Breast screening and health issues among rural females in Malaysia: How much do they know and practice?

ObjectiveThis study investigated rural women's knowledge of breast cancer and screening methods by ethnicity and examined the predictors of breast screening methods.MethodsA cross-sectional survey was conducted in 2011 in five rural districts of Perak; 959 women were interviewed using a semi-structured questionnaire. ANOVA and regression analysis were used in data analysis.ResultsWomen below 50 years old, of Malay ethnicity and who had secondary education scored better than those older, of Chinese ethnicity and had primary education (p < 0.001). The uptake of breast self-examination (BSE), clinical breast examination (CBE) and mammogram was 59%, 51% and 6.8%, respectively. Multivariate analysis revealed knowledge of breast cancer and CBE as top predictors of BSE, being married and knowledge of breast cancer as top predictors for CBE; and CBE as the top predictor of mammography uptake. Support from husbands and family members for breast cancer screening was a predictor for CBE and BSE.ConclusionKnowledge of breast cancer and its screening uptake varies by ethnicity, location and the type of support received. Efforts and approaches to improve the women's knowledge of breast cancer and its screening uptake therefore should be customized to address the different influencing factors.     

Acculturation and breast cancer screening among Hispanic women in New York City.

OBJECTIVES: This study investigated whether acculturation was associated with the receipt of clinical breast examinations and mammograms among Colombian, Ecuadorian, Dominican, and Puerto Rican women aged 18 to 74 years in New York City in 1992. METHODS: A bilingual, targeted, random-digit-dialed telephone survey was conducted among 908 Hispanic women from a population-based quota sample. Outcome measures included ever and recent use of clinical breast examinations and mammograms. Multivariate logistic regression models were used to assess the effect of acculturation on screening use. RESULTS: When demographic, socioeconomic, and health system characteristics and cancer attitudes and beliefs were controlled for, women who were more acculturated had significantly higher odds of ever and recently receiving a clinical breast examination (P < or = .01) and of ever (P < or = .01) and recently (P < or = .05) receiving a mammogram than did less acculturated women. For all screening measures, there was a linear increase in the adjusted probability of being screened as a function of acculturation. CONCLUSIONS: Neighborhood and health system interventions to increase screening among Hispanic women should target the less acculturated.     

Predictors of Breast Cancer Worry in a Hispanic and Predominantly Immigrant Mammography Screening Population

ObjectiveWorry about developing breast cancer (BC) has been associated with participation in screening and genetic testing and with follow-up of abnormal screening results. Little is known about the scope and predictors of BC worry in Hispanic and immigrant populations.MethodsWe collected in-person interview data from 250 self-identified Hispanic women recruited from an urban mammography facility (average age 50.4 years; 82% foreign-born). Women reported whether they worried about developing breast cancer rarely/never (low worry), sometimes (moderate worry), or often/all the time (high worry). We examined whether sociocultural and psychological factors (e.g., acculturation, education, perceived risk), and risk factors and objective risk for BC (e.g., family history, Gail model 5-year risk estimates, parity) predicted BC worry using multinomial and logistic regression.ResultsIn multivariable models, women who perceived higher absolute BC risk (odds ratio, 1.66 [95% confidence interval, 1.28–2.14] for a one-unit increase in perceived lifetime risk) and comparative BC risk (e.g., odds ratio, 2.73, 95% confidence interval, 1.23–6.06) were more likely to report high BC worry than moderate or low BC worry. There were no associations between BC worry and indicators of objective risk or acculturation.ConclusionsIn Hispanic women undergoing screening mammography, higher perceptions of BC risk, in both absolute and comparative terms, were associated independently with high BC worry, and were stronger predictors of BC worry than indicators of objective BC risk, including family history, mammographic density, and personal BC risk estimates.     

Longitudinal Patterns of Breast Cancer Screening: Mammography,Clinical, and Breast Self-Examinations in a Rural and Urban Setting

BackgroundWe identified breast screening patterns over time and patterns among women residing in rural and urban areas by sociodemographic factors.MethodsThis study employs a longitudinal design over 9 years from 2001 on 11,200 women aged 50 to 55 from the Australian Longitudinal Study on Women's Health. Area of residence was defined in accordance with the accessibility remoteness index of Australia Plus. Breast screening measures included mammography utilization, clinical breast examinations (CBE), and breast self-examinations (BSE).FindingsMost women had a mammogram in the past 2 years in combination with CBE or BSE or both. Despite poorer access to mammography services, women residing in rural areas had similar mammography screening rates to their urban counterparts. Women residing in rural areas were less likely to have CBEs, but more likely to conduct BSEs. The breast screening behaviors were generally consistent over time.ConclusionsThe poorer breast cancer survival among rural women is unlikely to be explained by differences in mammography service use. A substantial proportion of the population may be experiencing overscreening by conducting all three types of breast screening.     

