Undergo Cancer Screening Research Articles

Abstract 4603: Male pattern baldness in relation to prostate cancer-specific mortality: A prospective analysis in the NHANES I Epidemiologic Followup Study (NHEFS)

Abstract Background: Androgenic action underlies prostate gland development and prostate cancer progression. However, the role of such in prostate carcinogenesis remains unclear. Results from studies that have quantitated pre-diagnostic, circulating androgens at a single time-point in relation to prostate cancer are inconsistent, possibly due to the failure to capture cumulative or relevant age-specific hormone exposure. Therefore, we used male pattern baldness as a proxy of long-term androgen exposure, and investigated the association between dermatologist-assessed male pattern baldness and prostate cancer-specific mortality in the NHANES-I Epidemiologic Followup Study (NHEFS). Methods: We included 4,316 men from NHEFS, who were 25-74 years, received dermatologic exams, and had no prior cancer diagnosis at baseline. Hazard ratios (HRs) and 95% confidence intervals (95%CIs) were estimated using Cox proportional hazards regression with age as the time-metric and baseline hazard stratified by age at baseline. A hybrid model was used to account for stratification and clustering of the survey design, while adjusting for variables used to calculate sample weights. Results: During follow-up (median = 21 years), 3,284 deaths occurred, 107 of which had the underlying cause of prostate cancer. Any degree of baldness was associated with a 56% increased risk of prostate cancer-specific mortality (HR = 1.56; 95%CI = 1.02, 2.37) and, specifically, moderate balding was associated with an 83% increased risk of the outcome (HR = 1.83; 95%CI = 1.15, 2.92), each compared with no balding. Conversely, male pattern baldness was not statistically significantly associated with all-cause mortality. Conclusion: Our analysis suggests that male pattern baldness is associated with an increased risk of fatal prostate cancer, and supports the hypothesis of overlapping pathophysiological mechanisms. Impact: If the association between male pattern baldness and fatal prostate cancer is substantiated in future studies, male pattern baldness may contribute to predictive algorithms of prostate cancer risk, helping guide individuals as to whether they should opt to undergo cancer screening. Citation Format: Cindy Ke Zhou, Paul H. Levine, Sean D. Cleary, Heather J. Hoffman, Barry I. Graubard, Michael B. Cook. Male pattern baldness in relation to prostate cancer-specific mortality: A prospective analysis in the NHANES I Epidemiologic Followup Study (NHEFS). [abstract]. In: Proceedings of the 106th Annual Meeting of the American Association for Cancer Research; 2015 Apr 18-22; Philadelphia, PA. Philadelphia (PA): AACR; Cancer Res 2015;75(15 Suppl):Abstract nr 4603. doi:10.1158/1538-7445.AM2015-4603

Adherence to recommendations for cervical and breast cancer screening in systemic sclerosis

The aim of the study was to evaluate the adherence of systemic sclerosis (SSc) female patients to cervix and breast cancer screening procedures, as suggested by local guidelines. A cohort of 84 SSc women was asked if they had undergone mammography and Pap test during the previous 2- and 3-year intervals, as indicated according to the Italian recommendations. The results were compared with those collected in patients affected by other chronic rheumatic disorders and in the general population. More than 85% of SSc women declared to comply with an age-related cervix and breast cancer screening schedule. The data were similar to those collected in patients affected by other chronic rheumatic disorders, whereas the subjects belonging to the general population reported to undergo breast cancer screening more frequently. Among SSc women, neither the educational level, nor the lung and skin involvement influenced their cancer screening program compliance. Only a positive history of ischemic digital ulcers seemed to interfere with mammography. Our study reported a very high percentage of SSc female patients who adhered to programs for the early detection of cervical and breast cancer. The significant adherence to guidelines may be due to the schedule adopted by the local health public service, which regularly invites eligible subjects by mail to undergo cancer screening at no charge.

The Influence of Provider Patient-Centeredness on Patients’ Decisions to Undergo Cancer Screening Surveillance Tests: An Analysis of the Health Information National Trends Survey

The current study uses the 2012 Health Information National Trends Survey (HINTS; N = 3,959) to investigate whether a patient-centered provider is more likely to discuss cancer surveillance options (PSA, mammograms, Pap tests) with patients and whether these types of conversations have any impact on having these tests performed. Results demonstrated that patient-centeredness was related to communication with patients about uncertainty with PSA testing. Additionally, discussion of patient choice was related to increased Pap testing, while discussion of uncertainty with PSA testing efficacy was related to increased PSA testing. Future research should strive to increase our understanding of antecedents to patient decision making.

