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 and screening in American Indian and Alaska Native women

Data relative to breast cancer among American Indian and Alaska native (AI/AN) women are limited and vary by regions. Despite national decreases in breast cancer incidence and mortality rates, declines in these measures have not yet appeared among AI/AN women. Health disparities in breast cancer persist, manifest by higher stage at diagnosis, and lower screening rates compared to other racial and ethnic groups. Disproportionately more AI/AN are younger at diagnosis. Screening beginning at age 40, improving access, annual rescreening, community education and outreach, and mobile mammography for rural areas are ways to improve these disparities in breast cancer.     

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.     

Breast cancer screening knowledge, attitudes, and practices among Korean American women

PURPOSE/OBJECTIVES: To describe the knowledge and beliefs about breast cancer and breast cancer screening and practices of clinical breast examination (CBE) and mammography of Korean American women. DESIGN: Cross-sectional survey. SETTING: Two Korean churches in a mid-sized Southeastern U.S. city. SAMPLE: A convenience sample of 107 Korean women ages 40 and older. METHODS: Data were collected using Champion's Health Belief Model instrument (susceptibility, seriousness, benefits, and barriers) and the Breast Cancer Knowledge test through mailed questionnaires. MAIN RESEARCH VARIABLES: Knowledge and beliefs about breast cancer screening and practices of CBE and mammography. FINDINGS: The percentages of Korean American women who ever had a CBE and mammography were 67 and 58, respectively. Among the Health Belief Model variables, women who never had a CBE had significantly lower knowledge scores and higher perceived barriers to CBE than those who had. Women who never had a mammogram reported significantly higher perceived barriers to mammography. Logistic regression analyses demonstrated that husband's nationality, regular checkups, and encouragement from family members and physicians were significant predictors of CBE and mammography use. CONCLUSIONS: The frequency of breast cancer screening practices among Korean American women is below national objectives. IMPLICATIONS FOR NURSING PRACTICE: As healthcare professionals in a culturally diverse nation, nurses need to increase their awareness of cultural variations and provide culturally and linguistically appropriate breast health education. Additional studies with women from a variety of settings are needed to validate present study 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.     

Breast cancer screening and African American women: fear, fatalism, and silence

PURPOSE/OBJECTIVES: To explore the beliefs, attitudes, and practices related to breast cancer and breast cancer screening among low- and middle-income African American women. DESIGN: Qualitative study using focus group methodology. SAMPLE/SETTING: 26 African American women, age 40-65, selected from three employment groups, recruited from a community-based center and a local teacher's union in a moderate-sized urban area. METHODS: Three 90-minute focus group discussions exploring breast cancer beliefs, attitudes, and practices were audiotaped, transcribed verbatim, and analyzed using thematic context analysis techniques. FINDINGS: When breast cancer was discussed, fear was the predominant feeling expressed in all groups. This fear was a primary reason not to engage in breast cancer screening. Unemployed women and service workers emphasized the role of violence in causing breast cancer, whereas teachers discussed injury and sex as causing breast cancer. All participants stressed that breast cancer is seldom discussed within the African American community. Teachers added that this secrecy within the African American community leads to breast cancer being viewed as a white woman's disease. CONCLUSIONS: Despite initiatives promoting breast cancer awareness. African American women still hold misconceptions regarding the etiology of breast cancer and fatalistic perspectives regarding breast cancer outcomes, perhaps because breast cancer is discussed infrequently. Because pain, fear, and fatalism were discussed in all groups, future research should address the influence of these factors to increase screening behaviors. IMPLICATIONS FOR NURSING PRACTICE: Because unemployed women, service workers, and teachers differed in their beliefs about breast cancer and breast cancer screening, nurses must be mindful of the need to tailor Interventions to address the needs of both low- and middle-income African American women.     