Three-Year Prospective Adherence to Three Breast Cancer Screening Modalities

Background.This study prospectively examined rates of adherence to mammography, clinical breast examination (CBE), and breast self-examination (BSE) in a cohort of women over 3 years to determine whether participation in BSE influenced participation in the other two screening modalities.Methods.Women ages 51 and older (n= 450) who attended a small group educational session to learn BSE and to hear about CBE and mammography guidelines were assessed annually by telephone for 3 consecutive years to determine their subsequent breast cancer screening behavior.Results.Annual CBE and mammography screening are highly positively associated. Regular performance of BSE has a modest positive association with both CBE and mammography adherence over time.Conclusions.Women who perform BSE regularly over time may be more likely to adhere to the other breast cancer screening guidelines.     

Breast Cancer Knowledge, Attitude and Screening Behaviors Among Hispanics in South Texas Colonias

This study examines breast cancer knowledge, attitudes and screening behaviors of Hispanic women living in the South Texas colonias of Maverick and Val Verde Counties. We used the Health Belief Model to analyze the effects of HBM constructs on clinical breast exam (CBE) and mammogram screening. Using a multistage systematic sampling approach we interviewed women living within these colonias. Logistic regression analysis was used to predict CBE and mammography screening behaviors. The results indicate that knowledge, susceptibility, barriers and source of health information were statistically significant in predicting CBE among these women. In addition, background variables such as marital status and health insurance were also significant in predicting CBE. Findings further indicate that source of health information, barriers, and health insurance significantly predicts mammography screening behaviors. Results suggest that for women living in colonias along the South Texas Border socio-demographic variables play a significant role in CBE and mammography utilization.     

An Integrative Review on Breast Cancer Screening Practice and Correlates Among Chinese,Korean, Filipino,and Asian Indian American Women

Abstract

Breast cancer is the leading cancer diagnosed among Chinese, Filipino, and Korean women. Despite the efficacy of breast cancer screening, Asian American women have one of the lowest rates of mammography and clinical breast exam (CBE) of all U.S. ethnic groups. I provided a systematic overview to document factors related to three modalities of breast cancer screening (breast self-exam [BSE], CBE, and mammography) among four subgroups of Asian American women (i.e., Chinese, Korean, Filipino, and Asian Indian). Results showed that the existing studies provided evidence of demographic correlates to screening practice; however, fewer studies focused on cognitive and social–cultural correlates, and limited results were available with Filipino and Asian Indian groups.     

Breast self-examination: Knowledge and practices of Hispanic women in two southwestern metropolitan areas

The breast self-examination (BSE) practices of 1,453 Hispanic women in Phoenix, Arizona and San Diego, California were the focus of this study. Variables proposed as factors that influence the frequency and proficiency of BSE were demographic variables, particularly language and level of acculturation, having been taught BSE by a health professional, and experience with the disease. Results indicate that even though the majority of the women at both the Phoenix (78.1%) and San Diego (83.7%) sites had been taught BSE by a professional and most women in Phoenix (62.5%) and San Diego (63.4%) reported performing BSE within the past month, only 0.7% of the women at both sites were found to be proficient in the technique of BSE. Further, results indicate that language and acculturation were correlated with whether or not a woman performed BSE. These findings suggest that BSE education classes must provide information and techniques that promote proficiency in BSE, and must be designed to meet the unique needs of Hispanic women, particularly those of low acculturation levels.Work on this study was partially supported by grant 5 R01-CA57140-03 from the National Cancer Institute.     