A Population-Based Cohort Study of All-Cause and Site-Specific Cancer Incidence Among Patients With Type 1 Diabetes Mellitus in Taiwan.

BackgroundThe relationship between type 1 diabetes mellitus (T1DM) and cancer incidence remains unclear. We sought to assess the all-cause and site-specific cancer incidence in patients with T1DM.MethodsA retrospective cohort study design was employed, in which 14 619 patients with T1DM were retrieved from Taiwan’s National Health Insurance medical claims between 2000 and 2007. The study subjects were followed to the end of 2008, and cancer incidence was assessed. We calculated age-, sex-, and calendar year-standardized incidence ratios (SIRs) of all-cause cancer incidence and site-specific neoplasm incidence, with reference to the general population.ResultsSeven hundred and sixty patients were identified for all-cause cancer over 86 610 person-years, representing an incidence rate of 87.75 cases per 10 000 person-years. The incidence rate was higher in males than in female patients (109.86 vs 69.75 cases per 10 000 person-years). T1DM was associated with a significantly increased SIR of all-cause cancer (1.13; 95% confidence interval [CI], 1.05–1.22). The sex-specific SIR was significantly elevated in female patients (1.19; 95% CI, 1.07–1.33), but the SIR for male patients was insignificantly elevated (1.09; 95% CI, 0.99–1.20). Pancreatic cancer showed the greatest increase in SIR among both male and female patients with T1DM. Male patients experienced significantly increased SIRs for kidney, rectum, liver, and colon neoplasm, and significantly increased SIRs were noted for ovarian, bladder, and colon cancer in female patients.ConclusionsT1DM was associated with a 13% increase in risk of all-cause cancer incidence. Patients with T1DM should be advised to undergo cancer screening for certain types of cancer.

Cardiometabolic health nursing to improve health and primary care access in community mental health consumers: Protocol for a randomised controlled trial

BackgroundPeople with a serious mental illness are at significantly greater risk of poor cardiometabolic health with recent studies showing a greater than two-fold increase in the risk of obesity, infectious diseases, diabetes and cardiovascular disease. Contributing factors to this disparity include poorer health behaviours such as suboptimal physical activity, poor diet, smoking, alcohol and illicit drug misuse. In particular, the limited access to primary health care experienced by people with a serious mental illness has been highlighted. Persons with a serious mental illness are around 30% less likely than those without serious mental illness to receive health assessments, hospital admissions or procedures for cardiovascular disease and diabetes, and are less likely to undergo cancer screening or receive vaccinations. Studies show that mental health consumers may be more likely to use mental health services rather than primary care for contact with the health care system. However mental health nurses report several barriers to their capacity to provide cardiometabolic health care crucial for the treatment of people with a serious mental illness. ObjectivesTo assess the impact of a specialist Cardiometabolic Health Nurse on the physical health care of community based mental health consumers. SettingCommunity mental health facility in a large regional centre in Central Queensland, Australia. Design/methodsCommunity based mental health consumers will be randomised to receive either usual care, or consultations with a Cardiometabolic Health Nurse. The Cardiometabolic Health Nurse will be responsible for assessing the client and coordinating cardiometabolic health care as required. Post intervention review of health records will be performed with the primary outcome measure being self-reported physical health. Secondary outcomes include the utilisation of primary care services and changes in health behaviours. We hypothesise that the Cardiometabolic Health Nurse will increase the utilisation of health care services for mental health consumers. ResultsData collection commenced in March 2013 and will conclude September 2013. Preliminary finding are expected in December 2013.

