Breast cancer screening among American Samoan women

BACKGROUND: Little is known about breast cancer screening practices or predictors of age-specific screening for Samoan women. METHODS: Through systematic, random sampling procedures, we identified and interviewed 720 adult (> or =30 years) Samoan women residing in American Samoa, Hawaii, and Los Angeles. Multivariate logistic regressions were performed to determine independent predictors for recent age-specific screening. RESULTS: Only 55.6% of women (> or =30 years) had ever had a CBE and 32.9% of women (> or =40 years) had ever had a mammogram. Furthermore, only 24.4 and 22.4% of Samoan women (> or =40 years) residing in Hawaii and Los Angeles, respectively, had an age-specific mammogram within the prior year. Independent predictors of age-specific CBE screening included age, education, health insurance, ambulatory visit, and being a resident of Hawaii or Los Angeles; those for mammography included ambulatory visit and awareness of screening guidelines. CONCLUSION: Population-based estimates of age-specific breast cancer screening among Samoan women are lower than the national objectives and those reported for other minorities. Targeted efforts that address doctor-patient communication on preventive behavior, improved access to health care services (especially in American Samoa), and focused educational awareness programs are needed to improve the dismal screening rates observed in this indigenous population.     

Measuring adherence to mammography screening recommendations among low-income women

OBJECTIVES: (1) To describe the accuracy of self-report and administrative claims for measuring mammography adherence among low-income women; (2) to determine whether the accuracy of self-report differed between telephone interview and mailed questionnaire; and (3) to explore whether the method of measuring adherence affected associations between mammography adherence and participant sociodemographic characteristics. DESIGN: Retrospective cohort study of women receiving care from a Philadelphia Medicaid Managed Care Organization (MCO). PARTICIPANTS: Three hundred and ninety-nine low-income women eligible for screening mammography of whom 64% were African American, 14% Caucasian, 13% Hispanic, and 8% Asian American. MEASURES: Self-reported use of mammography screening, administrative mammography claims data, and dates of mammograms from radiology facility records. The "gold standard" categorized women as having undergone screening if they had either a billing claim or facility record for a mammogram in the past 12 months. MAIN RESULTS: Two hundred and eighty-three of the 399 women reported having had a mammogram in the past 12 months. The sensitivity of self-report was 0.93, specificity was 0.54, positive predictive value was 0.70, and negative predictive value was 0.86. One hundred and seventy-nine of the 399 women had a claim for a mammogram in the past 12 months. The sensitivity of claims data was 0.83 with a negative predictive value of 0.84. The sensitivity of self-report was higher with telephone data collection (0.98) than with mailed data collection (0.82), while the specificity was higher with mail (0.64) than telephone (0.50). African American race was associated with adherence to screening recommendations when mammography use was measured by self-report (RR 1.31, P = 0.002) but not when it was measured by claims or facility validation (RR 1.03, P = 0.56, and RR 1.12, P = 0.15, respectively). CONCLUSIONS: Accurate measurement of adherence to mammography screening among low-income women is difficult. Self-report substantially overestimates adherence (particularly when collected through telephone interviews), while also misclassifying some women who underwent screening as not having been screened (particularly when collected through mailed questionnaires). In contrast, administrative claims data substantially underestimates adherence. Inaccurate measurement of mammography adherence can lead to a biased understanding of the factors associated with adherence.     

Barriers to cervical cancer screening among low-income HIV-positive African American women

This study elucidates the perspective of low-income HIV-positive African American women who have not received cervical cancer screening for five or more years, on the barriers they face in accessing and using reproductive health care. We focused on how women who live in a severely economically depressed and racially segregated neighborhood experience barriers to cervical cancer screening. Andersen's Behavioral Model of Health Services Use, which allows for the organization of conditions and situations that bar utilization of health services, served as the theoretical framework. Findings from individual semi-structured interviews with 35 participants revealed the importance of psychological and emotional barriers as well as the more commonly reported economic, social, and health care system barriers. We suggest how access to care for this population can be increased by including psychological and emotional components in intervention efforts.     