Opening Pathways to Cancer Screening for Vietnamese-American Women: Lay Health Workers Hold a Key

Purpose.We describe a controlled trial of a community outreach intervention to promote recognition, receipt, and screening-interval maintenance of clinical breast examinations (CBE), mammograms, and Pap smears among Vietnamese-American women.Methods.Over a 3-year period, indigenous lay health workers conducted small-group sessions of Vietnamese women in a low-income district of San Francisco, California. Women in Sacramento, California, served as controls. Lay workers conducted 56 sessions on general prevention, 86 on cervical cancer, and 90 on breast cancer. Surveys of 306 to 373 women were conducted in the study communities in 1992 and 1996.Results.In the intervention community, recognition of screening tests increased significantly between pre- and postintervention surveys: CBE, 50 to 85%; mammography, 59 to 79%; and Pap smear, 22 to 78% (P= 0.001 for all). Receipt of screening tests also increased significantly: CBE, 44 to 70% (P= 0.001); mammography, 54 to 69% (P= 0.006); and Pap smear, 46 to 66% (P= 0.001). Best-fitting logistic regression models, adjusting for preintervention rates and significant covariates, also showed statistically significant odds ratios for the intervention effect (P< 0.0001).Conclusions.Trained Vietnamese lay health workers significantly increased Vietnamese women's recognition, receipt, and maintenance of breast and cervical cancer screening tests.     

An integrative review on breast cancer screening practice and correlates among Chinese, Korean, Filipino, and Asian Indian American women

Breast cancer is the leading cancer diagnosed among Chinese, Filipino and Korean women. Despite the efficacy of breast cancer screening, Asian American women have one of the lowest rates of mammography and clinical breast exam (CBE) of all U.S. ethnic groups. I provided a systematic overview to document factors related to three modalities of breast cancer screening (breast self-exam [BSE], CBE and mammography) among four subgroups of Asian American women (i.e., Chinese, Korean, Filipino, and Asian Indian). Results showed that the existing studies provided evidence of demographic correlates to screening practice; however, fewer studies focused on cognitive and social-cultural correlates, and limited results were available with Filipino and Asian Indian groups.     

Multiple Measures of Physical Activity,Dietary Habits and Weight Status in African American and Hispanic or Latina Women

Compared measures of physical activity and dietary habits used in the Health Is Power (HIP) study, and described the associations of physical activity and dietary habits among African American and Hispanic or Latino women, adjusted for weight status. Cross-sectional baseline data were compared for community dwelling, healthy African American (N = 262) and Hispanic or Latina women (N = 148) who participated in HIP. Physical activity was measured using the International Physical Activity Questionnaire (IPAQ) long form, the Check And Line Questionnaire (CALQ) log and accelerometry. Dietary habits were measured using NCI 24-h recall screeners, vegetable and fruit (VF) logs and the NCI Diet History Questionnaire (DHQ). Differences in physical activity and dietary habits were assessed using simultaneous 2 (ethnicity) × 3 (weight status) ANCOVAs adjusted for age and socioeconomic status. Women (M age = 44.4 ± 10.9 years) were obese (M = 34.0 ± 9.7 kg/m²), did not meet physical activity guidelines as measured by accelerometry (M = 19.4 ± 19.1 min MVPA/day) and ate few VF (M = 2.8 ± 2.7 servings/day). DHQ variables differed by weight status. IPAQ was associated with CALQ, and CALQ with accelerometry (P < .05). IPAQ was not associated with accelerometry. Regardless of ethnicity, normal weight women did more physical activity, reported more VF consumption, and consumed more fat calories than overweight and obese women (Ps < .05). African American women did more MVPA than Hispanic or Latino women (P < .001). Relationships between behaviors and weight status suggest accelerometry and DHQ are preferable, regardless of ethnicity; and studies may capture different domains of physical activity and dietary habits depending on measure used.     

Factors associated with routine screening for the early detection of breast cancer in cultural-ethnic and faith-based communities

Objectives: Studies have shown a lower adherence to health behaviors among women in cultural-ethnic minorities and faith-based communities, especially lower screening attendance for the early detection of breast cancer. This study compares factors related to cancer screening adherence in two distinct cultural-ethnic minorities in Israel: Arab women as a cultural-ethnic minority and Jewish ultra-Orthodox women as a cultural-ethnic faith-based minority.

Design: During the year 2014, a total of 398 Jewish ultra-Orthodox women and 401 Arab women between the ages of 40–60, were randomly selected using population-based registries. These women answered questionnaires regarding adherence to mammography and clinical breast examination (CBE), health beliefs and cultural barriers.

