Immediately after viewing the video, participants completed an identical knowledge survey. The survey was administered again two months after the initial intervention to determine long-term breast cancer knowledge retention. Age, breast cancer knowledge and screening practices, education, and health insurance. At baseline, breast cancer knowledge varied widely and respondents' answered an average of 3 out of 10 questions correctly. Postintervention, respondents answered an average of 8 out of 10 questions correctly, a significant increase from the baseline scores. At the two-month follow-up, respondents answered an average of 6 out of 10 questions correctly, still a significant increase from the baseline scores. Breast cancer knowledge of women who are deaf increased significantly by viewing an educational video in ASL and most of the new knowledge remained at the two-month follow-up. Nurses can help improve the Deaf community's (DC's) access to breast cancer-related information by disseminating awareness of this online program. With this online resource, nurses can more easily initiate discussions to help improve knowledge and screening behaviors in a linguistically and culturally appropriate manner. Improving the DC's access to breast cancer information is of paramount importance to reducing breast cancer morbidity and mortality in the DC.

Breast self-examination beliefs and practices, ethnicity, and health literacy: Implications for health education to reduce disparities.

This study aimed to quantitatively and qualitatively examine breast cancer screening practices, including breast self-examination (BSE), and health literacy among patients with chronic disease. A prospective, multi-method study conducted with a targeted purposive sample of 297 patients with diabetes and/or hypertension from four ethnic groups (Latino, Vietnamese, African American, White-American) at an urban community health center. A federally qualified health center in Western Massachusetts. In our four-year study, 297 participants completed cancer knowledge, beliefs, attitudes and screening utilization scales and measures of health literacy. In addition to survey data collection, we conducted in-depth interviews, focus groups, home visits, and chronic disease diaries (n=71). In focus groups, African American, Vietnamese and Latina participants offered interviewers an unprompted demonstration of BSE, reported regular BSE use at particular times of the month, and shared positive feelings about the screening method. In a sample where approximately 93% of women have had a mammogram, many also had performed BSE (85.2%). Women with adequate health literacy were more likely than those with inadequate health literacy to rely on it. Despite being positively inclined toward BSE, Vietnamese women, who had the lowest health literacy scores in our sample, were less likely to perform BSE regularly. BSE seemed to be an appealing self-care practice for many women in our study, but we conclude that proper BSE practices may not be reinforced equally across ethnic groups and among patients with low health literacy.

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health, Health Care and Insurance Survey

BackgroundThis study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices. MethodsFrom a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression. ResultsThe 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women. ConclusionThe study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.

Confirmatory Factor Analysis of the Chinese Breast Cancer Screening Beliefs Questionnaire

Chinese women have been consistently reported as having low breast cancer screening practices. The Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) was designed to assess Chinese Australian women's beliefs, knowledge, and attitudes toward breast cancer and screening practices. The objectives of the study were to confirm the factor structure of the CBCSB with a new, larger sample of immigrant Chinese Australian women and to report its clinical validity. A convenience sample of 785 Chinese Australian women was recruited from Chinese community organizations and shopping malls. Cronbach α was used to assess internal consistency reliability, and Amos v18 was used for confirmatory factor analysis. Clinical validity was assessed through linear regression using SPSS v18. The 3-factor structure of the CBCSB was confirmed, although the model required respecification to arrive at a suitable model fit as measured by the goodness-of-fit index (0.98), adjusted goodness-of-fit index (0.97), normed fit index (0.95), and root mean square error of approximation (0.031). Internal consistency reliability coefficients were satisfactory (>.6). Women who engaged in all 3 types of screening had more proactive attitudes to health checkups and perceived less barriers to mammographic screening. The CBCSB is a valid and reliable tool for assessing Chinese women's beliefs, knowledge, and attitudes about breast cancer and breast cancer screening practices. The CBCSB can be used for providing practicing nurses with insights into the provision of culturally sensitive breast health education.

Abstract A79: Perspectives of breast and cervical cancer screening among female African immigrants to the U.S.

