Validity and Reliability of Health Belief Model Questionnaire for Promoting Breast Self-examination and Screening Mammogram for Early Cancer Detection

Background: Early detection of breast cancer is essential in improving overall women’s health. The researchers sought to develop a comprehensive measure that combined the basic components of the health belief model (HBM) with a focus on breast self-examination (BSE) and screening mammogram amongst women.Methods: Questionnaire items were developed following a review of relevant literature of HBM on BSE and screening mammogram. The sampling frame for the study was Malaysian women aged 35 to 70 years old, living in Kuantan, Pahang and able to read or write in Bahasa Malaysia or English. As such, 103 women were randomly selected to participate in the study. Tests of validity using exploratory factor analysis (EFA) and reliability were subsequently performed to determine the psychometric properties of the questionnaire. Results: The EFA revealed nine factors (self-efficacy of mammogram, perceived barriers of BSE and mammogram, perceived susceptibility of breast cancer, perceived severity of breast cancer, cues to action for mammogram screening, perceived benefits of BSE, health motivation, perceived benefits of mammogram and self-efficacy of BSE) containing 54 items that jointly accounted for 74.2% of the observed variance. All nine factors have good internal consistency with Cronbach’s alpha ≥ 0.8. Fifty-four items remained in the final questionnaire after deleting 13 problematic items. The scale also showed good convergent and discriminant validity.Conclusion: The findings showed that the designed questionnaire was a valid and reliable instrument for the study involving women in Kuantan, Pahang. The instrument can help to assess women’s beliefs on BSE adoption and mammogram screening in health care practice and research.     

The associations between psychological distress and cancer prevention practices

The aim of the current study was to determine the extent to which psychological distress is associated with cancer prevention practices among otherwise healthy adults in the community (N=30,223). Using data from the 2000 National Health Interview Survey, a series of multiple logistic regression analyses were used to estimate the associations between psychological distress and selected cancer prevention practices. Results indicate that psychological distress was directly associated with an increased likelihood of daily cigarette smoking, physical inactivity, and obesity. Only smoking status mediated the relation between psychological distress and perceived cancer risk. Individuals who reported higher psychological distress were more likely to engage in specific cancer screenings before reaching the recommended age. This effect was partially mediated by perceived cancer risk. The higher levels of cigarette smoking and physical inactivity among psychologically distressed adults support the need for integration of cancer prevention and mental health interventions to reduce specific cancer risk in high-risk adults. Further research is needed to differentiate the causal pathways and mechanisms linking heightened individual cancer risk, potentially comorbid mental disorders or psychological conditions, and cancer screening adherence.     

Perceived risk of colorectal cancer: sources of risk judgments.

Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-preventive behavior research. This study describes studies using complimentary methodologies to investigate the determinants of perceived risk of developing colorectal cancer. In study 1, questionnaires were mailed to a community sample of 1,056 adults ages 45 to 65 years. They assessed risk factors for colorectal cancer and perceived risk of colorectal cancer and asked respondents to explain why they had rated their risk as they had. Consistent with previous studies, risk factors for colorectal cancer were significantly correlated with perceived risk, although associations were relatively weak. The most frequently cited reasons for risk judgments were diet, family history, and symptoms/general health. Not surprisingly, correlations between each risk factor and perceived risk were stronger among participants who had attributed their risk to that factor. Study 2 used semi-structured interviews to explore individuals' explanations for their perceived risk of colorectal cancer. Adults (n = 18) ages 60 to 63 years volunteered a variety of explanations, but their experiences of cancer seemed to be most salient to their risk estimates. These studies suggest that attributions people make for their risk judgments are important in understanding how they conceptualize risk, but appreciation of experiential and affective influences may be useful in fully understanding perceptions of risk.     

Screening and Perceived Severity of Cervical Cancer among Women Attending Mahalapye District Hospital,Botswana

Objectives: The objectives of the study were to describe women’s perceived severity to cervical cancer andits associations with socio-demographic characteristics. Methods: A cross-sectional study was conducted by aquestionnaire survey with a total of 300 participants selected by convenience sampling techniques. Results: Theparticipants’ mean age was 37years (SD=11) and the cervical cancer screening rate was 39%. Most of the womenwere sure about the severity of cancer as they responded mostly agreeing or strongly agreeing with statementsabout severity of cervical cancer. The range of average responses was 2.58 to 3.56. When the ever screened andthe never screened for cervical cancer was compared, it was observed that both groups equally believed thatthere is effective treatment for cervical cancer, and that cervical cancer makes a woman’s life difficult. Overall,60% of the never screened had low perceived severity while 33% of the screened had high perceived severity tocervical cancer. There was no significant association between perceived severity and screening for cervical cancer(c2 = 1.0795; p = 0.2988). Monthly income (c2=13.077; p<0001) and residential area (c2=15.457; p=0.004) weresignificantly associated with perceived severity. Conclusion: The screening rate is still far too low compared tothe national target of greater than 75%. Therefore, despite awareness of the perceived severity of cervical cancer,the reasons why at risk women fail to participate in cervical cancer screening need to be adequately explored.     