Results: Arab women adhered more than ultra-Orthodox women to mammography (p?<?.001) and CBE exams (p?<?.01). Religious beliefs, exposure barriers and perceived risk were higher among the ultra-Orthodox women, while social barriers, accessibility barriers and perceived severity were higher among the Arab women (p?<?.01). Adjusting for background factors, higher adherence to CBE and mammography were associated with lower levels of religious beliefs (AOR?=?0.90, 95% CI?=?0.69–1.17 AOR?=?0.62, 95% CI?=?0.39–0.82, respectively), perceiving a higher risk of cancer (AOR?=?1.93, 95% CI?=?1.23–3.04 and AOR?=?3.22, 95% CI?=?1.53–6.61), and having more fears related to cancer-related losses (AOR?=?1.51, 95% CI?=?1.19–3.00 and AOR?=?1.24, 95% CI?=?0.63–1.22). In addition, perceiving greater advantages of CBE was associated with higher adherence to CBE (AOR?=?1.82, 95% CI?=?1.45–2.29), while not receiving a physician’s recommendation was associated with lower adherence to mammography (AOR?=?1.82, 95% CI?=?1.45–2.29).

Conclusion: This study addressed a lacuna in screening behaviors of women from cultural-ethnic and faith-based communities. In order to increase adherence, health care professionals and policymakers should direct their attention to the specific nature of each community.     

The Influence of Relationship Power and Partner Communication on the Syndemic Factor among Hispanic Women

BackgroundThis study expands research on the substance abuse, intimate partner violence, human immunodeficiency virus (HIV), and depression syndemic theory for Hispanic women. We hypothesized relationship power and partner communication would be related to the syndemic.MethodsData were used from the baseline assessment of an effectiveness trial of SEPA (Salud/Health, Educación/Education, Prevención/Prevention, and Autocuidado/Self-care), an HIV/sexually transmitted infection risk reduction program for Hispanic women. Hispanic adult women (n = 320) completed measures (in Spanish or English) of relationship power, partner communication about HIV, and acculturation. The syndemic was defined with a factor model of substance abuse, intimate partner violence, risk for HIV/sexually transmitted infection, and depression using structural equation modeling.ResultsControlling for acculturation and education, relationship power was inversely related to the syndemic factor (β = −0.49, p < .001), but partner communication was not (β = 0.14, p = .054). Acculturation and education were also related to the syndemic factor. These variables combined accounted for more than one-half (53%) of the variance in the syndemic factor.ConclusionsFindings suggest the need to develop and test interventions that address the power dynamics of intimate relationships as a means of reducing health disparities among Hispanic women.     

Correlates of Unintended Birth Among Low-Income Hispanic Immigrants at High Risk for Depression

Hispanic women, a large and growing ethnic minority group in the U.S., have an unintended birth rate over twice the national average. However, little is known about unintended birth among Hispanic immigrants. The purpose of this study is to determine the sociodemographic, including immigration-related, correlates of unintended birth in this population. Data were collected as part of a preventive intervention among pregnant Hispanic immigrants at increased risk for depression (n = 215). The correlates of women’s self-reported pregnancy intention (intended, mistimed, unwanted) were examined using multinomial logistic regression. Similar to nationally representative findings, unintended birth was more common among younger women, single women and women not cohabiting with their partners, and women with more children. Additionally, women who had immigrated to the U.S. less than 1 year ago had almost a 4 times greater risk of a mistimed birth (RRR = 3.82, P < 0.05) compared to women who immigrated 1–4 years ago. Women with greater social support scores had a reduced chance of mistimed (RRR = 0.98, P < 0.10) and unwanted (RRR = 0.97, P < 0.05) birth. The findings have implications for development of effective and culturally appropriate family planning programs. They suggest that interventions should target young women, women who have achieved their desired family size, and very recent immigrants.     

Determinants of Breast, Cervical and Colorectal Cancer Screening Adherence in Mexican–American Women

Despite the effectiveness of cancer screening procedures, its utilization among Latinas remains low. Guided, in part, by the Behavioral Model for Vulnerable Populations, this study examined the associations between predisposing, enabling, and need factors with self-reported breast, cervical, and colorectal cancer screening adherence. Participants were 319 Mexican–American women, from a range of socioeconomic backgrounds, living near the United States-Mexico border. Women were adherent with breast cancer (BC) screening (≥42 years) if they had received at least one mammogram within the last 2 years, with cervical cancer (CC) screening (≥40 years) if they had received at least one Pap exam in the last 3 years, and with colorectal cancer (CRC) screening (≥52 years) if they had undergone one or more of the following: Fecal Occult Blood Test within the last year, or sigmoidoscopy in the last 5 years, or colonoscopy within the last 10 years. BC and CC screenings were higher in the current sample compared to national and state figures: 82% with mammography and 86% adherent with Pap exam screening. However, only 43% were adherent with CRC screening recommendations. Characteristics associated with mammography adherence included CC adherence and usual source of care. BC adherence was associated to CC adherence. Characteristics associated with CRC adherence included BC adherence, being premenopausal, and insurance coverage. A key correlate of cancer screening adherence was adherence to other preventive services. Results underscore the need for continued efforts to ensure that Latinas of all SES levels obtain regular and timely cancer screenings.     

