Beliefs and Behaviors of Breast Cancer Screening in Women Referring to Health Care Centers in Northwest Iran According to the Champion Health Belief Model Scale

Background: Breast cancer is the most common cancer in women. All ages are susceptible and more than90% of the patients can be cured with early diagnosis. Breast self-examination (BSE) and mammography can beuseful for this aim. In this study we examined the components of the Champion health belief model to identifyif they could predict the intentions of women to perform such screening. Materials and Methods: A total of380 women aged 30 and above who had referred to health-care centers were assessed for use of breast cancerscreening over the past year with a modified health belief model questionnaire. Logistic regression was appliedto identify leading independent predictors. Results: In this study 27% of the women performed BSE in thelast year but only 6.8% of them used mammography as a way of screening. There were significant differencesregarding all components of the model except for perceived severity between women that underwent BSE. overthe past year and those that did not. Findings were similar for mammography. Regression analysis revealedthat intentions to perform BSE were predicted by perceived self-efficacy and perceived barriers to BSE whileintentions to perform mammography were predicted by perceived barriers. Conclusions: This study indicatedthat self-efficacy can support performance of BSE while perceived barriers are important for not performingboth BSE and mammography. Thus we must educate women to increase their self-efficacy and decrease theirperceived barriers.     

Breast cancer early detection, health beliefs, and cancer worries in randomly selected women with and without a family history of breast cancer

BACKGROUND: Early detection practices (EDP) consist of clinical breast examination (CBE) and mammography. Breast self-examination (BSE) is no longer generally recommended, but many women still perform it. AIMS: To compare EDP, health beliefs, and cancer worries in women with and without a family history of breast cancer in a population-based sample. METHODS: 489 women aged 21-60 were randomly sampled from the entire Jewish female population of Israel; 61 (12.5%) had a family history of breast cancer. Participants answered questionnaires by phone, including demographic details, EDP performance, health beliefs, and cancer worries. RESULTS: Rates of CBE were similar in women with and without a family history (p>0.05). For women over 40, rates of undergoing mammography screening were similar (p>0.05), but regular attendance was reported more by women with a family history (p<0.05). More women under 40 with a family history of breast cancer attended mammography (p<0.05), but only about 14% had ever undertaken mammography screening and 27% had ever undertaken CBE. More than 50% of the women had performed BSE, while significantly more women with a family history reported its over-performance (p<0.01). Women with a family history reported higher perceived susceptibility (p<0.01), higher cancer worries (p<0.05), and fewer barriers to mammography (p<0.05). According to logistic regression analysis, higher odds of EDP were significantly related to perceiving fewer barriers and having higher cancer worries. A positive family history was related to higher odds of women undergoing mammography. Perceived susceptibility was significantly related to higher odds of BSE only. Over-performance of BSE was significantly related to having a positive family history, higher susceptibility, and higher cancer worries. CONCLUSIONS: (1) A high rate of women did not undergo CBE or mammography screening. Women under 40 with a family history of breast cancer who have never undergone CBE or mammography merit special attention. (2) The change in guidelines on BSE necessitates further study of its over-performance in relation to cancer worries. (3) Interventions are needed to promote attendance for CBE and mammography in younger women with a positive family history.     

The Effect of Education on the Early Diagnosis of Breast and Cervix Cancer on the Women’s Attitudes and Behaviors Regarding Participating in Screening Programs

The objective of this paper was to define the effect of education on the early diagnosis of breast and cervix cancer on the women?s attitudes and behaviors regarding participating in Cancer Early Diagnosis, Screening and Training Centers-CEDSTC screening programs. This semi-experimental study was completed with 342 women. The data were collected with forms “Champion’s Health Belief Model Scale Breast Cancer-HBMSBC” and “Health Belief Model Scale for Cervical Cancer and the Pap Smear Test-HBMSCCPST.” When the women’s health beliefs before and after 6 months of the education about the early diagnosis of breast and cervical cancers are considered, it is seen that the HBMSBC subscales health motivation, breast self-examination (BSE), and evasion to mammography (MMG) decreased and BSE self-efficacy and MMG benefit attitudes increased and HBMSCCPST subscales pap smear benefit attitudes increased and evasion to pap smear attitude decreased (p < 0.05). Six months after the education, 28.4% of the women had undergone MMG, 69.9% had performed BSE, and 33.6% had undergone a pap smear test. Education regarding early diagnosis of breast and cervix cancer was found to have positive effects on the health behaviors of the women related to BSE, MMG, and pap smear tests. The women require professional education program for increasing their attitudes and behaviors for CEDSTC screening programs. We suggest regularly providing education to increase participation in early screening programs.     

