Correlates of recent and regular mammography screening among Asian-American women

Title.  Correlates of recent and regular mammography screening among Asian-American women.
Aim.  This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women.
Background.  Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans.
Method.  A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study.
Results.  Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model.
Conclusion.  Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.     

The effect of physician-patient communication on mammography utilization by different ethnic groups

The differential utilization of screening mammography by racial/ethnic groups was examined through 35-minute bilingual, random digit dialed telephone interviews with 1,057 women over age 35 years. Results showed that 71% of hispanic women had never had a mammogram and that only 27% over age 50 years had had one in the year before the survey. White and black women over the age of 50 years were being screened more frequently with 34% of white women and 36% of black women having had a mammogram in the prior year. More than half of the hispanic women over age 50 years had never had a mammogram. Analyses showed that the most important variable that predicted whether women of all racial groups had a mammogram, at any time or within the last year, was whether their doctors had discussed mammography with them. The discussion did not need to be lengthy or complex. Hispanic women, however, were less likely to have physicians who discussed screening with them even though these women reported that they were just as motivated as other women to get a mammogram if their doctor referred them. Suggestions for what primary care physicians can do to increase mammography rates, especially among hispanic women, are discussed.     

Thai American women's perceptions regarding mammography participation

ABSTRACT Objectives: To identify the factors influencing mammography screening among Thai immigrant women in Southern California.
Background: Asian women have lower mammography screening rates than other U.S. women ( Centers for Disease Control [CDC], 2007 ), and only 53% of Thai women in Los Angeles had a mammogram in the prior 2 years ( Thai Community Development Center, 2004 ).
Design: A phenomenological approach was used to elicit Thai immigrant women's perceptions of the reasons for screening participation. Phenomenology is an appropriate means of describing screening as experienced by members of a population for which there is little information. Focus groups were used to collect data to provide a group perspective.
Sample: Thai women over 40 years of age in 2 Southern California counties were recruited at a local temple and a social services agency.
Measurement: Participants were asked about mammography participation and to describe the factors that influenced screening for themselves, family members, and friends. Thematic analysis identified major themes.
Results: Factors influencing mammography screening included knowledge, encouragement, health consciousness, physical factors, fear, cultural factors, social responsibilities, and logistical barriers.
Conclusions: Participants identified factors amenable to nursing intervention that may influence mammography screening in this population. Further study is needed to determine the prevalence of these factors.     

Do cultural factors predict mammography behaviour among Korean immigrants in the USA?

Title. Do cultural factors predict mammography behaviour among Korean immigrants in the USA? Aim. This paper is a report of a study of the correlates of mammogram use among Korean American women. Background. Despite the increasing incidence of and mortality from breast cancer, Asian women in the United States of America report consistently low rates of mammography screening. A number of health beliefs and sociodemographic characteristics have been associated with mammogram participation among these women. However, studies systematically investigating cultural factors in relation to mammogram experience have been scarce. Methods. We measured screening‐related health beliefs, modesty and use of Eastern medicine in 100 Korean American women in 2006. Hierarchical logistic regression was used to examine the unique contribution of the study variables, after accounting for sociodemographic characteristics. Findings. Only 51% reported past mammogram use. Korean American women who had previously had mammograms were statistically significantly older and had higher perceived benefit scores than those who had not. Perceived benefits (odds ratio = 6·3, 95% confidence interval = 2·12, 18·76) and breast cancer susceptibility (odds ratio = 3·18, 95% confidence interval = 1·06, 9·59) were statistically significant correlates of mammography experience, whereas cultural factors did not correlate. Post hoc analysis showed that for women with some or good English skills, cultural factors statistically significantly correlated with health beliefs and breast cancer knowledge (P < 0·05). Conclusion. Nurses should consider the inclusion in culturally tailored interventions of more targeted outreach and healthcare system navigation assistance for promoting mammography screening in Korean American women. Further research is needed to unravel the interplay between acculturation, cultural factors and health beliefs related to cancer screening behaviours of Korean American women.     