Abstract Black women in the US have both a higher percentage of late-stage diagnoses as well as the highest rates of mortality from breast cancer when compared to White, Hispanic-Latino, American-Indian and Asian women in the US. Moreover, in comparison to these same ethnic subgroups, Black women also have the second highest prevalence of cervical cancer. Many reports evaluating the cancer outcomes of Black women combine African born immigrants and US born Blacks. Previous literature however, suggests that this categorization ignores subtle yet important cultural differences between the two groups, which in turn have widespread effects on breast and cervical cancer screening practices. Therefore, this study investigated knowledge and awareness levels of breast and cervical cancer screening practices, specifically among female African born immigrants to the US. Utilizing qualitative methods, this project was completed in conjunction with the African Women's Cancer Awareness Association (AWCAA), an established organization with strong ties to the substantial African immigrant population in the Washington, DC metropolitan area. Data were collected from 41 participants through key informant interviews, focus group sessions and a questionnaire, over a three-month study period. Key informant interviews and focus group sessions ranged in duration from 45-90 minutes and followed a semi-structured interview approach. AWCAA assisted in the recruitment of women for focus groups that were structured by age, with women 20-39 and 40-70 years old. Results suggest that fatalism, stigma and privacy, are among the major factors that affect the decision to seek preventative screening for breast and cervical cancer. Additionally, the study implies that cervical cancer awareness is significantly lower among this population when compared to breast cancer awareness. Participants also attributed their lack of screening to its low priority in comparison to other obligations such as job and family commitments. Furthermore, spirituality and the belief that cancer is not a part of God's plan for their life, was seen through repetition of the comment, “It is not my portion.” Although this is a small, focused study, it is adds to the minimal current literature regarding African immigrant women's perspectives of breast and cervical cancer screening. Additionally, this study demonstrates differences between women of African descent residing in the US and the need for continued research in this field. Information to this regard is critical for researchers, physicians and public health educators, aiming to design culturally appropriate interventions to reduce the prevalence of breast and cervical cancer among female African immigrants. Citation Format: Ezinne G. Ndukwe, Karen Patricia Williams, Vanessa Sheppard, Amr Soliman. Perspectives of breast and cervical cancer screening among female African immigrants to the U.S. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A79.

Understanding Breast Cancer Screening Practices in Taiwan: a Country with Universal Health Care

While the incidence of breast cancer (BC) has been relatively low in Asian countries, it has been rising rapidly in Taiwan. Within the last decade, it has replaced cervical cancer as the most diagnosed cancer site for women. Nevertheless, there is a paucity of studies reporting the attitudes and practices of breast cancer screening among Chinese women. The aim of this study is to assess Taiwanese women's knowledge of and attitudes toward BC screening and to identify potential factors that may influence screening behavior. The study population consisted of a sample of 434 Taiwanese women aged 40 and older. Despite access to universal health care for Taiwanese women and the fact that a majority of the women had heard of the breast cancer screening (mammogram, clinical breast exams, etc.), the actual utilization of these screening modalities was relatively low. In the current study, the majority of women had never had mammograms or ultrasound in the past 5 years. The number one most reported barriers were "no time, " "forgetfulness, " "too cumbersome, " and "laziness, " followed by the perception of no need to get screened. In addition, the results revealed several areas of misconceptions or incorrect information perceived by study participants. Based on the results from the regression analysis, significant predictors of obtaining repeated screening modalities included age, coverage for screening, barriers, self-efficacy, intention, family/friends diagnosed with breast cancer. The findings from the current study provide the potential to build evidence-based programs to effectively plan and implement policies in order to raise awareness in breast cancer and promote BC screening in order to optimize health outcomes for women affected by this disease.

Health belief model and practice of breast self-examination and breast cancer screening in Iranian women

The objective of this study is to determine the role of different health belief model components in practice of breast cancer screening among Iranian women. A cross-sectional study of 500 women aged 18-65 years was conducted in an urban population under the coverage of a health therapeutic system in Babol, northern Iran in 2012. Demographic data and data regarding practice of breast self-examination (BSE), breast clinical examination (BCE), and mammography were collected by interview, and a standard health belief model questionnaire was used to assess women's attitudes in six different domains based on a Likert scale that ranked from 1 to 5. The average score of each item for each domain was calculated. The Wilcoxon rank test and a multiple logistic regression model were used to estimate the odds ratio of each domain for performing breast cancer screening (BSE, BCE, and mammography). The mean age of the women was 31.2 (9.4) years. Overall, the average scores in domains of perceived benefit, self-efficacy, and health motivation were significantly higher among those who performed BSE and BCE, but not for mammography. For the domains of perception of susceptibility, seriousness, and barriers, no significant differences were observed. Higher scores on the scales of perceived benefits, perceived confidence/self-efficacy, and health motivation showed significant positive association with performing BSE [adjusted OR (95 % confidence interval [CI]) 1.73 (1.11, 2.72), 4.01 (2.39, 6.73), and 2.01 (1.30, 3.08), respectively] and BCE [adjusted OR (95 % CI) 1.65 (1.0, 2.95), 2.33 (1.39, 3.91), and 1.58 (1.0, 2.53), respectively], but not for performing mammography. For perceived susceptibility, perceived seriousness, and barriers, no significant association was observed. Positive attitudes toward perceived benefits, perceived confidence/self-efficacy, and health motivation have a strong association with performing BSE and BCE. The impact of health belief model subscales on breast cancer screening may vary with respect to culture and values.

Breast Cancer Screening Practices Among Asian Americans and Pacific Islanders

To compare the breast cancer screening practices and related factors between Asian Americans and Pacific Islanders (PIs) and non-Hispanic whites. Using 2008 Behavioral Risk Factor Surveillance System data, reported mammogram usage among women aged 40+ were compared. Covariates included demographics, risk behaviors, health perception, care access, and general health practice behavior. PIs had higher rates of screening mammogram usage than did Asian Americans. Most covariates had different levels of influence on mammogram screening for the 2 groups, with a few in opposite directions. Understanding the magnitude and predictors of these disparities for racial/ethnic groups can help inform targeted interventions.