Regular Breast Cancer Screening Research Articles

Sonomammography versus MRI in Evaluation of BI-RADS III Breast Lesion

Background: Breast cancer is sometimes found after symptoms appear, but many women with breast cancer have no symptoms. This is why regular breast cancer screening is so important, early detection and treatment are the most important strategies to prevent deaths from breast cancer. Breast cancer that’s found early, when it’s small and has not spread, is easier to treat successfully, regular screening tests are the most reliable way for early detection. Objective: to high light the role of sonomammography versus Magnetic Resonance Imaging (MRI) in evaluation of BI-RADS III (Breast Imaging Reporting and Data System) breast lesion. Patients and Methods: in this retrospective study, 28 patients with BI-RADS III breast lesion were assessed by Digital mammography (DM), Ultrasound (US) and MRI. The resultant images were correlated with reports of the pathology specimens. Results: histopathological analysis was done for each lesion with 13 lesions (46.43%) proved to be benign, 15 lesions (53.57%) proved to be malignant. The sensitivity, specificity, Positive predictive value (PPV) and Negative predictive value (NPV) of mammography (MG), ultrasonography and MRI in BI-RADS III breast lesions were calculated. Conclusion: BI-RADS III lesions group is a very critical group to deal with as it exhibits characters of both malignant and benign lesions. According to our study Dynamic contrast enhanced - Magnetic Resonance Imaging. (DCE-MRI) should go hand by hand with sonomammogaphy especially in BI-RADS III patients group, patients with benign looking lesion six months follow up is recommended and those with malignant looking lesion biopsy should be done.

12 - A modelling study to evaluate the costs and effects of lowering the starting age of population breast cancer screening

Background: Increased breast cancer incidence between 45 and 50 years of age requires reconsideration of the current starting age of routine mammography. Our aim was to evaluate the quantitative benefits, harms, and cost-effectiveness of lowering the starting age of breast cancer screening in the Dutch general population. Methods: Economic modelling with a lifelong perspective compared biennial screening 48-74 and 46-74 to the current Dutch screening program (50-74). Tumour deaths prevented, years of life saved (YOLS), false positives, radiation-induced tumours, costs and incremental costseffectiveness ratios (ICERs) were evaluated. Results: Starting the screening at 48 vs. 50 led to an increase in: the number of small screen detected tumours (4.0%), tumour deaths prevented (5.6%), false positives (9.2%), YOLS (5.6%), radiation-induced tumours (14.7%), and costs (4.1%). Starting the screening at 46 vs. 48 increased the number of small screen detected tumours (3.3%), tumour deaths prevented (4.2%), false positives (8.8%), YOLS (3.7%), radiation-induced tumours (15.2%), and costs (4.0%). The ICER was €5,600/YOLS for 48-74 scenario and €5,600/YOLS for 46-74. Conclusions: Women could benefit from lowering the starting age of screening as more breast cancer deaths will be averted. Starting regular breast cancer screening earlier is also cost-effective. As the number of additional expected harms is relatively small in both alternative scenarios and the difference in ICERs is not large, introducing two additional screening rounds is justifiable.

Knowledge, Attitudes and Practices Regarding Breast Cancer amongst Lebanese Females in Beirut