Breast Cancer Screening Disparity among Korean American Immigrant Women in Midwest

Purpose: Using three breast cancer screening methods such as mammogram, Clinical Breast Examination (CBE), and Breast Self-Examination (BSE), this study investigated breast cancer screening rates and its associated factors in Korean American immigrant women. Method: Cross-sectional data were obtained from 168 Korean immigrant women aged 40 and older in Midwest. The Andersen’s Behavioral Model (1995) theoretically guided this study and logistic regression was used to examine factors associated with screening receipt and performance. Results: Study participants reported low screening rates, specifically mammography and CBE uptake. About 71% of the women had a mammography at least once in their lifetime, while about 36% indicating receipt of a mammogram in the last three years. About 59% of the women received a CBE at least once in their lifetime, while about 32% had CBE in the past three years. About 74% of study participants have performed BSE at least once in their life time, while about 69% have done it in the past three years. Knowledge of screening method was consistently correlated with participant’s three breast cancer screening uptake. Additional factors that were positively associated with screening included older age, low barriers to mammograms, and lower educational attainment. Conclusions: Overall, study participants reported low rates of breast cancer screening receipt and performance. It is required to promote screening uptake among Korean immigrant women, especially women with young age, a lower level of education, and lack of health accessibility. A community-based language-appropriate health education program should be developed to increase health care access.     

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.     

Health Promotion Lifestyle and Cancer Screening Behaviors: A Survey among Academician Women

Breast self examination (BSE), screening mammography and Pap smear screening can significantly reducemortality from breast and cervical cancer. In an effort to understand the factors that influence BSE,mammography, and Pap smear behavior of woman academicians, we here explored the relation between healthpromotion life-style and women’s cancer screening practice. A total of 750 woman academicians working in auniversity were enrolled, 350 of them responding to the survey. The study instruments used were the HealthPromotion Life-Style Profile (HPLP) scale and a questionnaire of demographic data. There was a significantrelationship between age-group, marital status, presence of cancer in the family, history of cervical erosion anddoing BSE, having mammography and a Pap smear. Additionally, both the general mean and nearly all domainsof HPLP were significantly related to BSE, mammography, and Pap smear behavior. This study demonstratedstrong relationships between breast and cervical cancer screening behavior and health promoting lifestyle inthis subgroup of women, making an important contribution to understanding the factors influencing women’shealth behavior.     

Beliefs,Attitudes, and Behavior of Turkish Women about Breast Cancer and Breast Self-Examination According to a Turkish Version of the Champion Health Belief Model Scale

Background: Breast cancer (BC) is one of the most common cancer affecting women worldwide. Although agreat deal of progress has been made in the health sciences, early diagnosis, and increasing community awareness,breast cancer remains a life-threatening illness. In order to reduce this threat, breast cancer screening needs tobe implemented in all communities where possible. Objective: The purpose of this study was to examine healthbeliefs, attitudes and behaviors about breast cancer and breast self-examination of Turkish women. Methods:Data were collected from a sample of 656 women, using an adapted Turkish version of Champion’s Health BeliefModel Scale (CHBMS), between January and May 2011, in Ordu province of Turkey. Results: The results showedthat 67.7% of women had knowledge about and 55.8% performed BSE, however 60.6% of those who indicatedthey practiced BSE reported they did so at irregular intervals. CHBMS subscales scores of women accordingto women’s age, education level, occupation, family income and education level of the women’s mothers, familyhistory of breast cancer, friend and an acquaintance with breast cancer, knowledge about breast cancer, BSEand mammography were significantly different. Conclusion: Knowledge of women about the risks and benefitsof early detection of breast cancer positively affect their health beliefs, attitudes, and behaviors. Health careprofessionals can develop effective breast health programs and can help women to gain good health behaviorand to maintain health.     

