Communicating breast cancer risk: patient perceptions of provider discussions

This study investigated the relationship between breast cancer risk communication delivered by providers and patient knowledge, perceptions, and screening practices. Telephone interviews were conducted with 141 African American (n = 71) and white (n = 70) first-degree relatives of breast cancer patients who received medical services at 2 university medical centers in North Carolina during 1994-95. Multiple items assessed subjects' reports of discussions with providers about family history and personal risk, knowledge of breast cancer risk factors, risk perceptions, breast cancer concerns, and screening practices. African American (AA) women were less likely than white women to report being informed of their increased personal risk of breast cancer because of family history. After controlling for education level, AA women aged > or = 50 years were less likely than white women to have ever had a mammogram. Both AA and white women who discussed family history and risk with their providers were significantly more likely to have had a mammogram within the past 2 years. Although these discussions seemed to increase participants' perceived risk of developing breast cancer, they did not promote knowledge of risk factors or increase levels of cancer concern. Study results indicate that provider discussions about family history and personal risk, accompanied by increases in risk perception, promote patient compliance with screening goals. Findings suggest that accurate knowledge about specific breast cancer risk factors may not be necessary to achieve screening compliance. However, additional studies are needed to investigate the relationship between knowledge of breast cancer risk factors and the adoption of behaviors associated with reducing breast cancer risk.     

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.     

The Group-Based Medical Mistrust Scale: psychometric properties and association with breast cancer screening

BACKGROUND: There is little research on medical mistrust as a barrier to breast cancer screening. This study investigated the psychometric properties of a new scale, the Group-Based Medical Mistrust Scale (GBMMS), and its association with cancer screening attitudes and breast cancer screening practices among African American and Latina women. METHODS: Participants were 168 African American and Latina urban women who completed the GBMMS and measures of sociodemographics, cancer screening pros and cons, acculturation, breast cancer screening practices and physician recommendation of such screening. RESULTS: A principal components analysis of GBMMS items revealed three factors that were analyzed as subscales: (1) suspicion, (2) group disparities in health care, and (3) lack of support from health care providers. Convergent validity of the GBMMS was supported by its negative association with perceived benefits of cancer screening and acculturation and positive association with perceived disadvantages of cancer screening. Results further showed that women who reported no previous mammogram or a long-term lapse in mammography participation (>5 years) had significantly higher total GBMMS scores (P < 0.04) compared to women who were either adherent to mammography guidelines or nonadherent but reported a mammogram within the past 5 years. This analysis controlled for physician recommendation. CONCLUSIONS: Results support the validity of the GBMMS and its association with breast cancer screening adherence. The GBMMS may be used to further investigate medical mistrust as a barrier to screening for cancers for which ethnic group disparities have been observed.     

Patterns of breast cancer screening among lesbians at increased risk for breast cancer

BACKGROUND: Women with a family history of breast cancer (i.e., in a mother, sister or daughter) are at increased risk for this disease. Previous data also suggest that lesbians are at increased risk for breast cancer. While the screening behaviors of women with a family history have been described, little is known about factors that influence screening behaviors of lesbians with the same risk factor profile. PURPOSE: The purpose of this study was to characterize the perceptions of susceptibility to breast cancer and describe factors that influence adherence to breast cancer screening guidelines in a sample of lesbians with a first-degree relative with a diagnosis of breast cancer. METHODS: Structured telephone interviews were conducted on a sample of 139 self-identified lesbians who had a first-degree relative with a diagnosis of breast cancer, were between the ages of 35 to 75 and had no previous history of cancer. Cross-sectional data obtained, included socio-demographics, breast cancer risk factors, breast cancer screening patterns, breast cancer perceptions, worries, and knowledge, and barriers and access to health care factors. Individual subject characteristics were examined for their association with adherence to mammography guidelines followed by a multivariate analysis to evaluate the most important combinations of factors. Outcome measures were age-specific adherence to ACS guidelines for both mammography and overall adherence (i.e., mammography, clinical breast examination and breast self-examination). RESULTS: The 139 lesbians interviewed for this study were young (mean age = 43), almost exclusively white (94%), highly educated (78% = college graduate and beyond), and partnered (68%). In the bivariate analysis of individual factors, being employed and reporting breast cancer worries were significantly and positively associated with adherence to mammography guidelines. Higher income and insurance type were significantly associated with mammography adherence. No factors were significantly associated with overall adherence. Multivariate logistic regression analyses revealed that only income level and degree of breast cancer worries were significantly and positively associated with mammography adherence. However, since there was a high correlation between income level and employment status, a regression model with employment status and worry was also significantly related to mammography adherence. CONCLUSIONS: In lesbians who are at an increased risk for breast cancer because of family history, breast cancer worries may motivate, rather than deter, adherence for mammography use. High income levels also appear to enable adherence in this population. IMPLICATIONS: Additional studies are needed to validate these findings, identify the prevalence of lesbians in general samples of women at increased risk for breast cancer, and prospectively test lesbian sensitive educational intervention strategies designed to facilitate adherence to mammography screening guidelines in this population.     