Risk perception and concern among brothers of men with prostate carcinoma

BACKGROUND: It is important for clinicians, researchers, and others who shape public health policy to understand the demographic correlates and psychologic factors that drive health behaviors, such as screening for early detection of cancer, particularly among individuals at high risk for developing the disease. METHODS: One-hundred eleven men whose brothers were diagnosed with prostate carcinoma completed a computer-assisted telephone interview aimed to assess their perception of absolute risk and concern about developing prostate carcinoma over the next 10 years and across their lifetime. Comparisons were made between selected demographic, behavioral, family pedigree characteristics, and measures of perceived risk and concern. RESULTS: The majority of men perceived their personal risk of developing prostate carcinoma to be > or =50%. Men who at the time of the interview were younger than their affected brother were significantly more concerned about prostate carcinoma and perceived their risk to be higher than men who were older than their brother. Estimates of personal risk and concern were also uniformly higher among men with more than one first-degree relative affected with prostate carcinoma compared to men with only one affected first-degree relative. Risk perception and concern about an impending prostate carcinoma diagnosis were associated with the use of supplements marketed for prostate health. CONCLUSIONS: The findings indicated that birth order in relation to a brother diagnosed with prostate carcinoma is significantly associated with risk perception and concern in unaffected family members. These results highlight the need for further study of the familial dynamics and characteristics that drive health behaviors and stress importance of public health education to inform men of personal risk assessment as well as the risks and benefits of screening. These studies ultimately can contribute to the success of strategies for the primary prevention and early detection of cancer.     

Prevalence of Cigarette Smoking and Associated Factors among Secondary School Teachers in Malaysia

Objective: The smoking prevalence in Malaysia is high, especially among men and adolescents. This studyaimed to determine the prevalence and associated factors towards cigarette smoking among school teachers inMalaysia. Methodology: This study was a school-based cross-sectional study conducted among 495 secondaryschool teachers. The questionnaire used in this study consisted of 29 questions categorized into two sections:socio-demographic characteristics and smoking behaviour. Data were analyzed using the Statistical Packagefor the Social Sciences (SPSS) program 13.0. ANOVA; t-tests were used in univariate analysis; multiple linearregression was applied for multivariate analysis. Results: The majority of the participants were female (81.6%),in the age group ranged between 30-39 years (44%), Malay (90.1%), married (89.7%), degree holders (85.1%),with monthly income ranged between 3000-3999 Ringgit Malaysia (33.5%), from urban areas (94.7%), theirspecialty is social studies (33.9%) and with no family history of cancer (83.6%). The prevalence of smokingamong school teachers in Malaysia was found to be 7.8%. Regarding reasons to start smoking among schoolteachers: the major reason was found to be relaxation (33.3%), followed by stress-relief (28.2%). Univariateanalysis showed that sex, educational status, monthly income and residency were significantly associated withsmoking among school teachers (p<0.001, p=0.004, p=0.031, p=0.010; respectively). Multivariate analysis showedthat gender and marital status were significantly associated with smoking among school teachers (p<0.001,p=0.033; respectively). Conclusion: The prevalence of smoking among school teachers in Malaysia was foundto be relatively low. Sex, marital status, educational status, monthly income and residency were significantlyassociated with smoking among school teachers.     

Associations between perceived cancer risk and established risk factors in a national community sample