Objectives:Regular screening for breast cancer is associated with better survival, but compliance with guidelines depends on good knowledge and attitudes. This study aimed to assess the level of breast cancer knowledge, attitudes and screening practices in Lebanese females, and identify their socio-demographic determinants as well as barriers to mammography use.Methods:This cross-sectional study was conducted with 371 Lebanese females residing in Beirut aged 18-65 with no history of breast cancer. The questionnaire applied was adapted from Stager and Champion. The overall knowledge score was determined with sections on general knowledge, curability, symptoms, and screening; the overall attitude score concerned attitudes towards breast cancer, screening, and barriers; and the overall practices score was for breast self examination (BSE), clinical breast examination (CBE) and mammography. Bivariate and multivariate analyses of socioeconomic determinants were performed for each score.Results:The mean knowledge score was 55.5±17.1% and that for attitudes was 71.9±8.3%. For self-examination, mammography and clinical examination practices, individual means were 45.7±42.3%, 77.9±36.5% and 29.1±45.5%, respectively. Knowledge, attitudes and practices correlated positively with each other (p<0.0001). The highest average was the knowledge of symptoms (72.8±24.7%), and the lowest that of curability (49.6±25.7%). Most frequent barriers to mammography were fear of learning bad news, pain, costs, and staff unpleasantness. Higher education was associated with better knowledge (p=0.002) and smoking with lower levels (p=0.003). Older age (p=0.002), higher education (p=0.02), and taking exercise (p=0.02) were associated with better attitudes. Higher education (p=0.02) and having children (p=0.003) were associated with better practices.Conclusion:More emphasis should be placed on educating females on the curability of breast cancer and specific targeting of the barriers identified.

Health Damaged Context: Barriers to Breast Cancer Screening from Viewpoint of Iranian Health Volunteers

BackgroundBreast cancer is common among cancer diseases and the second leading cause of death among women worldwide. The breast cancer-caused death is directly associated with diagnosis time of the disease. Screening is one of the major methods for health promotion in human societies. However, many women still refuse to do the periodic screening. The present study is aimed to analyze the experiences of health volunteers in order to understand the barriers to breast cancer screening among women at southeast of Iran.MethodsData collection was performed through focus groups. Using the purposive sampling method, 24 participants were selected and then were allocated to 6-member groups. The data were analysed using Lundman and Graneheim qualitative content analysis.ResultsThe main theme of “Health Damage Context” was extracted with four main categories, including: family barriers, cultural and social barriers, personal barriers and organizational barriers.ConclusionBased on the results of the present study, there are numerous barriers to regular breast cancer screening, and for the same reasons, the willingness to screening is sometimes not satisfactory. Therefore, in case of the women’s referral to health centers, nurses and other health-care professionals should inform them about the role of different screening methods in early diagnosis and rapid treatment of breast cancer.

A modelling study to evaluate the costs and effects of lowering the starting age of population breast cancer screening

BackgroundBecause the incidence of breast cancer increases between 45 and 50 years of age, a reconsideration is required of the current starting age (typically 50 years) for routine mammography. Our aim was to evaluate the quantitative benefits, harms, and cost-effectiveness of lowering the starting age of breast cancer screening in the Dutch general population. MethodsEconomic modelling with a lifelong perspective compared biennial screening for women aged 48–74 years and for women aged 46–74 years with the current Dutch screening programme, which screen women between the ages of 50 and 74 years. Tumour deaths prevented, years of life saved (YOLS), false-positive rates, radiation-induced tumours, costs and incremental cost-effectiveness ratios (ICERs) were evaluated. ResultsStarting the screening at 48 instead of 50 years of age led to increases in: the number of small tumours detected (4.0%), tumour deaths prevented (5.6%), false positives (9.2%), YOLS (5.6%), radiation-induced tumours (14.7%), and costs (4.1%). Starting the screening at 46 instead of 48 years of age increased the number of small tumours detected (3.3%), tumour deaths prevented (4.2%), false positives (8.8%), YOLS (3.7%), radiation-induced tumours (15.2%), and costs (4.0%). The ICER was €5600/YOLS for the 48–74 scenario and €5600/YOLS for the 46–74 scenario. ConclusionsWomen could benefit from lowering the starting age of screening as more breast cancer deaths would be averted. Starting regular breast cancer screening earlier is also cost-effective. As the number of additional expected harms is relatively small in both the scenarios examined, and the difference in ICERs is not large, introducing two additional screening rounds is justifiable.

