Breast cancer screening among Cambodian American women

Our aim was to describe and identify factors associated with breast cancer screening among Cambodian American women. We conducted a cross-sectional survey of 1,365 households using bilingual and bicultural interviewers. We found that low proportions of Cambodian American women were up to date on their clinical breast examinations (CBE; 42%) and mammograms (40%). More than 80% of women with female physicians have had at least one prior screening, and 52% have had the tests recently. Women with male Asian American physicians were less likely to have had screening as compared to women with female non-Asian physicians: ever had CBE (odds ratio [OR], 0.26); recent CBE (OR, 0.39); ever had mammogram (OR, 0.36); and recent mammogram (OR, 0.22). Breast cancer screening among Cambodian American women lags behind the general U.S. population. Tailored promotion efforts should address barriers and promote cancer screening by physicians, staff, and organizations serving this population.     

Breast cancer screening: stages of adoption among Cambodian American women

BACKGROUND: Little information is available on the breast cancer screening behavior of Cambodian American women. METHODS: We identified households from multiple sources using Cambodian surnames and conducted a cross-sectional survey, administered by bilingual and bicultural interviewers. Breast cancer screening stages of adoption were examined based on concepts from the transtheoretical model of behavioral change. RESULTS: Our response rate was 73% (398 women in clinical breast exam (CBE) analysis, and 248 in mammography analysis) with approximately 25% each in the maintenance stage. We found significant associations between screening stage with physician characteristics. Asian American female physician increased the likelihood of being in the maintenance stage (CBE, OR = 10.1, 95% CI 2.8-37.1; mammogram, OR = 74.7,95% CI 8.3-674.6), compared to Asian American male physician with precontemplation/contemplation stage as our referent outcome. CONCLUSION: Results from this study support the need to promote regular breast cancer screening among Cambodian American women.     

A multifaceted intervention to increase cervical cancer screening among underserved Korean women.

OBJECTIVE: Despite the proven survival benefits associated with cervical cancer screening, use of the Pap test continues to be suboptimal in some population subgroups, such as among Korean-American women who face considerable barriers to screening. Therefore, we evaluated a multifaceted intervention that combined psychoeducational counseling with patient navigation to address both psychosocial and access barriers to screening. METHOD: Women (n = 102) were recruited from Korean community centers and assigned to the intervention or control condition. The intervention group received cervical cancer education and patient navigation delivered by bilingual Korean health educators. The control group received general health education, including information about cervical cancer and screening. Assessments were obtained at baseline and postintervention. Screening behavior was assessed at 6 months postintervention. RESULTS: At baseline, 17% of participants reported having had a Pap test in the previous year. At 6 months postintervention, 83% of women in the intervention group had obtained screening compared with 22% in the control group, chi2(1) = 41.22, P < 0.001. Multivariate logistic regression analyses indicated that participation in the intervention was associated with screening (P < 0.001). Fewer psychosocial barriers (e.g., discomfort at having a stranger perform Pap) and greater self-efficacy were also associated with screening (P < 0.05). CONCLUSION: A combined modality intervention that delivers education with patient navigation training and assistance resulted in increased screening rates. Multifaceted approaches may be effective in reducing the psychosocial, access, and language barriers that contribute to cancer health disparities in underserved populations.     

A randomized controlled trial of interventions to promote cervical cancer screening among Chinese women in North America

BACKGROUND: North American Chinese women have lower levels of Papanicolaou (Pap) testing than other population subgroups. We conducted a randomized controlled trial to evaluate the effectiveness of two alternative cervical cancer screening interventions for Chinese women living in North America. METHODS: Four hundred and eighty-two Pap testing underutilizers were identified from community-based surveys of Chinese women conducted in Seattle, Washington, and Vancouver, British Columbia. These women were randomly assigned to one of two experimental arms or control status. Several Chinese-language materials were used in both experimental arms: an education-entertainment video, a motivational pamphlet, an educational brochure, and a fact sheet. Women in the first experimental group (outreach worker intervention) received the materials, as well as tailored counseling and logistic assistance, during home visits by trilingual, bicultural outreach workers. Those in the second experimental group (direct mail intervention) received the materials by mail. The control group received usual care. Follow-up surveys were completed 6 months after randomization to ascertain participants' Pap testing behavior. All statistical tests were two-sided. RESULTS: A total of 402 women responded to the follow-up survey (83% response rate). Of these women, 50 (39%) of the 129 women in the outreach group, 35 (25%) of the 139 women in the direct mail group, and 20 (15%) of the 134 women in the control group reported Pap testing in the interval between randomization and follow-up data collection (P<.001 for outreach worker versus control, P =.03 for direct mail versus control, and P =.02 for outreach worker versus direct mail). Intervention effects were greater in Vancouver than in Seattle. CONCLUSION: Culturally and linguistically appropriate interventions may improve Pap testing levels among Chinese women in North America.     