INTRODUCTION: Perceptions of personal cancer risk may not accurately reflect individual's exposure to established risk factors. The purpose of this study was to assess associations between perceived cancer risk and selected established risk factors, using a large nationally representative sample. METHODS: We used data from the 2000 National Health Interview Survey (NHIS) to perform a cross-sectional analysis of 30,223 adults without a cancer diagnosis. Multinominal logistic regression analyses were used to assess factors associated with medium and high perceived cancer risk. RESULTS: The effects of age, family history, and smoking status on perceived risk were linear and more pronounced on those with high perceived risk. High perceived risk was associated with every day smoking (relative risk ratio [RRR] = 4.27, 95% confidence intervals [CI] = 3.65-5.01), alcohol consumption (e.g. RRR = 1.26, 95% CI = 1.01-1.56 for current drinker), number of relatives with cancer (e.g. RRR = 20.64, 95% CI = 16.37-26 for those with both parents positive), low income (RRR = 1.25, 95% CI = 1.08-1.45), and female (RRR = 1.39, 95% CI = 1.23-1.57). Obesity (RRR = 1.32, 95% CI 1.1-1.6), but not overweight, was identified as an independent determinant. High perceived risk was inversely related to age (e.g. RRR = 0.19, 95% CI = 0.16-0.24 for adults 60 and older). Ethnic minorities were less likely to perceive cancer risk. Physical inactivity was not associated with high perceived risk. CONCLUSIONS: Among established risk factors, family history appears to be most reflected in the single measure of perceived cancer risk. The relationship between perceived cancer risk and exposure to established risk factors differs in important ways from what public campaigns have communicated with the public. Prevention messages should highlight that cancer risk increases with age and certain modifiable risk factors, including overweight and physical inactivity. The relationship between cancer risk perceptions and ethnicity merits further exploration.     

Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab,India

Objective: Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city. Methods: In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females. Results: Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women. Conclusion: Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer.     

Assessment of the Risk of Breast Cancer Development Applying NCI Tool among Iraqi Women

Objective: As part of the bioinformatics studies, we utilized National Cancer Institute (NCI)’s Breast Cancer Risk Assessment Tool to estimate the five-year period and lifetime risk of breast cancer development among Iraqi risky women. Methods: Totally, 110 risky women aged 21-67 (mean=36±7.4) years were interviewed by a series of questions regarding the risk of breast cancer development. Moreover, 100 cases with mutation in the BRCA1 or BRCA2 genes were included. Results: Our results demonstrated that the patient’s estimated risk of breast cancer development during the next five years and lifetime (until the age 90 years) included 0.96% (p=0.211) and 9.97% (p=0.002), respectively being relatively low. Accordingly, the lifetime risk for the breast cancer development was significantly higher (10.38%) than that of 5-year. However, the age of patients was not significantly associated to the breast cancer development as there was no significant difference among various age groups. Conclusion: It was concluded that long-term or lifetime period plays as a significant risk factor for developing breast cancer among female patients who had had a screening episode in Iraq.     

Determinants of colorectal cancer screening behavior among Chinese Americans

Colorectal cancer (CRC) is the most commonly diagnosed cancer among Chinese Americans and is the third leading cause of cancer death in this population. The objectives of this study were to determine the rates of CRC screening (via fecal occult blood test (FOBT), flexible sigmoidoscopy (FSIG), and colonoscopy) among Chinese Americans and predictors of utilizing these screening procedures. Participants (N = 206) completed a self-administered questionnaire assessing cancer screening behaviors and beliefs about perceived risk of developing cancer and treatment efficacy. A series of logistic regressions indicated that physician recommendation to obtain CRC screening significantly predicted whether Chinese Americans undergo FOBT, FSIG, or colonoscopy screening (p < 0.001). Acculturation and perceived risk of developing CRC did not predict obtaining any of the screening procedures. FOBT was the most commonly reported screening method used by respondents (65%), followed by FSIG (54%) and colonoscopy (49%). These findings highlight the need to make physicians more aware of the impact their recommendations have in determining CRC screening behavior among Chinese Americans.     

Incidence of and Risk Factors for Tuberculosis among Cancer Patients in Endemic Area: A Regional Cohort Study

Background and Objective: Cancer is a known risk factor for developing active tuberculosis (TB) disease. The incidence of and risk factors for TB are not known among cancer patients in Thailand. This study aimed to investigate risk factors for TB among cancer patients in an area with endemic TB infections. Methods: We used the Khon Kaen population–based cancer registry and two TB databases to conduct a retrospective cohort study of cancer patients. From 2001 to 2015, we identified 40,948 eligible cancer patients. Following until 2017, we identified cases of TB diagnosed after cancer diagnosis and analyzed primary cancer site, staging, treatment, and demographic factors. Adjusted incidence rate ratios (adj. IRR) were computed to identify risk factors among a sub–set of cancer types (n = 9,733) using Poisson regression. Results: Among all cancer patients, 472 cases of TB were diagnosed following cancer diagnosis (cumulative incidence = 1.15%, incidence rate = 421.86 cases per 100,000 patients per year). Among the sub–set of cancer types, 206 cases of TB were found (cumulative incidence = 2.11%, incidence rate = 848.26 cases per 100,000 patients per year). Risk factors for TB among cancer patients were sex (p < 0.001) (male adj. IRR  = 1.87, 95% CI: 1.36–2.59), age (p < 0.001) (age >70 adj. IRR  = 2.36, 95% CI: 1.56-3.55, compared to age ≤50) and cancer site (p < 0.001). Compared to thyroid cancer, TB infection was more associated with lung cancer without histopathological confirmation (adj. IRR  = 6.22, 95% CI: 2.57–15.04). Cancer stage and treatment did not show statistically significant trends. Conclusion: Old age, male sex, and certain cancer types were independent risk factors for TB in cancer patients. Targeted latent TB screening may be appropriate among high risk groups.     