Psychosocial predictors of breast self-examination behavior among female students: an application of the health belief model using logistic regression

BackgroundBreast cancer is a life-threatening condition affecting women around the world. The early detection of breast lumps using a breast self-examination (BSE) is important for the prevention and control of this disease. The aim of this study was to examine BSE behavior and its predictive factors among female university students using the Health Belief Model (HBM).MethodsThis investigation was a cross-sectional survey carried out with 334 female students at Urmia University of Medical Sciences in the northwest of Iran. To collect the necessary data, researchers applied a valid and reliable three-part questionnaire. The data were analyzed using descriptive statistics and a chi-square test, in addition to multivariate logistic regression statistics in SPSS software version 16.0 (SPSS Inc., Chicago, IL, USA).ResultsThe results indicated that 82 of the 334 participants (24.6%) reported practicing BSEs. Multivariate logistic regression analyses showed that high perceived severity [OR = 2.38, 95% CI = (1.02–5.54)], high perceived benefits [OR = 1.94, 95% CI = (1.09–3.46)], and high perceived self-efficacy [OR = 13.15, 95% CI = (3.64–47.51)] were better predictors of BSE behavior (P < 0.05) than low perceived severity, benefits, and self-efficacy. The findings also showed that a high level of knowledge compared to a low level of knowledge [OR = 5.51, 95% CI = (1.79–16.86)] and academic undergraduate and graduate degrees compared to doctoral degrees [OR = 2.90, 95% CI = (1.42–5.92)] of the participants were predictors of BSE performance (P < 0.05).ConclusionsThe study revealed that the HBM constructs are able to predict BSE behavior. Among these constructs, self-efficacy was the most important predictor of the behavior. Interventions based on the constructs of perceived self-efficacy, benefits, and severity are recommended for increasing women’s regular screening for breast cancer.

Abstract C57: Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework

Abstract Backgrounds: African American women have a higher mortality rate from breast cancer than any other ethnic group in the country, with an estimated 30,700 new cases of invasive breast cancer and 6,310 deaths expected to occur in 2016. In part the disparate breast cancer mortality rate suffered by African American women can be attributed to irregular mammography screening patterns, which contribute to later stages of diagnosis as compared with other racial ethnic groups. Regular mammography screening may significantly reduce breast cancer mortality and narrow this disparity; however, African American women underutilize mammography screening according to goals set by Healthy People 2020. The purpose of this paper is to identify factors influencing regular breast cancer screening among African American women. Method: In-depth individual interviews were conducted with 39 African-American women, ranging in age from 42 to 79, who visited the ED of a public hospital with non-urgent complaints and those who were seated in the waiting area. Using qualitative analysis we identified Perceptions (individually held knowledge, attitudes, values or beliefs), Enablers (societal, systematic or structural influences) and Nurturers (supportive or discouraging influences from significant others) that influenced screening decisions. The sample included women who had been screened in the past two years and those who had not. Using the PEN-3 as a theoretical guide we explored, from the perception of the women, the factors that influence screening behaviors. Findings: The themes that emerged were placed within the appropriate cells (perceptions, enablers or nurturers) in the PEN-3 framework. The findings indicated that women's perceptions included fear of pain associated with mammography, fear of results, and fear of the unknown, fatalistic beliefs, and limited knowledge of personal risk for breast cancer. The only difference between the perceptions of women who had screened in the past two years and never screened women was knowledge. Women who had been screened in the past two years had more knowledge of mammography procedure and endorsed perceptions such as screening provides reassurance and maintenance of good health. Enablers identified included cost, access, gender and attitudes of the mammography provider, socioeconomic and race related discrimination, and previous experiences within the healthcare system. Previously screened women were more likely to have a source of insurance but both screened and unscreened women discussed financial burden associated with screening. Participants in both screened and unscreened groups emphasized the fact that their previous experiences within the healthcare influenced screening decisions. Nurturers identified included observations of family member's experiences with cancer, lack of health-related social support and shared mammography experiences within participants' social network. Women who receive encouraging feedback about mammography from their social network are more likely to have been screened. Conclusion: African American women suffer a significant disparity of breast cancer mortality as compared to other women in the U.S. Despite improvements in access, related to the enactment of the Affordable Care Act, this disparity persists. This study explores the influences on the decisions related to regular mammography screening from the perspective of African American women. The findings from this study underscore the critical need for development of culturally tailored interventions that address the issues salient to this population as well as interventions that leverage the powerful social networks that influence health care decisions in this population. Citation Format: Adebola Adegboyega, Arica Brandford, Jennifer Hatcher. Repeat mammography screening among African American women: Qualitative application of the PEN-3 framework. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C57.