Previous Cancer Screening Behavior as Predictor of Endoscopic Colon Cancer Screening Among Women Aged 50 and Over, in NYC 2002

Colon cancer screening rates in women are low. Whether screening for breast and cervical cancer is associated with colon cancer screening behavior is unknown but could provide linkage opportunities. To identify the extent to which both breast and cervical cancer screening increases uptake of colon cancer screening among women in New York City. Women at least 50 years old completed questionnaires for the New York Cancer Project. Analyses compared rates of endoscopic colon cancer screening with adherence to screening recommendations for breast and cervical cancer. Of the 3,386 women, 87.8% adhered to breast and cervical cancer screening guidelines, yet only 42.1% had received endoscopic colon cancer screening. Most women with colon cancer screening (95%) also reported past mammogram and Pap-smear. In multivariable analysis, women who adhered to the other two procedures were more likely to have had colon cancer screening than women with no prior history (OR = 4.4; CI = 2.36, 8.20), after accounting for age, race/ethnicity, insurance status, family history of cancer and income. Significant predictors of endoscopic colon cancer screening included: age over 65 years (OR = 1.63; CI = 1.23, 2.15) with 50–65 years old as the reference, any health insurance (OR = 2.18; CI = 1.52, 3.13) and a family history of cancer (OR = 1.38; CI = 1.17, 1.61). Colorectal cancer screening remains low, even among women who undergo other cancer screening tests. Opportunities to link cancer screening tests to encourage colon cancer screening merit closer attention.     

Predictors of breast cancer screening in a panel study of African American women.

PURPOSE: This study examines the predictors of breast cancer screening participation in a panel study of African American women over age 40. We examine the effect of depression, age, beliefs and concerns about breast cancer and its risk, communication with social networks regarding screening, marital status, participation in religious organizations, breast cancer family history, and participation in a breast cancer education program. METHODS: Participants were recruited from 30 African American churches, two low-income housing projects, and from a health fair at a historically African American University (N = 364). Participants were interviewed upon recruitment, and three months later. Multinomial logistic regression models are estimated to assess the relative impact of covariates on the odds of getting a mammogram while controlling for other factors. We also assess predicted probabilities of screening at specific levels of covariates. RESULTS: We find that age, marriage, an educational intervention, talking with friends, and believing that early detection can lead to cure had a positive impact on getting a mammogram between T1 and T2. In contrast, depression significantly reduces the odds of getting a mammogram. Family histories of breast cancer and church participation have no effect on rates of mammography net of other factors.     

Cancer preventive screening behavior among elderly women

Screening procedures and recommendations for early detection of cervical and breast cancer are reviewed with special reference to suggested guidelines for screening among the elderly. Data on preventive practices related to cancer detection were obtained from 675 women in Maryland by telephone interviews. The elderly (65 years of age and older) reported fewer detection tests of any type; specifically, 23% report never having had a Pap test and an additional 28% have not had one within 5 years, compared with women under the age of 65, where 98% report having had a Pap test and 79% have had one within the past two years. Elderly women were also less likely than younger women to report receiving routine breast examinations by their physicians, to perform BSE, or to have been taught BSE by a health professional. Type of provider utilized, having a personal physician, and going to a gynecologist account for a significant proportion of the variance in screening practices.     

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.     

Determinants of adherence to physical activity guidelines among overweight and obese African American breast cancer survivors: implications for an intervention approach

Objective: Public health agencies encourage breast cancer survivors (BCSs) to follow their physical activity guidelines (PAGs). However, adherence to these guidelines is low. African American (AA) BCSs are more often overweight or obese and less likely than women of other races to report adherence to physical activity recommendations. This study examined socioeconomic, clinical, and psychosocial correlates with meeting PAGs.

Design: AA women diagnosed and treated for breast cancer and participating in a breast cancer support group (N?=?193) completed a lifestyle assessment tool capturing demographic characteristics; breast cancer diagnosis and treatment history; health-related quality of life; weight history, including body mass index and post-diagnosis weight gain; and physical activity. Logistic regressions were used to determine if these covariates were associated with meeting [>8.3 metabolic equivalent task (MET) hr/wk]; partially meeting (4.15–8.3 MET hr/wk); or not meeting (<4.15 MET hr/wk) PAGs.