Personalized targeted mailing increases mammography among long-term noncompliant medicare beneficiaries: a randomized trial

OBJECTIVES: The study purpose was to increase mammography screening among older women by identifying female Medicare beneficiaries without a recent mammogram and assesses the cost-effectiveness of a personalized targeted mailing encouraging them to have a mammogram. METHODS: A randomized paired controlled trial included 1229 pairs of women matched on zip code, race, and urban or rural county. Postintervention mammography claims were measured from November 1997 through December 1998. The subjects were female Medicare beneficiaries age > or = 70, living in Michigan for > or = 5 years, having no significant comorbidity likely to affect screening, and no mammogram for > or = 5 years. Intervention subjects received a personally addressed letter from the Medical Director of Michigan Medicare with materials emphasizing the individual's lack of use of the Medicare mammography screening benefit, reasons for screening, and how to be screened. RESULTS: Women who received the mailing were 60% more likely to have a subsequent mammogram (OR 1.6, P <0.005), with diagnostic mammograms increasing more than screening mammograms (2.8% vs. 0.8%). The absolute increase was greatest for women age 70 to 79, 10.6% in the intervention group versus 6.5% for controls, odds ratio 1.7 (P <0.02). A statewide Medicare intervention in Michigan would cost of 108,000 US dollars to 238,000 US dollars, producing 3500 to 4300 additional mammograms at 31 US dollars to 55 US dollars per additional mammogram. CONCLUSION: The intervention increased mammography among long-term noncompliant older women, particularly increasing diagnostic mammograms. This approach can be directly implemented in other states and nationally. It may also be useful for other preventive services.     

The intention of future mammography screening among Korean women

The purpose of this study was to understand factors that influence future mammography intention and to differentiate significant factors influencing future mammography intention between those who have past mammography experience and those who do not. A cross-sectional study design was used to analyze characteristics and factors that influence the intention to have a mammogram among middle-aged Korean women. A total of 310 women, aged 30 and older, participated in the study. The study results indicated that a combination of the Health Belief Model and the Theory of Reasoned Action was effective in predicting mammography intention of Korean women. It found that knowledge, perceived benefits, self-efficacy, and the subjective norm were significant factors affecting mammography intention in women who have past mammography experience. For women who have never had a mammogram, age, knowledge, perceived benefits, and self-efficacy provided a significant contribution to predicting mammography intention. Thirty-three to 43% of the variability in mammography intention can be explained by the combined influence of these independent variables. The findings from this study can be used to guide the design and implementation of tailored health education and promotion programs for Korean women according to their mammography experience, so as to increase mammography screening.     

Comparing the performance of mammography screening in the USA and the UK

To compare the performance of screening mammography in the USA and the UK, a consecutive sample of screening mammograms was obtained in women aged 50 and older from 1996 to 1999 who participated in the Breast Cancer Surveillance Consortium in the USA (n = 978,591) and the National Health Service Breast Cancer Screening Program in the UK (n = 3.94 million), including 6943 diagnosed with breast cancer within 12 months of screening. Recall rates were defined as the percentage of screening mammograms with a recommendation for further evaluation including diagnostic mammography, ultrasound, clinical examination or biopsy, and cancer detection rates including invasive cancer and ductal carcinoma in situ diagnosed within 12 months of a screening mammogram. All results were stratified by whether examinations were first or subsequent and adjusted to a standard age distribution. Among women who underwent a first screening mammogram, 13.3% of women in the USA versus 7.2% of women in the UK were recalled for further evaluation (relative risk for recall 1.9; 95% CI 1.8-1.9). For subsequent examinations recall rates were approximately 50% lower, but remained twice as high in the USA as in the UK. A similar percentage of women underwent biopsy in each setting, but rates of percutaneous biopsy were lower and rates of open surgical biopsy were higher in the USA. Women undergo screening approximately every 18 months in the USA and every 36 months in the UK. Based on a 20-year period of screening, the estimated percentage of women who would be recalled for additional testing was nearly threefold higher in the USA. The number of cancers detected was also higher in the USA (55 versus 43), and most of the increase was in the detection of small invasive and in situ cancers. The numbers of large cancers detected ( > 2 cm) were very similar between the two countries. Recall rates are approximately two to three times higher in the USA than in the UK. Importantly, despite less frequent screening in the USA, there are no substantial differences in the rates of detection of large cancers. Efforts to improve mammographic screening in the USA should target lowering the recall rate without reducing the cancer detection rate.     