Comparison of clinical and pathological characteristics between screen-detected and self-detected breast cancers: a Hong Kong study

Breast cancer is the leading cause of death of Hong Kong women with increasing incidence. This study aimed to determine any prognostic differences between screen-detected and self-detected cases of breast cancer in a cohort of Hong Kong patients. This was a case series with internal comparison carried out in a private hospital in Hong Kong. Approximately 3000 cases of Chinese patients diagnosed with ductal carcinoma in situ or invasive breast cancer were reviewed. The screen-detected group showed better pathological characteristics than the self-detected group. Number of lymph nodes involved, invasive tumour size, and tumour grade were more favourable in the screen-detected group. There was also a lower proportion of patients with pure invasive ductal carcinoma and mastectomy in the screen-detected group. This study provides indirect evidence that women in the local population may gain clinical benefit from regular breast cancer screening. The findings need to be validated in a representative population of Hong Kong women.

Abstract B76: Effects of navigation on initial and repeat mammography screening among medically underserved women

Abstract Purpose: Despite its increasing popularity to address breast cancer disparities, existing efforts to assess the effect of patient navigation on regular breast cancer screening utilization among medically underserved groups have been cross-sectional or ecological in nature. Such work is warranted to examine the longitudinal benefits of patient navigation, given one-time utilization of cancer screening is not sufficient strategy for improving early detection of breast cancer. Objective: Our study had two objectives. First, we test the effectiveness of navigation on adherence to initial recommended screening mammography appointments among a population of medically underserved, largely African American women. Second, for women with normal screening results, we test the effectiveness of navigation on attainment of subsequent screening mammograms. Methods: The larger trial, Patient Navigation in Medically Underserved Areas, is a five year project to assess the effectiveness of multimodal, primarily phone-based, navigation services to timely diagnostic resolution after an abnormal screening result within three hospitals located in South Chicago. The current study focuses on secondary outcomes concerning the effectiveness of navigation for mammography screening. Our analytic sample includes 4185 women referred for mammography screening with available medical record data concerning demographic (age, race, insurance, miles to clinic, neighborhood median income) and healthcare information (insurance, screening patterns). Participants were classified by their assignment from randomization, which was focused on the primary outcome (diagnostic follow-up), and whether they interacted with staff prior to the initial appointment: navigated with contact; control with contact; navigated without contact; and control without contact. Results: After adjusting for demographic and healthcare insurance, navigated with contact, women obtained the initial screening mammogram within fewer days relative to other groups, HR= 0.7, 95%CI [0.6, 0.9], p = .001 and greater odds of obtaining screening mammograms, OR = 1.6, 95%CI [1.3, 1.9], p &amp;lt;.0001. Complex differences were found when comparing control with contact and navigated without contact to control without contact, indicating placebo effects on interaction with staff focused on breast healthcare. Conclusions: Our study adds to a growing body of work demonstrating the usefulness of patient navigation, including the impact of delivering services outside of in-person interaction. Future studies are warranted to confirm our findings and assess the potential of these services in real life settings. Citation Format: Yamile Molina, Sage Kim, Anne L. Glassgow, Nerida M. Berrios, Julie Darnell, Heather Pauls, Ganga Vijayasiri, Richard Warnecke, Elizabeth A. Calhoun. Effects of navigation on initial and repeat mammography screening among medically underserved women. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B76.

Primary care characteristics and their association with health screening in a low-socioeconomic status public rental-flat population in Singapore- a mixed methods study.