Health belief model and practice of breast self-examination and breast cancer screening in Iranian women

Objective

The objective of this study is to determine the role of different health belief model components in practice of breast cancer screening among Iranian women.

Subjects and methods

A cross-sectional study of 500 women aged 18–65 years was conducted in an urban population under the coverage of a health therapeutic system in Babol, northern Iran in 2012. Demographic data and data regarding practice of breast self-examination (BSE), breast clinical examination (BCE), and mammography were collected by interview, and a standard health belief model questionnaire was used to assess women’s attitudes in six different domains based on a Likert scale that ranked from 1 to 5. The average score of each item for each domain was calculated. The Wilcoxon rank test and a multiple logistic regression model were used to estimate the odds ratio of each domain for performing breast cancer screening (BSE, BCE, and mammography).

Results

The mean age of the women was 31.2 (9.4) years. Overall, the average scores in domains of perceived benefit, self-efficacy, and health motivation were significantly higher among those who performed BSE and BCE, but not for mammography. For the domains of perception of susceptibility, seriousness, and barriers, no significant differences were observed. Higher scores on the scales of perceived benefits, perceived confidence/self-efficacy, and health motivation showed significant positive association with performing BSE [adjusted OR (95 % confidence interval [CI]) 1.73 (1.11, 2.72), 4.01 (2.39, 6.73), and 2.01 (1.30, 3.08), respectively] and BCE [adjusted OR (95 % CI) 1.65 (1.0, 2.95), 2.33 (1.39, 3.91), and 1.58 (1.0, 2.53), respectively], but not for performing mammography. For perceived susceptibility, perceived seriousness, and barriers, no significant association was observed.

Conclusions

Positive attitudes toward perceived benefits, perceived confidence/self-efficacy, and health motivation have a strong association with performing BSE and BCE. The impact of health belief model subscales on breast cancer screening may vary with respect to culture and values.     

Predictors of breast cancer screening behavior in women with a strong family history of the disease

This study applied the self-regulation model to examine cognitive and emotional predictors of screening in unaffected women with a strong family history of breast cancer. 748 unaffected female members of an Australian registry of multiple-case breast cancer families formed the sample. Participants completed a baseline psychosocial questionnaire and a screening questionnaire 3 years later. Multinomial logistic regression was employed to determine predictors of under- and over-screening according to national guidelines. At follow-up 16% of women under-screened and 10% over-screened with mammography; 55% under-screened with clinical breast examination (CBE); and 9% over-screened with breast self-examination (BSE). Of the women found screening according to guidelines for mammography 72% reported ever having received specific recommendations for mammography screening from a health professional. Compared to appropriate screeners, under-screeners on mammography were less likely to have received a screening recommendation (as were under-screeners on CBE), were younger and reported lower perceived breast cancer risk, but were at higher relative risk (RR) of breast cancer and were more likely to report elevated depression. Over-screeners on mammography were more likely to be younger and have a lower RR of breast cancer. Over-screeners on BSE reported elevated cancer-specific anxiety, were less likely to be university educated and more likely to have received a recommendation for BSE. Under- and over-screening is common in women with a strong family history of breast cancer. Evaluation of interventions targeting perceived risk of breast cancer, anxiety and depression are needed to ensure women obtain accurate advice from relevant specialists and enact screening recommendations.     

Analyzing factors associated with women’s attitudes and behaviors toward screening mammography using design-based logistic regression