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

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

Breast and cervical cancer screening and health beliefs among African American women attending educational programs

This article assessed the relationship between breast and cervical cancer screening rates and health beliefs in African American women participating in Witness Project of Harlem (WPH) education sessions. WPH is a culturally sensitive, faith-based breast and cervical cancer screening education program targeting African American women in medically underserved New York City communities. A questionnaire administered to women participating for the first time in a Witness Project education session collected demographics, adherence to breast and cervical cancer screening, and information about health beliefs related to cancer worry, medical mistrust, and religious faith. Screening adherence guidelines applied were as per the American Cancer Society recommendations. No statistically significant relationship was found between worry about getting breast or cervical cancer and screening adherence, or between screening adherence and agreement with statements about medical mistrust and religious beliefs. The low screening mammography and monthly breast self-exam rates emphasize the utility of programs like WPH that teach the importance of screening mammography and breast self-exam and point to the need for increased access to quality health care and cancer screening in underserved populations.     

Predictors of adherence to screening mammography among Korean American women

BACKGROUND: Breast cancer is the most commonly diagnosed cancer among Korean American women (KAW). Many KAW are not aware of the importance of regular screening. This research estimates the rates of regular breast cancer screening and examines the predictors and barriers to obtaining regular mammograms. METHODS: Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing. RESULTS: About 33% had regular mammograms. In multiple logistic regression analyses, the strongest correlate of regular mammograms was knowledge of screening guidelines. Age, spoken English proficiency, and physician recommendations were associated with regular mammograms. Employment interacted with insurance: Employed women without insurance had lower rates of mammograms than those employed with insurance. The most frequent reason for not having regular mammograms was a woman's belief that she was at low risk for breast cancer. CONCLUSIONS: Results indicate that knowledge of screening guidelines and physician recommendations for screening are important in this minority population. Culturally relevant educational programs about breast cancer screening should be developed for less acculturated women and recent immigrants.     

Breast cancer literacy and health beliefs related to breast cancer screening among American Indian women

ABSTRACT

The purpose of this article is to examine the health beliefs and literacy about breast cancer and their relationship with breast cancer screening among American Indian (AI) women. Using the Health Belief Model (HBM) and hierarchical logistic regression with data from a sample of 286 AI female adults residing in the Northern Plains, we found that greater awareness of breast cancer screening was linked to breast cancer screening practices. However, perceived barriers, one of the HBM constructs, prevented such screening practices. This study suggested that culturally relevant HBM factors should be targeted when developing culturally sensitive breast cancer prevention efforts.     

Breast cancer knowledge, attitudes, and screening behaviors among African American women: the Black cosmetologists promoting health program

Background

Recent surveillance data from Bangladesh indicate rising HIV infection among intravenous drug users (IDU) in the country. We suggest a likely association between HIV risk factors in this group and other groups, such as males who have sex with males (MSM).

Methods

Data on MSM in Bangladesh was collected and analyzed from numerous primary and secondary sources, including government ministries, non-profit health organizations, and personal communications.

Results

The overall prevalence of HIV in Bangladesh is relatively low, but surveillance data indicate that infection has reached significant proportions in certain high-risk groups and may soon spread to other groups, specifically MSM.

Conclusion

The epidemiology of HIV infection in other countries suggests that increasing rates of HIV in higher-risk populations can precede an epidemic in the general population. We review the data concerning MSM, IDU and HIV in Bangladesh from a variety of sources and propose ways to prevent HIV transmission.     

Pain predicts non-adherence to pap smear screening among middle-aged African American women

BACKGROUND: Middle-aged African American women have the highest incidence and mortality of invasive cervical cancer in the United States and the lowest adherence to pap smear screening. METHODS: In 2001, we identified factors associated with non-adherence to screening recommendations using three focus group interviews and subsequently developed a questionnaire administered to 144 African American women aged 45 to 65 years. RESULTS: The perception that the Pap test was painful was associated with non-adherence to screening recommendations (OR = 4.78; 95%CI: 1.67-13.7). Difficulty to pay for the office visit coupled with perceived pain was associated with a nearly sixfold increase in risk of non-adherence (OR = 5.8; 95%CI: 2.8-15.5). Previously identified barriers to screening including lower education and socioeconomic status, poor access to care, knowledge of and exposure to known risk factors of invasive cervical cancer, cancer fatalism, and perceived racism were not independently associated with non-adherence. CONCLUSIONS: These data suggest that, among middle-aged African American women, future interventions addressing pain during a Pap test will likely increase acceptability of and adherence to cervical cancer screening. Pain could be addressed either by providing information during the pap test and/or using smaller lubricated speculums.     