BackgroundIn Singapore, subsidized primary care is provided by centralized polyclinics; since 2000, policies have allowed lower-income Singaporeans to utilize subsidies at private general-practitioner (GP) clinics. We sought to determine whether proximity to primary care, subsidised primary care, or having regular primary care associated with health screening participation in a low socioeconomic-status public rental-flat community in Singapore.MethodsFrom 2009–2014, residents in five public rental-flat enclaves (N = 936) and neighboring owner-occupied precincts (N = 1060) were assessed for participation in cardiovascular and cancer screening. We then evaluated whether proximity to primary care, subsidised primary care, or having regular primary care associated with improved adherence to health screening. We also investigated attitudes to health screening using qualitative methodology.ResultsIn the rental flat population, for cardiovascular screening, regular primary care was independently associated with regular diabetes screening (adjusted odds ratio, aOR = 1.59, CI = 1.12–2.26, p = 0.009) and hyperlipidemia screening (aOR = 1.82, CI = 1.10–3.04, p = 0.023). In the owner-occupied flats, regular primary care was independently associated with regular hypertension screening (aOR = 9.34 (1.82–47.85, p = 0.007), while subsidized primary care was associated with regular diabetes screening (aOR = 2.94, CI = 1.04–8.31, p = 0.042). For cancer screening, in the rental flat population, proximity to primary care was associated with less participation in regular colorectal cancer screening (aOR = 0.42, CI = 0.17–0.99, p = 0.049) and breast cancer screening (aOR = 0.29, CI = 0.10–0.84, p = 0.023). In the owner-occupied flat population, for gynecological cancer screening, usage of subsidized primary care and proximity to primary care was associated with higher rates of breast cancer and cervical cancer screening; however, being on regular primary care followup was associated with lower rates of mammography (aOR = 0.10, CI = 0.01–0.75, p = 0.025). On qualitative analysis, patients were discouraged from screening by distrust in the doctor-patient relationship; for cancer screening in particular, patients were discouraged by potential embarrassment.ConclusionsRegular primary care was independently associated with regular participation in cardiovascular screening in both low-SES and higher-SES communities. However, for cancer screening, in the low-SES community, proximity to primary care was associated with less participation in regular screening, while in the higher-SES community, regular primary care was associated with lower screening participation; possibly due to embarrassment regarding screening modalities.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0411-5) contains supplementary material, which is available to authorized users.

Knowledge, barriers and attitudes towards breast cancer mammography screening in jordan.

Breast cancer is the most common type of cancer in Jordan. Current efforts are focused on annual campaigns aimed at increasing awareness about breast cancer and encouraging women to conduct mammogram screening. In the absence of regular systematic screening for breast cancer in Jordan, there is a need to evaluate current mammography screening uptake and its predictors, assess women's knowledge and attitudes towards breast cancer and screening mammograms and to identify barriers to this preventive service. This cross-sectional study was conducted in six governorates in Jordan through face- to-face interviews on a random sample of women aged 40 to 69 years. A total of 507 participants with mean age of 46.8±7.8 years were interviewed. There was low participation rate in early detection of breast cancer practices. Breast self-examination, doctor examination and periodic mammography screening were reported by 34.9%, 16.8% and 8.6% of study participants, respectively. Additionally 3.8% underwent breast cancer screening at least once but not periodically, while 87.6% had never undergone mammography screening. Reported reasons for conducting the screening were: perceived benefit (50%); family history of breast cancer (23.1%); perceived severity (21.2%); and advice from friend or family member (5.8%). City residents have shown higher probability of undergoing mammogram than those who live in towns or villages. Results revealed negative perceptions and limited knowledge of study participants on breast cancer and breast cancer screening. The most commonly reported barriers for women who never underwent screening were: fear of results (63.8%); no support from surrounding environment (59.7); cost of the test (53.4%); and religious belief, i.e. Qadaa Wa Qadar (51.1%). In the absence of regular systematic screening for breast cancer in Jordan, the uptake of this preventive service is very low. It is essential for the country of Jordan to work on applying regular systematic mammography screening for breast cancer. Additionally, there is a need for improvement in the current health promotion programmes targeting breast cancer screening. Other areas that could be targeted in future initiatives in this field include access to screening in rural areas and removal of current barriers.

Intrinsic motivation factors based on the self-determinant theory for regular breast cancer screening.