Mammography screening behavior in older women caregivers

The purposes of this study are to explore older caregivers' mammography participation and the facilitators and barriers to mammography screening. Of the 52 older female caregivers with a mean age of 65 years (range 50-90) interviewed by telephone, 80.8% had had a mammogram within 12 months. Significant facilitators included health care provider recommendation and beliefs in the efficacy of treatment. Significant barriers included health care providers' failure to recommend mammograms, caregiver procrastination, fear of pain, and lack of symptoms. Caregivers with higher burden reported less frequent self- and provider-conducted breast examinations.     

Efficacy of a simple, low-cost educational intervention in improving knowledge about risks and benefits of screening mammography

OBJECTIVES: To assess the efficacy of a minimal cost and involvement educational intervention in improving women's knowledge about screening mammography and to explore patient perceptions of the educational intervention. PARTICIPANTS AND METHODS: During the study period (March 10, 2005, to July 1, 2005), 1446 participants in the Mayo Mammography Health Study scheduled for a mammogram within 4 weeks at the Mayo Clinic in Rochester, Minn, were randomized to 2 study groups and mailed surveys about mammograms. The 2 groups received separate surveys; both surveys contained knowledge-based questions about mammography, but the educational intervention group survey also contained qualitative questions that assessed the educational pamphlets. RESULTS: Of the 668 surveys returned (responders), 248 (34.4%) were from the control group, and 420 (58.3%) were from the intervention group. Approximately 80% of responders had had more than 7 prior mammograms. Significant increases in knowledge about mammography were found in the educational intervention compared with the control group on questions regarding age to begin screening mammography (67.9% vs 54.4%; P < .001), recommended frequency of mammograms (86.4% vs 75.4%; P < .001), overall reduction in mortality due to screening mammography (55.2% vs 8.9%; P < .001), and proportions of women who required follow-up mammograms (35.5% vs 14.9%; P < .001) or biopsy (59.5% vs 13.3%; P < .001). Qualitative data results indicated that most women who received the educational intervention found the pamphlets helpful and informative despite having had many previous mammograms. CONCLUSION: The results suggest that providing women scheduled for screening mammograms with physician-approved educational material before their appointment significantly increases knowledge about screening mammography, risks and benefits, and possible follow-up.     

The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population

BACKGROUND: Access and satisfaction are determinants of preventive service use, but few studies have evaluated their role in breast and cervical cancer screening in multiethnic populations. OBJECTIVES: We sought to investigate the relationship between race/ethnicity, access, satisfaction, and regular mammogram and Papanicolaou test receipt in 5 racial/ethnic groups. RESEARCH DESIGN: We conducted a telephone survey in 4 languages. SUBJECTS: Our subjects were black, Chinese, Filipino, Latino, or white women aged 40 to 74 residing in Alameda County, California. MEASURES: Outcome: regular mammograms (last test within 15 months and another within 2 years prior) and Papanicolaou tests (36 months and 3 years, respectively). Independent: race/ethnicity, sociodemographic variables, access (health insurance, usual site of care, regular doctor, check-up within 12 months, knowing where to go, copayment for tests), and satisfaction (overall satisfaction scale, waiting times, test-related pain and embarrassment, test satisfaction). RESULTS: Among women who had ever had a mammogram or Papanicolaou test, 54% and 77%, respectively, received regular screening. In multivariate analyses, regular mammography was positively associated with increased age (odds ratio [OR] 1.05 per year), private insurance (OR 1.7), check-up in the past year (OR 2.3), knowing where to go for mammography (OR 3.0), and greater satisfaction with processes of care (OR 1.04 per unit), and negatively with not knowing copayment amount (OR 0.4), too many forms to fill out (OR 0.5), embarrassment at the last mammogram (OR 0.6), and Filipino race/ethnicity. Similar results were found for regular Papanicolaou tests. CONCLUSIONS: Access and satisfaction are important predictors of screening but do little to explain racial/ethnic variation. Tailored interventions to improve regular mammography and Papanicolaou test screening in multiethnic populations are needed.     