Cancer screening in women: body mass index and adherence to physician recommendations

BACKGROUND: The reasons that obese women are less likely to obtain mammograms and Papanicolaou tests (Pap smears) are poorly understood. This study evaluated associations between body mass index (BMI) and receipt of and adherence to physician recommendations for mammography and Pap smear. METHODS: Data from the 2000 National Health Interview Survey (8289 women aged 40 to 74 years) were analyzed in 2006 using logistic regression. Women with previous hysterectomy were excluded from Pap smear analyses (n=5521). Outcome measures were being up-to-date with screening, receipt of physician recommendations, and women's adherence to physician recommendations for mammography and Pap smear. RESULTS: After adjusting for sociodemographic variables, healthcare access, health behaviors, and comorbidity, severely obese women (BMI > 40 kg/m(2)) were less likely to have had mammography within 2 years (odds ratio [OR]=0.50, 95% confidence interval [CI]=0.37-0.68) and a Pap smear within 3 years (OR=0.43, 95% CI=0.27-0.70). Obese women were as likely as normal-weight women to receive physician recommendations for mammography and Pap smear. Severely obese women were less likely to adhere to physician recommendations for mammography (OR=0.49, 95% CI=0.32-0.76). Women in all obese categories (BMI > 30 kg/m(2)) were less likely to adhere to physician recommendations for Pap smear (ORs ranged from 0.17 to 0.28, p<0.001). CONCLUSIONS: Obese women are less likely to adhere to physician recommendations for breast and cervical cancer screening. Interventions focusing solely on increasing physician recommendations for mammography and Pap smears will probably be insufficient for obese women. Additional strategies are needed to make cancer screening more acceptable for this high-risk group.     

Vietnamese American women: breast cancer knowledge, attitudes, and screening adherence

Breast cancer screening behavior and attitudes was measured among a convenience sample of 275 Vietnamese American women as part of a cancer education program evaluation. Follow-up interviews were completed with 178. Only 36% reported having adequate knowledge on this topic, and 87% indicated an interest in receiving more information. Rates of receiving a mammogram were below recommended levels.     

Breast and cervical cancer screening among Mississippi Delta women

The purpose of the study was to determine breast and cervical cancer screening among women living in the Mississippi Delta region. Using data from the Behavioral Risk Factor Surveillance System for 1999--2000, we determined the prevalence of mammography (women 40 years and older, n = 6,028) and Pap testing (women 18 years and older, n = 6,502) within the past 2 or 3 years, respectively. We examined predictors of testing and compared results with those for women living elsewhere in the United States. Among Delta women, 69.4% (95% confidence interval [CI] 67.9% to 70.9%) had a mammogram and 85.5% (95% CI 84.3% to 86.6%) a Pap test. Mammography prevalence was lower among black and white Delta women than among black and white women elsewhere. Pap testingwas lower among older (65 years and older) Delta women or women who did not visit a doctor within the past year than among their counterparts elsewhere. Additional interventions are needed to meet the goals of Healthy People 2010 for all women.     

Breast cancer screening and health behaviors among African American and Caribbean Women in New York City

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

Breast cancer screening among relatives of women with breast cancer.