The purpose of this study was to identify factors of intrinsic motivation that affect regular breast cancer screening and contribute to development of a program for strategies to improve effective breast cancer screening. Subjects were residing in South Korea Gangwon-Province and were female over 40 and under 69 years of age. For the investigation, the Intrinsic Motivation Inventory (IMI) was modified to the situation of cancer screening and was used to survey 905 inhabitants. Multinominal logistic regression analyses were conducted for regular breast cancer screening (RS), one-time breast cancer screening (OS) and non-breast cancer screening (NS). For statistical analysis, IBM SPSS 20.0 was utilized. The determinant factors between RS and NS were "perceived effort and choice" and "stress and strain" - internal motivations related to regular breast cancer screening. Also, determinant factors between RS and OS are "age" and "perceived effort and choice" for internal motivation related to cancer screening. To increase regular screening, strategies that address individual perceived effort and choice are recommended.

Prevention of Oncological Diseases: Primary and Secondary Prevention

Cancer is the leading cause of death worldwide. Because there is presently no cure for cancer, the best strategy to combat oncological diseases is through early detection and prevention. The methods currently available are vaccines to target specific viruses (primary prevention), in combination with screening (secondary prevention), use of biomarkers, and administration of adjuvant therapy (tertiary prevention). Modifiable lifestyle-related risk factors are also important in cancer prevention. Vaccination has been proven to be highly effective against targeted diseases leading to the development of cancer, particularly if the vaccination is given in the early years of life. The need for regular screening (for breast cancer, cervical cancer, etc.) should not be neglected and should be followed to detect unusual changes or abnormalities in the body. With discoveries as targeted therapies, adjuvant treatment becomes a secure component of tertiary prevention in the betterment of disease management. The discovery of biomarkers and subsequent targeted therapies has led to personalized medicine as the current trend in cancer care.

Socioeconomic factors affecting colorectal, breast and cervical cancer screening in an Asian urban low-income setting at baseline and post-intervention

BackgroundInequalities in cancer screening are little studied in Asian societies. We determined whether area and individual measures of socio-economic status (SES) affected cancer screening participation in Singapore and prospectively evaluated an access-enhancing community-based intervention. MethodsThe study population involved all residents aged >40years in two housing estates comprising of owner-occupied (high-SES area) and rental (low-SES area) flats. From 2009 to 2011, non-adherents to regular screening for colorectal/breast/cervical cancer were offered free convenient screening over six months. Pre- and post-intervention screening rates were compared with McNemar's test. Multi-level logistic regression identified factors of regular screening at baseline; Cox regression analysis identified predictors of screening post-intervention. ResultsParticipation was 78.2% (1081/1383). In the low-SES area, 7.7% (33/427), 20.4% (44/216), and 14.3% (46/321) had regular colorectal, cervical and breast cancer screening respectively. Post-intervention, screening rates in the low-SES area rose significantly to 19.0% (81/427), 25.4% (55/216), and 34.3% (74/216) respectively (p<0.001). Area SES was more consistently associated with screening than individual SES at baseline. Post-intervention, for colorectal cancer screening, those with higher education were more likely to attend (p=0.004); for female cancer screening, the higher-income were less likely to attend (p=0.032). ConclusionsAccess-enhancing community-based interventions improve participation among disadvantaged strata of Asian societies.

Considerations for the Long-Term Management of Women Living with HIV in Europe

The average age at which women are first diagnosed with HIV is increasing and, due to advances in antiretroviral therapy (ART), women are living with HIV for longer. Once regarded as a fatal disease of young males, HIV is now considered a lifelong chronic condition affecting both men and women into older age. This raises questions for the long-term management of women living with HIV in Europe, such as how age affects the ART response, what the consequences are of long-term ART, and whether the comorbidities of ageing and menopause are different in women with HIV compared with men or uninfected women. Non-AIDS-related events, such as cancer, are increasingly responsible for the deaths of women with HIV, and European guidelines now recommend that they undergo regular screening for breast, cervical and colorectal cancer, and vaccination for human papillomavirus. The other major outcome of the greater life expectancy of women living with HIV is that a greater number are reaching menopause. Some studies suggest that HIV infection is linked with earlier onset of menopause and altered menopausal symptomatology. Many questions remain, and there is a need for more studies addressing ageing and sustained ART use in women living with HIV in Europe.