Evaluation of a <Emphasis Type="Italic">Radionovela</Emphasis> to Promote HPV Vaccine Awareness and Knowledge Among Hispanic Parents

Hispanic women have more than a 1.5-fold increased cervical cancer incidence and mortality compared to non-Hispanic white women in the United States. The Centers for Disease Control recommends the HPV vaccine for females at ages 11 and 12 years, though it is approved for females aged 9–26 to protect against the primary types of high-risk HPV (HPV-16 and HPV-18) that cause approximately 70% of cervical cancer cases. Few culturally-tailored Spanish HPV vaccine awareness programs have been developed. This study evaluates the efficacy of a Spanish radionovela as an educational tool. Rural Hispanic parents of daughters aged 9–17 (n = 88; 78 mothers and 10 fathers) were randomized to listen to the HPV vaccine radionovela or to another public service announcement. Participants completed a 30 min pretest posttest questionnaire. Parents who listened to the HPV radionovela (intervention group) scored higher on six knowledge and belief items. They were more likely to confirm that HPV is a common infection (70% vs. 48%, P = .002), to deny that women are able to detect HPV (53% vs. 31%, P = .003), to know vaccine age recommendations (87% vs. 68%, P = .003), and to confirm multiple doses (48% vs. 26%, P = .03) than control group parents. The HPV vaccine radionovela improved HPV and HPV vaccine knowledge and attitudes. Radionovela health education may be an efficacious strategy to increase HPV vaccine awareness among Hispanic parents.     

Acculturation,Behavioral Factors,and Family History of Breast Cancer among Mexican and Mexican-American Women

BackgroundIncidence rates for breast cancer are higher among Mexican-American (MA) women in the United States than women living in Mexico. Studies have shown higher prevalence of breast cancer risk factors in more acculturated than less acculturated Hispanic/Latinas in the United States. We compared the prevalence of behavioral risk factors and family history of breast cancer by level of acculturation and country of residence in women of Mexican descent.MethodsData were collected from 1,201 newly diagnosed breast cancer patients living in Mexico (n = 581) and MAs in the United States (n = 620). MA participants were categorized into three acculturation groups (Spanish dominant, bilingual, and English dominant); women living in Mexico were used as the referent group. The prevalence of behavioral risk factors and family history of breast cancer were assessed according to acculturation level, adjusting for age at diagnosis and education.ResultsIn the adjusted models, bilingual and English-dominant MAs were significantly more likely to have a body mass index of 30 kg/m² or greater, consume more than one alcoholic beverage a week, and report having a family history of breast cancer than women living in Mexico. All three U.S. acculturation groups were significantly more likely to have lower total energy expenditure (≤533 kcal/d) than women in Mexico. English-dominant women were significantly less likely to ever smoke cigarettes than the Mexican group.ConclusionsOur findings add to the limited scientific literature on the relationships among acculturation, health behavior, and family history of breast cancer in Mexican and MA women.     

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.     

DIFFERENCES IN MEXICAN-BORN AND U.S.-BORN WOMEN OF MEXICAN DESCENT REGARDING FACTORS RELATED TO BREAST CANCER SCREENING BEHAVIORS

A survey on factors related to breast cancer screening was completed by 179 U.S.-resident women of Mexican descent who were either Mexican born (n = 76) or U.S. born (n = 103). The U.S.born women had significantly higher levels of income, education, and acculturation and were significantly more likely to be covered by health insurance and to receive health professional interventions such as breast self-exam (BSE) instruction. Accordingly, these U.S.-born women engaged in BSE more frequently and were more motivated to engage in other health behaviors. In comparison, the Mexican-born women reported significantly greater beliefs that breast cancer is a serious illness and that they were relatively more susceptible to this illness. For the Mexican-born women health locus of control was significantly more geared toward powerful others and chance factors. Factor differences suggest that Mexican-born women face more breast cancer screening barriers than the U.S.born women of Mexican descent.