Older Adults and Forgoing Cancer Screening

Although there is a growing recognition that older adults and those with extensive comorbid conditions undergo cancer screening too frequently, there is little information about patients' perceptions regarding cessation of cancer screening. Information on older adults' views of screening cessation would be helpful both for clinicians and for those designing interventions to reduce overscreening. To obtain a deeper understanding of older adults' perspectives on screening cessation and their experiences communicating with clinicians about this topic. Semistructured interview study. Senior health center affiliated with an urban hospital. We interviewed 33 older adults presenting to a senior health center. Their median age was 76 years (range, 63-91 years). Of the 33 participants, 27 were women; 15 were African American, 16 were white, 1 was Asian, and 1 was American Indian. We transcribed audio recordings of interviews and analyzed them using methods of grounded theory to identify themes and illustrative quotes. Undergoing screening tests was perceived by participants as morally obligatory. Although many saw continued screening as a habit or custom not involving any decision, cessation of screening would require a major decision. Many asserted that they had never discussed screening cessation with their physicians or considered stopping on their own; some reported being upset when their physician recommended stopping. Although some would accept a physician's strong recommendation to stop, others thought that such a physician's recommendation would threaten trust or lead them to get another opinion. Participants were skeptical about the role of statistics and the recommendations of government panels in screening decisions but were more favorable toward stopping because of the balance of risks and benefits, complications, or test burdens. For many older adults, stopping screening is a major decision, but continuing screening is not. A physician's recommendation to stop may threaten patient trust. Effective strategies to reduce nonbeneficial screening may include discussion of the balance of risks and benefits, complications, or burdens.

Abstract B21: The moderating effect of acculturation on gender roles and cancer screening variables among Vietnamese American women.

Abstract Vietnamese women are less likely to undergo cancer screening in comparison to women from other ethnic and minority populations. These health disparities suggest the need to uncover both access/structural barriers as well as cultural barriers to cancer screening for Vietnamese women. The aim of the present study was to examine the influence of demographic variables and the interplay between gender roles and acculturation on breast and cervical cancer screening outcomes among Vietnamese women. A convenience sample of 100 Vietnamese women were recruited from two faith-based institutions for a larger cancer-screening intervention. All participants completed measures on demographic variables, measures of gender roles and acculturation, and cancer screening variables. Results indicated that traditional masculine gender roles were associated with increased self-efficacy for breast and cervical cancer screening. Higher levels of acculturation were associated with higher probability of having had a Pap test. Lastly, acculturation moderated the relationship between traditional female gender roles and cancer screening variables. For highly acculturated women, higher levels of feminine gender roles predicted higher probability of having had a previous CBE and higher levels of self-efficacy for cervical cancer screening, while the opposite was true for lower acculturated women. The findings provide evidence for the interplay between gender and cultural identities and how they may impact Vietnamese women's health outcomes. Programming and intervention strategies need to recognize intra-group differences within ethnic minority populations. Citation Format: Anh Bao Nguyen, Trenette T. Clark, Faye Z. Belgrave. The moderating effect of acculturation on gender roles and cancer screening variables among Vietnamese American women. [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 B21.

Study on the Factors Related With Intention of Cancer Screening Among Korean Residents

This study investigated the relationship between intention of undergoing cancer screening and information, motivation, and behavioral skills using an information-motivation-behavioral skills model. The authors performed a telephone survey of a random sample of 2030 residents aged 30 to 69 years from 6 counties of Gangwon province, South Korea from July 15 to July 25, 2009. Questions about information, motivation, and behavioral skills were examined using a confirmatory factor analysis and relationships among factors were analyzed using a structure equation model. The intention of undergoing cancer screening showed a positive relationship between intention to undergo cancer screening and information(r = .134, P < .001), social norms(r = .059, P = .009), and behavioral skills(r = .129, P < .001). Therefore, comprehensive intervention considering motivation and behavioral skills as well as information is necessary to improve cancer screening rates.