Breast self-examination: Knowledge, attitude, and practice among female dental students in Hyderabad city, India

Aim:The aim was to assess the knowledge, attitude, and practice (KAP) regarding breast self-examination (BSE) in a cohort of Indian female dental students.Materials and Methods:A cross-sectional descriptive questionnaire study was conducted on dental students at Panineeya Institute of Dental Sciences, Hyderabad, Andhra Pradesh, India. Data were analyzed using SPSS software (version 12). Chi-square test was used for analysis of categorical variables. Correlation was analyzed using Karl Pearson's correlation coefficient. The total scores for KAP were categorized into good and poor scores based on 70% cut-off point out of the total expected score for each. P-value of <0.05 was considered statistically significant.Results:This study involved a cohort of 203 female dental students. Overall, the total mean knowledge score was 14.22 ± 8.04 with the fourth year students having the maximum mean score (19.98 ± 3.68). The mean attitude score was 26.45 ± 5.97. For the practice score, the overall mean score was 12.64 ± 5.92 with the highest mean score noted for third year 13.94 ± 5.31 students. KAP scores upon correlation revealed a significant correlation between knowledge and attitude scores only (P<0.05).Conclusion:The study highlights the need for educational programs to create awareness regarding regular breast cancer screening behavior.

Using the TTM to Examine Factors related to Regular Breast Cancer Screening

Using the TTM to Examine Factors related to Regular Breast Cancer Screening

Mammography Adherence: A Qualitative Study

Regular mammography accounts for half of the recent declines in breast cancer mortality. Mammography use declined significantly in 2008. Given the success of regular breast cancer screening, understanding why mammography use decreased is important. We undertook a focus group study to explore reasons women who were previously adherent with regular mammography no longer were screened. We conducted 20 focus groups with white non-Hispanic, black non-Hispanic, Hispanic, Japanese American, and American Indian/Alaska Native women, and segmented the groups by age, race/ethnicity, and health insurance status. A conceptual framework, based on existing research, informed the development of the focus group guide. Discussion topics included previous mammography experiences, perceptions of personal breast cancer risk, barriers to mammography, and risks and benefits associated with undergoing mammography. Atlas.ti was used to facilitate data analysis. All focus groups (n=128 women) were completed in 2009 in five cities across the United States. Half of the groups were held with white non-Hispanic women and the remainder with other racial/ethnic groups. Major barriers to routine mammography included (1) concerns about test efficacy, (2) personal concerns about the procedure, (3) access to screening services, (4) psychosocial issues, and (5) cultural factors. For uninsured women, lack of health insurance was the primary barrier to mammography. Multilevel interventions at the health-care provider and system levels are needed to address barriers women experience to undergoing regular mammography screening. Ultimately, breast cancer screening with mammography is an individual behavior; therefore, individual behavioral change strategies will continue to be needed.

Attitudes and Health Beliefs Associated With Breast Cancer Screening Behaviors Among Turkish Women

This research was undertaken to determine the attitudes and health beliefs of a sample of Turkish women about breast self-examination (BSE), clinical breast examination, and mammography. Data were collected by means of a researcher-designed questionnaire and the Champion Health Belief Model Scale. A total of 1,342 women participated in this study. It was found that 10.1% of the women practiced BSE once a month, 19.8% of the women had had a clinical breast examination, and 15.0% had had a mammogram. Age and marital status were significant variables that influenced whether the women used only one or multiple methods for early detection of breast cancer. Participants who had higher levels of confidence for BSE and lower perceptions of barriers to BSE were more likely to perform BSE. Participants who perceived higher levels of confidence to perform BSE were more likely to be using all three early detection methods. Interventions and strategies that help women develop confidence in their abilities to perform early breast cancer detection methods are likely to encourage them to engage in regular screening for breast cancer.