Results: Only 54% of AA BCSs reported meeting current PAGs. Participants reporting weight gain of ≤5 lbs post-diagnosis, and those who received surgical treatment for breast cancer were more likely to complete at least 8.3 MET hr/wk. Better physical functioning and lesser pain intensity were associated with meeting PAGs.

Conclusion: Several factors influence physical activity behaviors and are likely to be important in developing effective interventions to assist AA survivors manage their weight. It is essential that providers and breast cancer support groups that assist survivors to remain physically active and to manage their weight should be aware of these factors. These findings may help generate hypotheses for future research to undergird efforts to increase physical activity among African American BCSs.     

The Impact of Family History of Breast Cancer on Knowledge,Attitudes, and Early Detection Practices of Mexican Women Along the Mexico-US Border

Rates of breast cancer (BC) have increased in Mexico, with the highest incidence and mortality rates observed in the northern Mexican states. This study aimed to describe the BC knowledge, attitudes and screening practices among Mexican women with and without a family history of BC residing along the Mexico-US border, and identify factors associated with screening behaviors. One hundred and twenty eight Mexican women aged 40 and older completed an interviewer-administered questionnaire on sociodemographic characteristics, knowledge, family history, and screening practices. There were no significant differences between Mexican women with and without a family history. Over 60% of women in both groups had never had a mammogram/breast ultrasound, and more than 50% had never obtained a clinical breast exam. Age, marital status, insurance, and breast cancer knowledge significantly influenced BC screening behaviors among Mexican women. Further research is needed to examine other key factors associated with screening utilization, in effort of improving BC rates.     

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.     

Peer Reviewed: Differences in Knowledge of Breast Cancer Screening Among African American,Arab American,and Latina Women

Introduction

We examined differences in knowledge and socioeconomic factors associated with 3 types of breast cancer screening (breast self-examination, clinical breast examination, and mammogram) among African American, Arab, and Latina women.

Methods

Community health workers used a community-based intervention to recruit 341 women (112 Arab, 113 Latina, and 116 African American) in southeastern Michigan to participate in a breast cancer prevention intervention from August through October 2006. Before and after the intervention, women responded to a previously validated 5-item multiple-choice test on breast cancer screening (possible score range: 0 to 5) in their language of preference (English, Spanish, or Arabic). We used generalized estimating equations to analyze data and to account for family-level and individual correlations.

Results

Although African American women knew more about breast cancer screening at the baseline (pretest median scores were 4 for African American, 3 for Arab and 3 for Latina women), all groups significantly increased their knowledge after participating in the breast cancer prevention intervention (posttest median scores were 5 for African American and 4 for Arab and Latina women). Generalized estimating equations models show that Arab and Latina women made the most significant gains in posttest scores (P < .001).

Conclusion

Racial/ethnic differences in knowledge of breast cancer screening highlight the need for tailored information on breast cancer screening for African American, Arab, and Latina women to promote adherence to breast cancer screening guidelines.     

Breast cancer screening among African American women: adherence to current recommendations

Breast cancer remains one of the leading causes of cancer death among African American women, and rates of mammography screening for African American women remain lower than rates for their Caucasian counterparts. The purpose of the current study was to explore the reasons for nonadherence to American Cancer Society breast screening guidelines among African American women who had not received a mammogram within the past year. Participants included 91 African American women between 40 and 84 years of age recruited from churches, housing projects, and a health fair at a historically African American university who had not received a mammogram within the past 12 months. Findings revealed that 36% of participants had never received a mammogram, 43% did not have their breasts examined by their doctor once a year, 55% did not perform monthly self-examination, and 23% did not know how to examine their breasts for breast cancer. The most frequently reported reason for not getting a mammogram was because the participant's doctor had not suggested it.     

Japanese American women: behaviors and attitudes toward breast cancer education and screening

Moores University of California, San Diego, Cancer Center's Asian Grocery Store-Based Cancer Education Program trained bilingual, bicultural student health educators to provide breast cancer information to Japanese American women. A subset consented to help evaluate the program by completing baseline and follow-up surveys. Study participants reported high adherence to mammography screening guidelines, but lower than optimal adherence to clinical breast examination (CBE) and monthly breast self-examination (BSE) guidelines. While less than half of the women felt they had enough knowledge about breast cancer, nearly all indicated that they would be willing to share any knowledge they gained with loved ones and that their loved ones would be receptive to their information. A limitation of the study is its small sample.     

Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.

Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.     

The impact of family history of breast cancer on women's health beliefs, salience of breast cancer family history, and degree of involvement in breast cancer issues.

Prior investigations have employed the Health Belief Model (HBM) to predict health care utilization and cancer screening behaviors. The HBM is expanded in the current investigation to include issue involvement with breast cancer and salience of breast cancer family history. Differences in the constructs of this expanded HBM, as they relate to mammography screening, between women with positive and negative family histories of breast cancer were assessed in 378 women. Perceived benefits and barriers were found to be similar for women with positive and negative family histories of breast cancer. However, susceptibility, cues to action, salience of family history, and issue involvement were found to be more relevant for women with a positive family history of breast cancer. These findings have implications for interventions directed at increasing compliance with recommendations for breast cancer screening.     

Breast Cancer Prevention Knowledge, Attitudes, and Behaviors Among College Women and Mother–Daughter Communication

Although breast cancer prevention targets mostly women ages 40 and older, little is known about breast cancer prevention for young women and mother’s advice. The purpose of this study was to examine breast cancer prevention knowledge, attitudes, and behaviors among college women and mother–daughter communication. Hispanic and non-Hispanic students at a southwestern university completed a breast cancer prevention survey with items for mother’s advice, breast self-awareness and risk reduction knowledge, self-efficacy, susceptibility, family history, provider breast self-exam (BSE) recommendation, peer norms, BSE practice, and demographics. An openended item was also used to elicit types of mother’s advice. Logistic regression was used to assess predictors for receiving mother’s advice for breast cancer prevention and BSE practice. Self-reported data using a survey were obtained from 546 college women with a mean age of 23.3 (SD = 7.75). Nearly 36 % received mothers’ advice and 55 % conducted BSE. Predictors for receiving mother’s advice were age, self-efficacy, and family history of breast cancer. Predictors for BSE practice were mother’s advice, age, self-efficacy, and provider BSE recommendation. Family history of breast cancer and knowledge were not significant predictors for BSE practice. Findings support the need for clinicians, community health educators, and mothers to provide breast cancer prevention education targeting college women.     

It won't happen to me: lower perception of heart disease risk among women with family histories of breast cancer

BACKGROUND: The threat that breast cancer poses to American women, particularly to women with family histories of the disease, has received widespread attention in both medical and popular literatures. While this emphasis may have laudable consequences on breast cancer screening, it may also have a negative consequence, obscuring women's recognition of their risks for other health threats, such as heart disease. This study examined the possibility that women with family histories of breast cancer may be particularly susceptible to overestimating their risks of breast cancer while minimizing their risks of cardiovascular disease. METHODS: Healthy women with (n = 73) and without n = 104) family histories of breast cancer (64% African American, 26% Caucasian, 10% other ethnicities, mean age 41.7 years) were recruited from medical centers in New York City, and completed questionnaires concerning their family histories and perceptions of risk. RESULTS: Consistent with the study hypothesis, women with family histories of breast cancer had significantly higher perceived lifetime risk of breast cancer (P<0.0002) but lower perceived lifetime risk of heart disease (P<0.002) than women without family histories. Additionally, women with family histories of breast cancer had lower perceived colon cancer risk (P<0.02), suggesting that women with family histories of breast cancer may be underestimating their risks for a variety of diseases. CONCLUSION: The emphasis on breast cancer risk, especially for women with family histories of the disease, may need to be balanced by educational efforts concerning women's risk of other diseases, particularly cardiovascular disease.     

Barriers to breast cancer screening: an integrative review

Breast cancer has been increasing at an alarming rate and is considered to be of epidemic proportions in the United States, with current estimates indicating that 1 in 8 women will develop breast cancer during their lifetimes, according to Breast Cancer Facts and Figures, 1997, by the American Cancer Society [ACS]. In spite of the advances in technology to improve early diagnosis and an increased emphasis on education to promote awareness of early detection, 46,000 women die annually. A significant number of these losses could be prevented through risk reduction measures, yet many women do not practice breast self-exam (BSE) or receive adequate clinical screening. The purpose of this integrative review is to provide an analysis of the barriers to breast cancer screening with recommendations for future research. The studies will be categorized using the three modalities for breast cancer screening, mammography, clinical breast exam (CBE) and BSE. Demographic variables that impede breast cancer screening will be integrated into each section. The evidence is clear that in spite of breast cancer screening guidelines, increased awareness and access to mammography screening, women in the United States are not being screened adequately. Recommendations for future research will be included.