BACKGROUND. National surveys indicate that only 15% to 30% of all women in the general population 50 years of age or older have an annual mammogram. METHODS. We studied first-degree female relatives of women with breast cancer, who are at elevated risk of disease, to describe the breast cancer screening practices of these relatives and to improve their practices through a program of intensive education. We report here the screening behaviors of 2471 relatives of women with breast cancer. RESULTS. Self-reported behaviors were as follows: 49% performed monthly breast self-examination and 70% had annual breast examinations by a medical professional. Of 983 women 50 years of age or older, 49% had had a mammogram, but only 14% have a mammogram annually. Of women 50 years of age or older who had never had a mammogram, 92% reported never having had one recommended by a medical professional. CONCLUSIONS. Our findings indicate that screening behaviors in relatives of breast cancer patients are not substantially different from those of women in the general population. Enhanced efforts both to educate medical professionals and to encourage women to demand screening mammography are necessary to reduce breast cancer mortality.     

Perceived social support and HIV/AIDS medication adherence among African American women

HIV/AIDS incidence is increasing more quickly among women than any other segment of the population. The typical woman with HIV/AIDS is young, in her late 20s, economically challenged, and of childbearing age. Adherence to HIV therapies is critical if patients are to achieve and maintain virologic suppression. The author recruited HIV/AIDS-infected African American women from an outpatient clinic to investigate the women's perceptions of social support and how it affected their medication adherence. She collected data through tape-recorded interviews using a semistructured guide and journaling over a 2-week period. Facilitators of adherence included supportive family members and having young children. Barriers to adherence included perceived stigma, feeling unloved or uncared for, relationship turbulence, and having a husband who was also HIV positive. Although participants reported being "fairly" satisfied with the quality of support they received, emotional support and often instrumental support were most desired and wanted.     

Responses to behaviorally vs culturally tailored cancer communication among African American women

OBJECTIVE: To examine whether tailored cancer communication for African American women can be enhanced by tailoring on 4 sociocultural constructs: religiosity, collectivism, racial pride, and time orientation. METHODS: In a randomized trial, participants (n=1,227) received a women's health magazine tailored using behavioral construct tailoring (BCT), culturally relevant tailoring (CRT), or both (COMBINED). Two follow-up interviews assessed responses to the magazines. RESULTS: Responses to all magazines were positive. The health focus of the magazines was initially obscured in the CRT condition, but this disappeared over time, and CRT magazines were better liked. CONCLUSIONS: Implications for developing and understanding effects of tailored cancer communication are discussed.     

Compliance rates and predictors of cancer screening recommendations among Appalachian women

High rates of morbidity and mortality in the Appalachian region of the country warrant examination of the preventive care behavior of its residents. This study determined compliance rates for breast and cervical cancer screening recommendations for women residing in Appalachian states and identified predictors of such compliance using the Behavioral Risk Factor Surveillance System data (1995-97). Healthy People 2000 goals were used as benchmarks for progress. Appalachian women have made good progress toward goals pertaining to breast and cervical cancer screening. Compliance with other preventive services, having insurance coverage, residing in urban areas, better self-reported health, and higher education were independently associated with increased odds of compliance with annual-screening recommendations. Risk factors of obesity and smoking were associated with decreased odds of compliance. Findings should be useful to health care providers, policy makers, and researchers in their efforts to educate, encourage, and promote preventive care behavior among residents of Appalachia.     

Increasing mammography screening among low-income African American women with limited access to health information

BACKGROUND: Previous research showed low-income African American women with limited access to breast screening information through mass media to have a low likelihood of obtaining screening. This report describes a controlled evaluation of a component of a community-based breast screening promotion program focused on increasing screening among low-income African American women. METHODS: A direct-contact screening promotion component tailored to the needs of low-income African American women was conducted between 1990 and 1997 in one of two matched Florida study areas. Before and after assessments of breast screening, behavior and psychosocial mediators of screening were examined using logistic regression analyses for 1201 women with differing levels of exposure to media information about breast screening. RESULTS: Recent/repeat mammography use increased significantly in the program area for women with limited access to media information, although there was no significant program impact on hypothesized psychosocial mediators of screening. CONCLUSIONS: The program led to increased mammography use among low-income African Americans having limited access to screening information through the media. For these women, using direct contact to deliver educational messages and facilitation of access to services may be the best method available to promote regular mammography.