Predictors of cervical cancer screening for Chinese American women

Research on Chinese American women's cervical cancer screening behaviours is limited and there are few studies that examine factors associated with obtaining regular Pap tests. The purpose of this study was to use the transtheoretical model (TTM) as a framework to examine correlates of Pap testing and stages of change. Chinese American women (N = 121) were recruited to complete a cross‐sectional, self‐report survey. Survey items assessed stages of change, self‐efficacy, perceived benefits and barriers, and demographic variables including screening and family history for cervical cancer. Eighty‐one per cent of women reported that they had ever had a Pap test. Most participants were in the maintenance stage (55%), with 10% in each action and pre‐contemplation, 8% in contemplation, 1% in preparation and 16% in the relapse stage. Women in the action/maintenance stage were more likely to be older, married and have a higher education level. Women in the action/maintenance stage had significantly lower perceived barrier scores compared to women in both the contemplation/preparation and pre‐contemplation/relapse stages. Findings partially support the use of TTM for cervical cancer screening among this population and indicate the importance of perceived barriers. Results may inform interventions to increase screening rates among Chinese American women.     

Effectiveness of cervical cancer screening over cervical cancer mortality among Japanese women

Background: Various studies have revealed that cervical cancer(CC) screening significantly reduces both CC incidence and mortalityin developed countries. Although Japan introduced a nationwidegovernment funded annual CC screening for the women aged 30+in 1982, the effectiveness of CC screening on CC mortality hasnot yet been evaluated by any prospective cohort study. Therefore,the present study evaluated the association of CC mortalitywith self-reported CC screening and some other factors by anationwide cohort study. Methods: Baseline survey of the Japan Collaborative Cohort Studyfor the enrollment of subjects was completed during 1988–90and followed until 2003. This study only analyzed 63 541 women,aged 30–79 years, who were free from any cancer historyat enrollment. Results: During the follow-up period, 38 CC deaths were identified.The mean age at mortality was 67.0 years, with a mortality rateof 4.2 per 100 000 person-years. Participation rate in CC screeningwas 46.9%. Age-adjusted Cox model indicated significantly lowerCC mortality [hazard ratio (HR) = 0.30, 95% confidence interval(CI) = 0.12–0.74] due to CC screening. Protectivenessremained almost the same (HR = 0.30, 95% CI = 0.12–0.76)when adjusted for age, body mass index and number of deliveries.The results also revealed that CC screening could reduce atleast 50% of CC deaths even after excluding the effect of possibleself-selection bias. Conclusions: CC screening in Japan may reduce CC mortality significantlyfor women aged 30–79 years. However, further studies withmore CC deaths and increased statistical power are needed tovalidate the findings.     

Breast and cervical cancer screening among Appalachian women.

Medical service shortages, rural residence, and socioeconomic and cultural factors may pose barriers to breast and cervical cancer screening among women living in the Appalachian region of the United States. This study determined the rates of breast and cervical cancer screening in Appalachia and identified factors associated with screening. Data from the Behavioral Risk Factor Surveillance System, 1996 to 1998, for the Appalachian region were analyzed to determine the percentage of women > or =40 years of age who had had a mammogram or clinical breast examination (CBE) within the past 2 years and the percentage of women > or =18 years of age who had had a Pap test within the past 3 years. Screening rates were compared with those for women living elsewhere in the United States. Screening rates were further assessed according to demographic, socioeconomic, and physical and behavioral health factors. Multiple logistic regression analyses were conducted to examine the predictors of screening. Overall, 14,520 Appalachian women > or =18 years of age reported on Pap tests; 13,223 women > or =40 years of age reported on mammogram screening, and 13,124 women reported on CBE screening. Among Appalachian women, 68.8% [95% confidence interval (CI), 67.8-69.9] had a mammogram, 75.1% (95% CI, 74.1-76.1) had a CBE in the past 2 years, and 82.4% (95% CI, 81.5-83.3) had a Pap test in the past 3 years. These rates were at most approximately 3% lower than those for women living elsewhere in the United States, but these differences were statistically significant. Older women and women with less education or income were screened less commonly. Women who had visited a doctor within the past year were more likely to have been screened. Additional interventions are needed to increase breast and cervical cancer screening rates for Appalachian women to meet the goals of Healthy People 2010, targeting in particular population groups found to have lower screening rates.     