Abstract B33: Cancer survivors as messengers

Abstract Using data from the iterative EDIFICE surveys carried out in France on cancer screening behaviours in the general population, survivors were asked whether they had or not urged their relatives or friends to undergo cancer screening tests. Among our representative sample of 1564 individuals, aged 40–74 years old, 110 were cancer survivors (7%). Among the survivors, 76 (69%) declared having made positive advices for cancer screening. Interestingly 6% (7 survivors out of 110) declared that following their intervention, a cancer was found in friends or relatives after a screening test. Since there are currently 2 000 000 survivors living in France, one could consider that more than 84 000 cancers have been discovered after survivors had urged friends and/or relatives to undergo a cancer screening. For colorectal cancer, attendance rate for screening is only about 40% of the targeted population. For a screening test like FOBT, the tumour detection rate is close to 1.25% of tested individuals. If 50% of current survivors could convince one reluctant person to undergo a screening test, every other year, then 12 500 colorectal tumours could be detected at an early stage. Stories and personal communication are by far more effective than mass media campaign in risk management communication. For survivors who wish to be involved in cancer control, it could be hypothesized that their efficiency and impact could even be increased using inexpensive process and tools such as, communication aids such as flyers (facts and data) and/or training. The increasing number of survivors and their strong commitment could be used to convey preventive counselling and advices on cancer screening, particularly for colorectal cancer which is still underperformed. Citation Information: Cancer Prev Res 2011;4(10 Suppl):B33.

Abstract A22: The Kin KeeperSM Intervention: Women move beyond psychological barriers to Pap screening

Abstract Cancer health disparities are underlined by structural and conceptual barriers, such as: Adequate cancer awareness and education, functional cancer literacy, appropriate and timely access to cancer screening and follow-up care, and psychological aspects of the decision to undergo cancer screening. Cervical cancer health disparities can be impacted by early detection and screening with the Papanicolaou (Pap) test. The Kin KeeperSM Cancer Prevention Intervention is a culturally and linguistically tailored breast and cervical cancer educational intervention designed to improve functional cancer literacy. The Health Belief Model (HBM) was used as a framework to explore potential associations between responses to a cervical Cancer Literacy Assessment Tool (C-CLAT) item assessing a psychological barrier to Pap screening and a woman's screening accomplishments. Methods: The Kin KeeperSM model has three levels of participants: community health worker (CHW), CHW's female clients (“kin keepers”), and female family members of female clients. Trained CHWs recruited 543 Black, Latina, and Arab women from Detroit and Dearborn, MI to participate in the two-year study. Analysis included only women with two years of data, thus the final number of participants was 446 (117 Black, 157 Latina, 172 Arab). Kin keepers recruited female family members in year one and delivered the cervical cancer educational intervention in year two. After recruitment, CHWs from three local agencies administered the C-CLAT to all participants in English, Spanish, or Arabic before administering an educational intervention (pre-C-CLAT) and after the educational intervention (post-C-CLAT 1); and provided women with Personal Action Plans (PAPs) to identify screening goals based on three statements: Find a health care provider to do first-ever Pap; schedule first-ever Pap; and continue getting yearly Pap. The outcome of interest was indication of these goals as accomplishments in year two. After kin keepers delivered the educational intervention in year two, CHWs administered a post-C-CLAT 2 and an accomplishment-oriented PAP to all participants. Using multivariable logistic regression, we observed the potential effect of responses to a C-CLAT item and sociodemographic covariates on PAP accomplishments. The C-CLAT item “Getting a Pap test is very painful,” suggests a psychological barrier to screening, thus it is relevant to a classic HBM construct, perceived barriers. Post-C-CLAT 1 responses to this item were scored with an answer key and SPSS (PASW Statistics 18) was used for statistical analyses. Results: In year one, the most significant covariates affecting the goals women selected were race, relationship to the kin keeper, and health insurance status. Response to the C-CLAT item “Getting a Pap test is very painful” was not significant to the goal to continue annual Pap tests, yet race and possibly relationship to the kin keeper were significant (with an alpha of .105, p-values were .038 and .104, respectively). Analysis of women's PAP accomplishments 12 months later indicates the majority of women found a health care provider for a first-ever Pap test, scheduled a Pap in the past 12 months, and had a Pap in the past 12 months. Relationship to the kin keeper was the only statistically significant covariate (p = .035) in analysis of having had a Pap test in the last 12 months. Conclusions: Future interventions designed to impact cervical cancer health disparities should support women's intentions to pursue screening despite potential psychological barriers. Such studies should explore dynamics between female family members and how these relationships might modify screening decisions and accomplishments. This research was funded by National Institutes of Health (NIH), National Institute for Nursing Research (NINR), 1R01NR011323. Citation Information: Cancer Epidemiol Biomarkers Prev 2011;20(10 Suppl):A22.