Association between health insurance coverage of office visit and cancer screening among women

BACKGROUND: Little is known regarding the nuances of insurance benefit design that may affect the receipt of clinical preventive services. OBJECTIVE: To evaluate whether differences in insurance coverage of physician office visits influences the receipt of cancer screening in women who have full coverage for the screening services. DESIGN: Cohort study of women enrolled in fee-for-service (FFS) or Preferred Provider Organization (PPO) health plans, where FFS plans have less generous office visit coverage, for the period 1995 to 1997. SETTINGS AND PARTICIPANTS: General Motors Corporation's employees and their dependents. MAIN OUTCOME MEASURES: Papanicolaou and mammography rates in women aged 21 to 64 years (n = 139,294) and 52 to 64 years (n = 56,554), respectively. RESULTS: Compared with FFS plans, enrollees in PPO plans were significantly more likely to obtain a Papanicolaou smear and mammogram (adjusted relative risk [RRa] = 1.22; 95% CI, 1.21-1.24; and RRa, 1.17; 95% CI, 1.15-1.18, respectively). The association was more pronounced among hourly individuals (RRa, 1.27; 95% CI, 1.26-1.29 for Papanicolaou smears; RRa, 1.17; 95% CI, 1.16-1.19 for mammograms) than among salaried individuals (RRa, 1.10; 95% CI, 1.08-1.12 for Papanicolaou smears and RRa, 1.10; 95% CI, 1.06-1.12 for mammograms), corresponding to a greater differential in office visit coverage among the hourly group. CONCLUSIONS: Benefit structure appears to have an important effect on receipt of cancer screening in women. The findings highlight the need to ensure that future reforms of the health care system do not adversely affect the use of preventive services.     

The role of physician recommendation in women's mammography use: is it a 2-stage process?

OBJECTIVE: To explore the use of a 2-stage model in explaining the role of physician recommendation in women's use of mammography screening and to provide an integrated framework for understanding the mammography-use process. METHODS: Data on 1,301 women aged > or =52 years from the North Carolina Breast Cancer Screening Program (NC-BCSP) questionnaire were combined with information from 91 of their physicians from the North Carolina Medical Board. A 2-stage system of equations using women's characteristics (demographic, health, access), physicians' characteristics (demographic, practice), women's beliefs, and women's report of a physician recommendation was created and statistically tested. The model was estimated using 2-stage logistic and probit estimation. RESULTS: The 2-stage approach produced different results compared with the single pooled model. In the second-stage mammography-use model, younger age, family history of breast cancer, and a woman's having ever requested a mammogram retained significance (P < or = 0.05) in addition to the predicted value of physician recommendation obtained from the first stage. Women's characteristics significantly associated with physician recommendation in the first stage included some access, health risk, and demographic variables as well as physician age and race (P < or = 0.05). CONCLUSIONS: A 2-stage model for estimating mammography use among women with regular physicians may be more informative than a single model. These results imply that programs designed to increase mammography rates should focus on ensuring appropriate physician recommendations in addition to encouraging women to request screening. Future research should consider using an integrated framework for evaluating utilization of mammography and other preventive services.     

The pattern of attendance at general practice in the years before the diagnosis of cervical cancer. A case control study

The study concerned a nation-wide Danish investigation of 519 women who received the diagnosis of cancer of the cervix uteri in 1983. Data on doctor-contact patterns during the single year, and for the 3 years pre-diagnosis were obtained on 428 of the women (82%), and a comparison was made with an age- and practice-matched control group. Significantly more patients than controls had had no doctor contact, and their odds rate for cancer development was higher than that of the patients who had had at least one contact with their general practitioner during the previous one or three years. Those patients with more advanced stages of cancer, those who had never had a cytological examination, and those living in counties without organized screening programmes were in general the ones with fewest doctor-contacts, and the odds rates for cancer development among the no-contact patients were highest in these groups. No doctor-contact was more common among patients living in counties without organized screening programmes, and these women represented a relatively higher risk group than those living in counties with organized screening. More women are thus caught in the organized screening net, compared with unsystematized screening. The findings support systematic rather than opportunistic unsystematic screening for cancer of the cervix.     