Breast Cancer Awareness of Rural Women in Malaysia: is it the Same as in the Cities?

Breast cancer is the most common cancer among women globally. This study was conducted to compare theawareness of breast cancer and the practice of breast self-examination (BSE), clinical breast examination (CBE)and mammography screening among rural females in Pahang and Perak. A cross-sectional study was carried outin five selected rural districts of Pahang and Perak. Two hundred and fifty households were randomly selectedand interviewed face to face using a semi-structured questionnaire. The majority of residents from both stateswere Malay, aged between 50 and 60 years and had a secondary level of education. Malay women aged 40–49years and women with a higher level of education were significantly more aware of breast cancer (p<0.05). Abouthalf of these women practiced BSE (60.7%) and CBE (56.1%), and 7% had underwent mammography screening.The results of this study suggest that women in Pahang and Perak have good awareness of breast cancer andthat more than half practice BSE and CBE. The women’s level of education appears to contribute to their levelof knowledge and health behaviour. However, more effort is needed to encourage all women in rural areas toacquire further knowledge on breast cancer.     

Food intake and risk of squamous cell carcinoma of the skin in a community: the Nambour skin cancer cohort study

There is some evidence that dietary factors may modify the risk of squamous cell carcinoma (SCC) of the skin, but the association between food intake and SCC has not been evaluated prospectively. We examined the association between food intake and SCC incidence among 1,056 randomly selected adults living in an Australian sub-tropical community. Measurement-error corrected estimates of intake in 15 food groups were defined from a validated food frequency questionnaire in 1992. Associations with SCC risk were assessed using Poisson and negative binomial regression to the persons affected and tumour counts, respectively, based on incident, histologically confirmed tumours occurring between 1992 and 2002. After multivariable adjustment, none of the food groups was significantly associated with SCC risk. Stratified analysis in participants with a past history of skin cancer showed a decreased risk of SCC tumours for high intakes of green leafy vegetables (RR = 0.45, 95% CI = 0.22-0.91; p for trend = 0.02) and an increased risk for high intake of unmodified dairy products (RR = 2.53, 95% CI: 1.15-5.54; p for trend = 0.03). Food intake was not associated with SCC risk in persons who had no past history of skin cancer. These findings suggest that consumption of green leafy vegetables may help prevent development of subsequent SCCs of the skin among people with previous skin cancer and that consumption of unmodified dairy products, such as whole milk, cheese and yoghurt, may increase SCC risk in susceptible persons.     

Perceived risk for gastric cancer among the general Korean population: a population‐based survey

Objective: We measured the perceived risk for developing gastric cancer and investigated how a range of socio‐demographic, lifestyle, health, and psychological factors were associated with risk perception in a population‐based sample in Korea. Methods: This study was based on the 2006 Korean National Cancer Screening Survey conducted by the National Cancer Center, in which trained interviewers met face‐to‐face with participants selected by a nationally representative random sampling. The participants included 1673 adults, aged 40 years or older, who had not previously been diagnosed with cancer. Simple and multiple ordinal regression were used to determine the associations between perceived risk and socio‐demographic, lifestyle, health, and psychological factors. Results: Almost half of the subjects (48.3%) thought their chance of developing gastric cancer was lower than that of other men or women of the same age. A higher level of worry concerning gastric cancer was strongly associated with a higher perceived risk for gastric cancer development. Those who drink alcohol two or more days per week, and who are unmarried all perceived their risk as being higher. However, those without a previous gastric cancer screening, a personal history of gastric disease, or a good overall health status had a lower perceived risk for gastric cancer development. Conclusion: This study found comparative optimism about the risk for developing gastric cancer in a Korean population. It is necessary to increase people's ability to accurately perceive their risk for cancer. Copyright © 2008 John Wiley & Sons, Ltd.     

Perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer

As more women survive the experience of breast cancer, it is essential to discover the impact it has on a woman's life. The purpose of this study was to determine differences in perceived health, self-esteem, health habits, and perceived benefits and barriers to exercise in women who have and who have not experienced stage I breast cancer and its treatment. A random sample of 55 women who have experienced stage I breast cancer and have not received adjuvant therapy was selected and matched to a cohort of women in the community who had not experienced cancer. No significant differences were found in perceived health, self-esteem, and health habits between women who had experienced breast cancer and the matched cohorts. There was a significant difference in both perceived benefits and barriers to exercise between groups (t = 2.4, df = 106, p = 0.18), with the matched cohorts scoring higher on perceived benefits and barriers to exercise.     

Has the investment in public cancer education delivered observable changes in knowledge over the past 10 years?

BACKGROUND: During the 1990s, Western countries, such as Australia, directed substantial funds toward public cancer education. An important indicator of whether this investment has been worthwhile is a shift over time in the proportion of the population who have accurate knowledge regarding cancer. METHODS: In the year 2000, a cross-sectional telephone survey was administered to 685 residents selected from the New South Wales (Australia) Electronic White Pages telephone directory. This study replicated in part a survey conducted in 1989. RESULTS: In the 2000 survey, smoking (96.0%) and sun exposure (80.4%) were well-known as risk factors for lung cancer and melanoma, respectively. However, community knowledge of risk factors for colorectal, breast, cervical, and prostate cancer was poor. Most respondents were able to nominate mammograms (82.2%) and Pap tests (86.8%) as screening tests for breast and cervical cancer, respectively. Approximately two-thirds of the sample were able to nominate foods that reduce the risk of developing cancer. Compared with the 1989 data, there appeared to have been improvements in community knowledge of mammograms as a screening test for breast cancer. For the other cancers, knowledge gains appeared smaller or marginal. With regard to the lifetime risk of developing these cancers, community understanding remains poor. Predictors of greater knowledge include a higher level of education. CONCLUSIONS: Where ongoing investments have been made, like in the case of breast cancer education, there have been improvements in community knowledge. However, major challenges remain. Potential targets for future public education campaigns are discussed.     

Body mass, polymorphisms in obesity-related genes, and the risk of developing breast cancer among women with benign breast disease

BACKGROUND: A cohort study was conducted among post-menopausal women to determine whether genetic polymorphisms in selected obesity-related genes (PPARG, LPL, LEPR, PON1, PON2, TNF-alpha) were associated with the progression of benign breast disease (BBD) to breast cancer and whether the selected polymorphisms modified the association between body mass and breast cancer among women with BBD. METHODS: Among participants in an ongoing cohort study, 994 Caucasian post-menopausal women had a breast biopsy for BBD. Of these women, 61 subsequently developed breast cancer. A short questionnaire was administered at baseline in 1989. Genotypes were determined using DNA extracted from blood collected in 1989. RESULTS: In this cohort, body mass index (BMI) was positively associated with the risk of developing breast cancer. In contrast, polymorphisms in PON1 (Gln192Arg) and LEPR (IVS2+6920) were associated with a decreased risk of developing invasive breast cancer. No statistically significant associations were observed for polymorphisms in PPARG, PON2, LPL, or TNF and breast cancer risk or for interactions between the polymorphisms and BMI and breast cancer risk. CONCLUSIONS: The findings suggest that specific polymorphisms in the PON1 and LEPR genes may play a role in progression of BBD to breast cancer among post-menopausal Caucasian women.     

Association of interleukin-18 gene promoter polymorphism on the risk of cervix carcinogenesis in north Indian population

Cervical cancer is one of the most common neoplastic diseases affecting women, with a combined worldwide incidence of almost half a million new cases. Considering the fact that IL-18 plays an important role in the interactions among T cells, NK cells, and macrophages and induces IFN-gamma production, efforts should be made to understand the clinical impact of IL-18 cytokine in patients with solid malignancies, as not much study has been conducted in cervix carcinoma. In this study, we have observed in GC genotype statistically significant marginal increased risk of developing of cervical cancer (OR 1.8, 95% CI 1.17-2.76, p = 0.006). Similarly, when the GC with CC genotypes were combined results were once more statistically significant with borderline risk of developing cervix cancer (OR 1.6,95% CI 1.09-2.50, p = 0.01). Likewise, we found statistically significant increased risk between cases and controls in GC genotype and passive smokers with risk of cervical cancer (OR 4.3, 95%CI 2.13-8.99, p = 0.00001). Our investigation suggests that IL-18 gene -137 in different genotypes, as also in passive smokers, may increase risk of cervix carcinogenesis in north Indian women.