Cancer Screening Among Patients With Advanced Cancer

Cancer screening has been integrated into routine primary care but does not benefit patients with limited life expectancy. To evaluate the extent to which patients with advanced cancer continue to be screened for new cancers. Utilization of cancer screening procedures (mammography, Papanicolaou test, prostate-specific antigen [PSA], and lower gastrointestinal [GI] endoscopy) was assessed in 87,736 fee-for-service Medicare enrollees aged 65 years or older diagnosed with advanced lung, colorectal, pancreatic, gastroesophageal, or breast cancer between 1998 and 2005, and reported to one of the Surveillance, Epidemiology, and End Results (SEER) tumor registries. Participants were followed up until death or December 31, 2007, whichever came first. A group of 87,307 Medicare enrollees without cancer were individually matched by age, sex, race, and SEER registry to patients with cancer and observed over the same period to evaluate screening rates in context. Demographic and clinical characteristics associated with screening were also investigated. For each cancer screening test, utilization rates were defined as the percentage of patients who were screened following the diagnosis of an incurable cancer. Among women following advanced cancer diagnosis compared with controls, at least 1 screening mammogram was received by 8.9% (95% confidence interval [CI], 8.6%-9.1%) vs 22.0% (95% CI, 21.7%-22.5%); Papanicolaou test screening was received by 5.8% (95% CI, 5.6%-6.1%) vs 12.5% (95% CI, 12.2%-12.8%). Among men following advanced cancer diagnosis compared with controls, PSA test was received by 15.0% (95% CI, 14.7%-15.3%) vs 27.2% (95% CI, 26.8%-27.6%). For all patients following advanced diagnosis compared with controls, lower GI endoscopy was received by 1.7% (95% CI, 1.6%-1.8%) vs 4.7% (95% CI, 4.6%-4.9%). Screening was more frequent among patients with a recent history of screening (16.2% [95% CI, 15.4%-16.9%] of these patients had mammography, 14.7% [95% CI, 13.7%-15.6%] had a Papanicolaou test, 23.3% [95% CI, 22.6%-24.0%] had a PSA test, and 6.1% [95% CI, 5.2%-7.0%] had lower GI endoscopy). A sizeable proportion of patients with advanced cancer continue to undergo cancer screening tests that do not have a meaningful likelihood of providing benefit.

Cancer survivors: familial risk perception and management advice given to their relatives

The aim of this study was to describe 2 years cancer survivors' perception of the cancer risk running in their family, and to describe how frequently these survivors recommended cancer screening to their relatives. A national cross-sectional survey was launched by the French Ministry of Health to investigate the living conditions of adult cancer patients 2 years after cancer diagnosis. Among the 13,923 patients identified, 6,957 were eligible to participate in this study and 4460 (64.1%) answered the questionnaire administered by telephone. One participant out of every two (50.8%) reported that they thought their relatives' risk of cancer was greater than that of the relatives of unaffected persons. Higher percentages were recorded among breast and colorectal cancer patients (65 and 65.1%, respectively), and lower percentages among those with lung and hematological cancer (34.9 and 28.4%, respectively). Overall, 61.1% of the participants had already advised relatives to undergo cancer screening and 10.4% planned to do so. Eighty-one percent of the participants with breast cancer and 76.3% of those with colorectal cancer said they had advised relatives to undergo screening. Lower percentages were obtained among patients with urinary tract (41.7%) and hematological malignancies (27.1%). Although patients' perceptions tend to fit the latest data on the frequency of cancer germline mutations, physicians should help their patients to convey more accurate advice to their families. If survivors were better informed, they could play a critical role by conveying relevant and sound risk reduction messages to their relatives.

An Experimental Investigation of the Effects of Acknowledging False Negative and False Positive Errors on Clients' Cancer Screening Intentions: The Lesser of Two Evils?

Two studies investigated people's motivations for testing, and the influence of awareness of test inaccuracies, on their intentions to undergo cancer screening tests. Study 1 used a between‐subjects design in which participants stated their intentions regarding one of several screening tests with equal accuracy but with either false negative, false positive, or unspecified errors. Study 2 used a within‐subjects design in which participants indicated their intentions regarding each of those screening tests. In Study 1, intentions for testing were relatively high, affected by instrumental (illness prevention) motivations, and unaffected by type of error acknowledged. Individuals with higher emotional (reassurance seeking) motivations had lower intentions to uptake tests with false positive errors. In Study 2, intentions to uptake all tests were lower compared to Study 1, and were affected by emotional motivations. Participants preferred a test with unspecified errors over tests with specified errors, and, when forced to choose, preferred tests with false negative over false positive errors. Findings are discussed in relation to Error Management Theory and Self‐Regulation Theory, emphasising the need to recognise motivations, affect, and framing as important factors in informed screening decisions.