Breast cancer screening compliance among young women in a free access healthcare system

BACKGROUND AND OBJECTIVES: To examine mammographic screening compliance among young military healthcare beneficiaries and to examine factors related to one time and recent mammographic compliance. METHODS: Medical records were reviewed for 1,073 subjects (age 41-47) recording dates of the two most recent screening mammograms. Examined outcomes were: whether the woman ever had mammography and, if so, whether she had a mammogram within 400 days. Examined predictors were: ethnicity, age, Gail Model risk score, family history, whether the woman knew a young woman with breast cancer, and importance attributed to breast cancer screening. RESULTS: 90.4% of women studied had at least one mammogram. 71.1% underwent screening within 400 days. Rates of ever having mammography were higher for women with family history of breast cancer and Asian, Pacific Islander, Black or Hispanic women. No measured covariate correlated with having mammography within 400 days. CONCLUSIONS: One time screening participation was high in this select group of women for whom cost and access barriers were removed, but was lower with regard to having a recent mammogram. Correlates of ever having and recent mammography are not synonymous.     

Adherence to screening mammography among American Indian women of the northern plains

Breast cancer is a burden for American Indian (AI) women who have younger age at diagnosis and higher stage of disease. Rural areas also have had less access to screening mammography. An Indian Health Service Mobile Women’s Health Unit (MWHU) was implemented to improve mammogram screening of AI women in the Northern Plains. Our purpose was to determine the past adherence to screening mammography at a woman’s first presentation to the MWHU for mammogram screening. Date of the most recent prior non-MWHU mammogram was obtained from mammography records. Adherence to screening guidelines was defined as the prior mammogram occurring 1–2 years before the first MWHU visit among women >41 years, and was the main outcome, whereas, age and clinic site were predictors. Adherence was compared with national data of the Breast Cancer Surveillance Consortium (BCSC). Among 1,771 women >41 years, adherence to screening mammography guidelines was 48.01 % among >65 years, 42.05 % among 50–64 years, 33.43 % among 41–49 years, and varied with clinic site (25.23–65.93 %). Age (p < 0.0001) and clinic site (p < 0.0001) were associated with adherence. Overall, adherence to screening mammography guidelines was found in 39.86 % (706/1771) of MWHU women versus 74.34 % (747,095/1,004,943) of BCSC women. The majority (60.14 %) of women at first presentation to the MWHU had not had mammograms in the previous 2 years, lower screening adherence than nationally (25.66 %). Adherence was lowest among women ages 41–49, and varied with clinic site. Findings suggest disparities in mammography screening among these women.     

Breast and colorectal cancer screening among low-income women with psychiatric disorders

This study investigated breast and colorectal cancer screening among 196 low-income women being treated for psychiatric illnesses. Main outcome measures included breast self-examination (BSE), clinical breast examination (CBE), mammography, digital rectal examination (DRE), and fecal occult blood test (FOBT). Results indicated that 49% and 66% of women 40 years of age or older had obtained mammograms and CBEs, respectively, in the preceding year. Forty-four per cent of women 20 years of age or older reported monthly BSE. Forty-six per cent and 35% of women 50 years of age or older reported having digital rectal exams (DRE) or fecal occult blood tests (FOBT), respectively, in the preceding year. Multivariate analyses showed that physician recommendation of screening was the strongest predictor of having obtained a mammogram, CBE, DRE or FOBT in the preceding year. Physician recommendation and self-confidence in performing BSE were the strongest predictors of monthly BSE. These results highlight the importance of physician recommendation of adherence to screening guidelines for breast and colorectal cancer. Because psychiatrists frequently treat psychiatric patients on a regular basis, they are in a unique position to encourage cancer screening and to monitor compliance with their recommendations.     

Breast cancer screening and family history among rural women in Wisconsin.