Efficacy of screening in preventing cervical cancer among older women

Background

Although the effectiveness of cervical cancer screening has been firmly established in reproductive-age women, its usefulness in older women is unclear. We sought to evaluate the efficacy of cervical cancer screening in older women.

Methods

We conducted a case–control study within two integrated health care systems in the northwestern United States. Cases (n = 69) were women aged 55–79 years who were diagnosed with invasive cervical cancer during 1980–1999. Controls (n = 208) were women with an intact uterus and no diagnosis of cervical cancer, but otherwise similar to cases in terms of age and length of enrollment in the health plan. We reviewed medical records to ascertain screening history during the 7 years prior to reference date.

Results

Compared to cases, controls were more likely to have received a Pap test. After adjustment for age and current smoking status, screening prior to an estimated 1-year duration of the occult invasive phase of cervical cancer was associated with a substantial reduction in risk [odds ratio (OR) 0.23; 95 % CI 0.11–0.44]. Similar results were obtained using different estimates of the duration of the occult invasive phase. Analysis of the relative incidence of invasive cervical cancer in relation to the time following a negative screening test suggested a large reduction during the first year (OR 0.09; 95 % CI 0.03–0.24). The incidence remained low for several years thereafter, returning to the incidence among unscreened women after 5–7 years.

Conclusions

Cervical cancer screening by means of cytology is highly efficacious in older women. Our findings also suggest that five-yearly screening is approximately as efficacious as more frequent screening.     

Psychological impact of positive cervical cancer screening results among Japanese women

Background

While cervical cancer screening is useful for detecting and then treating the disease at an early stage, most women with screen-positive results are free from cervical cancer but nevertheless subject to the unnecessary worry entailed in receiving such results. The purpose of this study was to examine whether receiving a screen-positive result was actually related to psychological distress among Japanese women who underwent cervical cancer screening.

Methods

We conducted a questionnaire survey at health facilities in a semiurban city of Ibaraki prefecture, involving 1744 women who underwent cervical cancer screening and 72 who received screen-positive results and then underwent further testing. We used the K6 scale to assess their psychological distress (K6 score ≥5) and performed multiple logistic regression analyses to estimate the relative effect of receiving screen-positive results on psychological distress.

Results

Psychological distress was more prevalent among women with screen-positive results (OR 2.22; 95 % CI 1.32–3.74), while it was also related to history of mental health consultation (OR 2.26; 95 % CI 1.69–3.01) and marital status (OR 1.32; 95 % CI 1.02–1.70).

Conclusions

Receiving a positive cervical cancer screening result was associated with psychological distress. To alleviate this psychological impact, the current form of communicating the screening results should be reconsidered.

     

Disparities in cervical cancer screening between Asian American and Non-Hispanic white women

BACKGROUND: Asian American women have higher cervical cancer mortality rates than non-Hispanic White women, yet have lower Pap screening rates than their White counterparts. This study examined whether ethnic differences in the use of Pap screening were associated with differences in cultural views, controlling for demographic and access factors. METHODS: Cross-sectional survey data from the Commonwealth 2001 Health Care Quality Survey were used. Non-Hispanic White (n = 2,146) and Asian American women (including Chinese, Vietnamese, Korean, Filipino, and Japanese; n = 259) were included in this study. Eastern cultural views were measured by beliefs in the role of self-care and luck. Access factors (having health insurance, regular providers, and communication with providers) and demographics of patients and providers were measured. The outcome was receipt of a Pap test in the past 2 years. RESULTS: Asian American women had a lower rate of obtaining a recent Pap test (70%) than non-Hispanic White women (81%; P = 0.001). More Asians believed in the role of luck and self-care and experienced access barriers than Whites (P < 0.0001). Women with less Eastern cultural views are more likely to be recently screened than women with more (odds ratio, 1.08; 95% confidence interval, 1.00-1.16; P < 0.05). All access factors and provider gender types predicted the outcome. Within the Asian subgroups, Vietnamese women had lower screening rates (55%) and greater Eastern cultural views than their Asian counterparts. CONCLUSION: More research is needed to understand cultural and other barriers to Pap screening in high-risk Asian women, and attention should be paid to within-group differences.     