Colorectal Cancer Screening in the Elderly: The Need for Informed Decision Making

Colorectal Cancer Screening in the Elderly: The Need for Informed Decision Making

Low Health Literacy Is Associated with Less Knowledge About Colorectal Cancer but Not Adherence to Colonoscopy Among Veterans

Purpose: Low literacy is an important predictor of health behavior and has been shown to have an impact on adherence to medications and recommendations to undergo cancer screening. Our objective was to determine the association between health literacy, knowledge and adherence to colonoscopy among veterans at high risk for colorectal cancer (CRC). Methods: In this prospective, observational cohort study, subjects referred for diagnostic evaluation of heme-positive stool, hematochezia, anemia, or a family history of CRC, were recruited from the Durham VA Gastroenterology Clinic. Subjects completed a validated CRC knowledge questionnaire (total knowledge score ranged from 0–100) and were administered the Rapid Estimate of Adult Literacy in Medicine (REALM). The REALM was used to classify individuals as having adequate (>9th grade) or low (<8th grade) health literacy (LHL). The primary endpoint was adherence to colonoscopy, defined as an individual having undergone a complete colonoscopy. Chi-square statistic and T-test were used to evaluate differences between groups. Results: A total of 619 subjects completed the study. Mean age was 59 years and 91% were male; 53% were White, 42% Black; 44% of subjects had LHL. Total knowledge score was slightly lower in the LHL group (76% vs. 80%; P= 0.02). Overall adherence rate was high: 518 (84%) completed their diagnostic colonoscopy. Adherence status between the 2 groups was lower in the LHL group but this difference was not statistically significant (82% versus 86%, P= 0.24). Conclusion: LHL is associated with less knowledge about CRC screening but this is the only study to date that has looked at the impact of health literacy on outcomes such as adherence to diagnostic colonoscopy. While LHL rates were high in this cohort of veterans, and this may have translated into less knowledge about CRC, importantly, it did not have an impact on adherence to diagnostic colonoscopy. These findings are especially significant since adherence to colonoscopic evaluation is imperative in this patient population referred for diagnostic evaluation.

Histological Diagnosis of Prostate Cancer in Korean Men Aged 70 79 Years

The objective of this study was to evaluate the value of the prostate-specific antigen (PSA) in the diagnosis of prostate cancer in elderly Korean men, aged 70-79 years. Patients with an abnormal digital rectal examination (DRE) and/or a serum PSA level greater than 2.0 ng/ml underwent a biopsy. A total of 344 men (median age 73 years) constituted the study cohort. Of 344 men, 163 (47.4%) were diagnosed with prostate cancer upon initial biopsy. The positive predictive value (PPV) for cancer was 48.4% for a PSA cutoff of 4 ng/ml, 65.3% for a cutoff of 10 ng/ml, and 87.0% for a cutoff of 20 ng/ml. When combined with an abnormal DRE, the predictive values for these PSA cutoffs increased to 79.3, 87.3 and 100%, respectively. When 10 ng/ml was chosen as a PSA cutoff level, about 50% of patients were found to have a Gleason score of 7 or higher. When 4 ng/ml was chosen as a PSA cutoff level, more than 50% of patients with an abnormal DRE were found to have a Gleason score of 7 or higher. In elderly men, more than 50% of patients are found to have cancers with a Gleason score of 7 or higher when their PSA level is greater than 10 ng/ml. This threshold may be lowered to 4 ng/ml in the presence of an abnormal DRE. Our findings provide a rationale for recommending a prostate biopsy in elderly patients with an abnormal DRE and/or an elevated serum PSA level. However, at present, it is not clear whether elderly men have better outcomes when they undergo cancer screening.