Supplemental Cancer Screening for Women With Dense Breasts: Guidance for Health Care Professionals

Mammography is the standard for breast cancer screening. The sensitivity of mammography in identifying breast cancer, however, is reduced for women with dense breasts. Thirty-eight states have passed laws requiring that all women be notified of breast tissue density results in their mammogram report. The notification includes a statement that differs by state, encouraging women to discuss supplemental screening options with their health care professionals (HCPs). Several supplemental screening tests are available for women with dense breast tissue, but no established guidelines exist to direct HCPs in their recommendation of preferred supplemental screening test. Tailored screening, which takes into consideration the patient’s mammographic breast density and lifetime breast cancer risk, can guide breast cancer screening strategies that are more comprehensive. This review describes the benefits and limitations of the various available supplemental screening tests to guide HCPs and patients in choosing the appropriate breast cancer screening.     

Mammography at a crossroad. How do physicians reconcile conflicting study results with the biologic truths of breast cancer?

The value of routine mammography screening for breast cancer has been the subject of heated debate for much of the last decade. Ten years ago, a baseline mammogram was recommended for women at age 35, and annual mammograms were recommended after age 40. These guidelines were based on the results of mammography trials in Europe and the United States in which a 30% reduction in breast cancer deaths was seen among women who underwent screening.     

Identifying Injection Drug Users at Risk of Nonfatal Overdose

Objectives: Drug overdose is the second leading cause of accidental deaths among U.S. adults aged 15–64 years. Emergency physicians have a unique opportunity to provide overdose prevention interventions, because habitual drug users are in frequent need of medical care. The authors evaluated associations between individual-level risk factors and experiencing an overdose in the past six months to determine which characteristics and behaviors may be most predictive of overdose.
Methods: The authors used data from a sample of street-recruited habitual drug users who participated in face-to-face interviews about overdose from November 2001 to February 2004. This analysis was restricted to 772 respondents who had been injecting for at least one year and who had injected heroin within the past two months.
Results: A total of 16.6% of participants had overdosed in the past six months. Characteristics and behaviors that were independently associated with an increased risk of a recent overdose were having had a prior overdose (odds ratio [OR], 28.58; 95% confidence interval [CI] = 14.10 to 57.96), using cocaine/crack in the past six months (OR, 2.07; 95% CI = 1.25 to 3.45), using alcohol in the past six months (OR, 1.90; 95% CI = 1.01 to 3.57), experiencing serious withdrawal symptoms in the past two months (OR, 2.70; 95% CI = 1.58 to 4.61), and younger age.
Conclusions: Drug users who have previously experienced a nonfatal overdose are at very high risk of experiencing future overdoses. Further longitudinal studies are needed to identify robust predictors of overdose risk over time in habitual drug users, but these data suggest that drug users who have overdosed warrant aggressive prevention efforts such as agonist maintenance treatment or provision of take-home naloxone.     

Asian Indian women: knowledge, attitudes and behaviors toward breast cancer early detection

Education programs have been developed to promote adherence to recommended breast cancer screening guidelines. Few studies have assessed the degree to which ethnic subgroups are perceiving and acting on the proffered information. Such assessment is vital to the creation of efficient public health interventions. This paper describes the reported breast cancer knowledge, attitudes, and screening behaviors of 194 American Asian Indian women. While monthly breast self exam adherence was low, only 40.7%, 61.3% of women 40 and older, and 70% of women 50 and older, reported having had a mammogram within the past 12 months. These rates for annual mammography screening are high relative to many other ethnic groups. While the results are encouraging, the respondents may not be representative of all Asian Indian women. The majority of these women reported that their breast cancer knowledge is inadequate. They were willing to be called upon to share with others any knowledge they gained. There is a clear opportunity for public health nurses to provide Asian Indian women with a more comprehensive understanding of breast health and disease. Those women can then share their health knowledge with other women within their ethnic group.