EDITORIAL

As we return to our usual lives after another exciting and educational annual meeting of the Consortium of Multiple Sclerosis Centers (CMSC), the International Journal of MS Care (IJMSC) returns as well to its usual spectrum of articles covering the range of issues confronted by multiple sclerosis (MS) professionals. While the Spring 2011 issue focused on the theme of mobility in MS, the current issue reflects the breadth of concerns that we face in caring for MS patients. Highlighted on the cover is an excellent article on meeting the needs of people with primary progressive MS (PPMS) and their families by our colleagues at the National Multiple Sclerosis Society (NMSS) and the Multiple Sclerosis Association of America (MSAA). The CMSC, which sponsors the IJMSC, has joined with the NMSS and the MSAA along with several other organizations to form the MS Coalition, and we are therefore particularly honored to publish this important piece, in which Dr. Holland (formerly with the NMSS), Dr. Kalb, and colleagues describe a collaborative effort by the NMSS and the MSAA to analyze and address the needs of people with PPMS, who have often felt neglected by the MS community. The authors point out that treatment strategies for this group of patients have focused on managing the symptoms of the disease and providing counseling and other forms of psychosocial support in which the MS nurse plays a particularly large role.Ms. Hoogs and colleagues from the Jacobs Neurological Institute of the State University of New York at Buffalo also tackle a sometimes neglected area in MS care: the connection between cognition and physical disability. Their study highlights the association between cognition and health-related quality of life, which points to the broad impact of cognitive impairment and the importance of its early identification in the comprehensive care of MS patients. We hope that future issues of the IJMSC will address treatment strategies in this important area as we learn more about the problem.Continuing our serendipitous “theme” of potentially neglected topics, Dr. Attarian and colleagues from Loyola University in Chicago, the Universities of Vermont and Michigan, and Harvard University address the need for restful sleep in MS patients. Their study examined the effect of eszopiclone on sleep disturbances and daytime fatigue in MS patients. Their work highlights not only the need to improve sleep in MS patients but also the complicated nature of fatigue in MS, as improved sleep generally did not eliminate daytime fatigue in the study participants. Ms. Todd and Dr. Stuifbergen of the University of Texas at Austin, in their study of barriers and facilitators related to breast cancer screening in women with MS, address the reasons why MS patients often neglect their health apart from their MS. Their examination of the multitude of difficulties—both physical and psychological—that MS patients face in obtaining regular breast cancer screening is enlightening, and they offer several useful suggestions for overcoming these hurdles.Dr. Buchanan and colleagues from Mississippi State University and Indiana University examine the role of informal caregivers in the lives of MS patients. All of us have seen patients whose informal caregivers suffer significantly in providing the best care that they can, and this article highlights the importance of addressing these care-givers' burden levels and mental health needs and helping them obtain support.We are also pleased to publish an article in an area that the IJMSC seldom addresses: the practicalities of MS practice. Dr. Foley of the Rocky Mountain Multiple Sclerosis Clinic in Salt Lake City, Utah, and Ms. Dunne of Grassi &amp; Co in Jericho, New York, examine the management of an in-office infusion center, which allows increased contact of patients with their primary MS care providers as well as constituting a potential source of revenue with which to maintain the MS practice in an era of continually rising costs and decreasing reimbursement. This article reminds us that without a financially viable practice model, we will not be able to provide the care that our patients deserve. Finally, Dr. Avila-Ornelas and colleagues at Baylor College of Medicine in Houston report on their study of the use of intravenous corticosteroids to reduce the risk of postpartum relapse in women with MS. They found that administration of methylprednisolone immediately after delivery reduced the percentage of patients having relapses during the first postpartum trimester but not over the second and third trimesters.Whether or not you were able to attend the CMSC annual meeting in Montreal, we hope that you will find useful the CD that accompanies this issue, which contains abstracts from the wonderful spectrum of presentations at the meeting. This electronic supplement was once again generously supported by an educational grant from Bayer HealthCare Pharmaceuticals, Inc. We invite your submissions of research or reviews relevant to MS professionals and wish you a good summer.