The Roles of Citizenship Status, Acculturation, and Health Insurance in Breast and Cervical Cancer Screening Among Immigrant Women

Immigrant women are less likely to undergo cancer screening. However, few national studies have examined the role of citizenship status or acculturation. The objective of this study was to examine differences in Papanicolaou (Pap) smear and mammography screening among U.S.-born women and immigrants who are naturalized citizens or remained noncitizens. Among Latinas, we also determined if acculturation is related to screening after adjusting for covariates. The authors conducted a cross-sectional analysis of the Adult Section of the 2000 National Health Interview Survey, a nationally representative sample. A total of 18,342 women completed the survey, including 1445 who were not citizens. For Pap smears, women age 18-65 were appropriately screened if they reported testing within the past 3 years. For mammograms, women age 50-70 were considered appropriately screened if they reported testing within the past 2 years. We determined acculturation using a modified version of the Marin scale. After adjusting for age, education, family income, and marital status, noncitizens remained significantly less likely to report having a mammogram than U.S.-born women (14 percentage point difference; P < 0.01). However, after adjusting for health insurance coverage and a usual source of care, these disparities were markedly attenuated. For Pap smears, after adjusting for sociodemographics and access to care, disparities persisted (11 percentage points, P < 0.01). Among Latinas, differences in Pap smears between noncitizens and the U.S.-born disappeared after further controlling for acculturation. Our study suggests that initiatives to diminish disparities in screening should prioritize improving access to care for noncitizens. Our study also lends support to culturally sensitive interventions aimed at improving Pap smear screening among noncitizens.

Misperceptions of Medical Understanding in Low-Literacy Patients: Implications for Cancer Prevention

Patients with limited literacy skills often have difficulty understanding medical information, are less likely to undergo cancer screening, and present with cancer at later stages than patients with better literacy skills. Since primary care physicians are responsible for performing or initiating the majority of cancer screening in the United States, they need to be able to not only identify patients who might not understand medical information but also communicate effectively with them about cancer prevention and screening. To determine whether family medicine residents could identify patients who might have difficulty understanding medical information because of limited literacy, we measured the literacy skills of patients in a university-based family medicine clinic using the short form of the Test of Functional Health Literacy in Adults (S-TOFHLA). After the patients completed their office visits with a physician, we asked family medicine residents to rate the patients' ability to understand medical information. Among 140 patients who met with 18 family medicine resident physicians, 24% had limited literacy skills based on testing with the S-TOFHLA. Residents identified only about half of these patients as having poor or below average understanding of medical information. IN many cases, family medicine residents are unable to identify patients who, based on assessment of their literacy skills, are likely to have difficulty understanding medical information. When working with residents, medical educators should promote the habit of taking poor literacy into account when communicating with patients.

Stufen und Hürden der Teilnahme an Krebsvorsorgeuntersuchungen bei 45 - 60-jährigen Männern - Ergebnisse einer empirischen Untersuchung

Between 2002 and 2004 the Centre of Applied Health Sciences of the University of Lüneburg carried out a research project concerning the cancer screening behaviour of men. Within a standardised survey all men aged 45 - 60 years of a local health insurance company were interviewed by a postal questionnaire about their cancer screening behaviour including their main reasons to engage or not to engage in the (insurance financed) cancer screening tests. 337 questionnaires could be analysed. As a theoretical framework, the "transtheoretical model" of Prochaska et al. was used to characterise the men according to their degree of readiness to engage in cancer screening tests. 25% of the men were regularly engaged in cancer screening tests. 40% have been engaged at least once or were in the stage of "preparation" to do so in the near future. 35% were resistant to undergo cancer screening tests. Anxiety concerning the check-up itself or the possibility to have a positive result were the main barriers for men not to engage in cancer screening. As an important factor to overcome such barriers, these men mentioned the need for better communication between doctors and patients. To improve cancer screening behaviour, this was considered more important than general information campaigns or organisational changes concerning the check-ups.

Effects of Risk and Time Preference and Expected Longevity on Demand for Medical Tests

Despite their conceptual importance, the effects of time preference, expected longevity, uncertainty, and risk aversion on behavior have not been analyzed empirically. We use data from the Health and Retirement Study (HRS) to assess the role of risk and time preference, expected longevity, and education on demand for three measures used for early detection of breast and cervical cancer—regular breast self-exams, mammograms, and Pap smears. We find that individuals with a higher life expectancy and lower time preference are more likely to undergo cancer screening. Less risk averse individuals tend to be more likely to undergo testing.