This study examines the relationship between family history of breast cancer and current compliance with mammography screening guidelines. A random telephone survey of women age 40 or older living in rural Wisconsin (N = 2398) was conducted to determine mammography screening knowledge, family history of breast cancer, attitudes, intentions, physician recommendation, and compliance with screening guidelines. Compared with women without a family history of breast cancer, women with a family history were significantly more likely to demonstrate correct knowledge (p = 0. 01); express intentions in compliance with recommended screening guidelines (p < 0.001); report having been advised by a physician to obtain a mammogram (p < 0.001); and be in current compliance with mammography screening guidelines (p < 0.001). Results of simultaneous and individual logistic regression suggest that the effects of family history on compliance with screening guidelines are directly mediated through the combination of women's knowledge, women's intentions, and physician recommendation. Thus, programs to increase compliance with mammography screening guidelines should address both women and providers.     

Breast cancer in black American women

A case-control study of breast cancer among Black American women was conducted in seven hospitals in New York City from 1969 to 1975. Results are reported for 127 cases and 317 controls. Compared to women with a first birth before age 19, those with a first birth after 25 had a relative incidence rate for breast cancer of 3.8 and 2.2 for the pre- and postmenopausal age-groups, respectively. Compared to nulliparous women, parous women had a relative incidence rate of 0.6 for premenopausal and 0.7 for postmenopausal women. The incidence rate of breast cancer for women with a menopause after age 49 was estimated to be 3.1 times that of women with a menopause before age 45. Thus, the known risk factors for breast cancer among Whites are also related to the etiology of the disease among Blacks. The incidence rate of breast cancer has increased among younger Blacks since 1947 and is now similar to that among younger Whites. However, among older women, the incidence rate is still appreciably higher for Whites. The most likely explanation of this pattern is that Black women born since about 1925 are being exposed at the same frequency as White women to the causes of breast cancer.     

Attitudes towards HPV testing: a qualitative study of beliefs among Indian,Pakistani, African-Caribbean and white British women in the UK

This study examined attitudes to human papillomavirus (HPV) testing among a purposively selected sample of women from four ethnic groups: white British, African Caribbean, Pakistani and Indian. The design was qualitative, using focus group discussion to elicit women's attitudes towards HPV testing in the context of cervical cancer prevention. The findings indicate that although some women welcomed the possible introduction of HPV testing, they were not fully aware of the sexually transmitted nature of cervical cancer and expressed anxiety, confusion and stigma about HPV as a sexually transmitted infection. The term 'wart virus', often used by medical professionals to describe high-risk HPV to women, appeared to exacerbate stigma and confusion. Testing positive for HPV raised concerns about women's sexual relationships in terms of trust, fidelity, blame and protection, particularly for women in long-term monogamous relationships. Participation in HPV testing also had the potential to communicate messages of distrust, infidelity and promiscuity to women's partners, family and community. Concern about the current lack of available information about HPV was clearly expressed and public education about HPV was seen as necessary for the whole community, not only women. The management of HPV within cervical screening raises important questions about informed participation. Our findings suggest that HPV testing has the potential to cause psychosocial harm to women and their partners and families.     

Breast and colorectal cancer screening and associated correlates among Chinese older women

Objective: To explore the participation rates for breast and colorectal cancer screening and identify associatedcorrelates among elderly women. Methods: Logistic regressions were conducted using data collected in 2006from 1,533 elderly women aged 60 years or above who had completed a screening instrument, the MinimumData Set-Home Care, while applying for long-term care services at the first time in Hong Kong. Results: Theparticipation rates for breast and colorectal cancer screening among frail older Chinese women were 3.7% and10.8% respectively. Cognitive status was inversely associated with the likelihood of participation in screening(breast: OR = 0.66, 95%CI = 0.47-0.94; colon: OR = 0.81, 95%CI = 0.66-0.99), as was educational level withthe likelihood of participation in breast cancer screening (no formal education: OR = 0.20, 95%CI = 0.06-0.61,some primary education: OR = 0.31, 95%CI = 0.10-1.00). Conclusion: The delivery of cancer preventive healthservices to frail older women is less than ideal. Cognitive status and educational level were important factorsin cancer screening behaviour. Tailor-made strategic promotion programmes targeting older women with lowcognitive status and educational levels are needed to enhance awareness and acceptance within this vulnerablegroup.     

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.