Knowledge, behavior and beliefs related to cervical cancer and screening among Turkish women

Objective: The aims of this study were to explore Turkish women’s knowledge, behavior and beliefs relatedto cervical cancer and screening. Methods: The study was performed in two cities in the East of Turkey betweenSeptember 2009 and April 2010, with a sampling group of 387 women. Data were collected by means of aninterview form with the Health Belief Model Scale for Cervical Cancer and Pap Smear Test - Turkish Version.Results: Women in the research group were found to have poor knowledge, inadequate health behavior andlow/medium level false beliefs regarding cervical cancer screening. There was relation between health beliefsand characteristics of women and particularly education (F = 10.80, p = 0.01). Similarly, it was found that Papsmear barriers were influenced by demographic characteristics and that women with low-level education (p =0.001), divorced women (p = 0.05), women with low-income(p = 0.05), women who gave their first birth whenthey were 18 or younger (p = 0.05) and women not applying any contraceptive method at all (p = 0.01) weredetermined to have negative Pap smear barriers. Conclusions: Primarily the knowledge, attitudes and beliefsof women in the target group should be evaluated to increase their participation in cervical cancer screeningand to prepare effective education strategies.     

Cancer screening for underserved women: the breast and cervical cancer intervention study

OBJECTIVE: To report on the effect of the Breast and Cervical Cancer Intervention Study (BACCIS), a multicomponent intervention conducted in the San Francisco Bay Area between 1992 and 1997. METHODS: BACCIS targeted approximately 25,000 multiethnic, underserved women in eight neighborhoods and the public health clinics that served them. An outreach intervention using lay health worker peers and clinic provider inreach intervention to improve breast and cervical cancer screening were evaluated in a quasi-experimental, controlled trial with pretest and posttest household surveys of 1,599 and 1,616 women, respectively. Surveys were conducted in English, Spanish, Mandarin, and Cantonese. RESULTS: Analyses of community survey results showed no significant improvement in reported screening behaviors. Reports of mammography in the intervention areas in the previous 2 years, or for Pap smear in the previous 3 years, did not differ significantly (73-71% and 84-87%, respectively, for pretest and posttest surveys). CONCLUSION: High baseline screening rates, lack of sensitive measures of change at the population level, contamination of the control group, and an imbalance of predictive factors at baseline contributed to the difficulty of assessing the value of the intervention. Lessons learned from this inconclusive study may be of value to future community intervention studies of cancer screening and other health behaviors in multiethnic underserved urban populations.     

Costs and cost effectiveness of a health care provider-directed intervention to promote colorectal cancer screening among Veterans.

PURPOSE: Colorectal cancer screening is underused, particularly in the Veterans Affairs (VA) population. In a randomized controlled trial, a health care provider-directed intervention that offered quarterly feedback to physicians on their patients' colorectal cancer screening rates led to a 9% increase in colorectal cancer screening rates among veterans. The objective of this secondary analysis was to assess the cost effectiveness of the colorectal cancer screening promotion intervention. METHODS: Providers in the intervention arm attended an educational workshop on colorectal cancer screening and received confidential feedback on individual and group-specific colorectal cancer screening rates. The primary end point was completion of colorectal cancer screening tests. Sensitivity analyses investigated cost-effectiveness estimates varying the data collection methods, costs of labor and technology, and the effectiveness of the intervention. RESULTS: Rates of colorectal cancer screening for the intervention versus control arms were 41.3% v 32.4%, respectively (P < .05). The incremental cost-effectiveness ratio was dollar 978 per additional veteran screened based on feedback reports generated from manual review of records. However, if feedback reports could be generated from information technology systems, sensitivity analyses indicate that the cost-effectiveness estimate would decrease to dollar 196 per additional veteran screened. CONCLUSION: An intervention based on quarterly feedback reports to physicians improved colorectal cancer screening rates at a VA medical center. This intervention would be cost effective if relevant data could be generated by existing information technology systems. Our findings may have broad applicability because a 2005 Medicare initiative will provide the VA electronic medical record system as a free benefit to all US physicians.