We examined the factors associated with screening mammography adherence behaviors and influencing factors on women’s attitudes toward mammography in non-adherent women. Design-based logistic regression models were developed to characterize the influencing factors, including socio-demographic, health related, behavioral characteristics, and knowledge of breast cancer/mammography, on women’s compliance with and attitudes toward mammography using the 2003 Health Information National Trends Survey data. Findings indicate significant associations among adherence to mammography and marital status, income, health coverage, being advised by a doctor to have a mammogram, having had Pap smear before, perception of chance of getting breast cancer, and knowledge of mammography (frequency of doing mammogram) in both women younger than 65 and women aged 65 and older. However, number of visits to a healthcare provider per year and lifetime number of smoked cigarettes are only significant for women younger than 65. Factors significantly associated with attitudes toward mammography in non-adherent women are age, being advised by a doctor to have a mammogram, and seeking cancer information. To enhance adherence to mammography programs, physicians need to continue to advise their patients to obtain mammograms. In addition, increasing women’s knowledge about the frequency and starting age for screening mammography may improve women’s adherence. Financially related factors such as income and insurance are also shown to be significant factors. Hence, healthcare policies aimed at providing breast cancer screening services to underserved women will likely enhance mammography participation.     

Effects of Education Based on the Health Belief Model on Screening Behavior in High Risk Women for Breast Cancer,Tehran, Iran

Background: Breast cancer is the most common malignancy in women. Early diagnosis allows efficienttreatment and increases survival, but the efficacy of breast self examination (BSE) is not sufficiently wellestablished. The American Cancer Society aims to give women the opportunity to recognize the utility,limitations and adverse effects of breast cancer screening through education models based on psychologicaltheories. With the Health Belief Model, people’s health perceptions and attitudes influence their practices, forexample with screening. Objective: The purpose of this randomized controlled clinical trial was to determine theeffect of education based on this model on breast cancer screening in high risk Iranian women. Materials andMethods: Participants were women with a family history of breast cancer (mother, sister, and daughter). Afterexplanation of the study objectives to participants, they were recruited on obtaining oral consent and each filledout the study questionnaire based on the Health Belief Model. Allocation was into two groups by computerizedrandomization, control and intervention, receiving education on breast cancer screening. Perceived susceptibilityto and seriousness of breast cancer, perceived usefulness of and barriers to BSE, clinical breast examination,and mammography, and self-efficacy in the ability to perform these, were assessed, with comparison of scoresfor BSE practice before and after education and doing mammography and clinical examination by a physicianin intervention and control group. Results: The mean age was 37.8±11.7 (range 19-60). The mean rank in theintervention group significantly differed before and after the education, but except for “ perceived threat “and“perceived usefulness of breast self examination”, we did not find any significant differences from the controlgroup. After educational sessions, breast self examination and clinical examination practice rates were elevated.Conclusion: Health education based on well known psychological theories for breast cancer screening should beextended to the entire populations in developing countries. In addition, we should pay attention to barriers towomen undergoing mammography, such as costs, shame and accessibility, and increase the target populationawareness and positive attitudes towards benefits of early breast cancer screening.     

Early breast cancer detection behaviors among ethnically diverse low-income women

We examined factors associated with early breast cancer detection behaviors among 301 ethnically diverse low-income women participating in a breast cancer educational outreach program. Multivariate analyses showed that women who had a mammogram in the past year were more likely to be more knowledgeable about breast cancer than women who did not have a mammogram in the past year. Women who had received a mammogram at any time in the past and who had a clinical breast examination during the preceding year were more likely to have received encouragement to obtain mammography than those who had never received a mammogram and did not get a CBE during the preceding year. For women between the ages of 20 and 39, recommendation of mammography and breast cancer knowledge were related positively to ever having a mammogram. Recommendation of breast self-examination (BSE) and number of barriers to BSE were related to monthly BSE practice. Results suggests that health care providers play an important role in motivating low-income minority women to comply with breast cancer screening recommendations.     

Determining the Awareness of and Compliance with Breast Cancer Screening among Turkish Residential Women

Background: Breast cancer is the leading cause of cancer-related deaths in women. Despite being associatedwith high morbidity and mortality, breast cancer is a disease that can be diagnosed and treated early. Materialsand Methods: In this cross-sectional study of 321 women, data were collected by Questionnaire, Breast CancerRisk Assessment Form and Champion’s Health Belief Model Scale. Mann-Whitney U, Kruskal-Wallis, Chisquaredtests and logistic regression were used in the statistical analysis. Results: It was found that only 2.2%of women have high and very high risk levels of breast cancer risk. There is a positive correlation between earlydiagnosis techniques and Health Belief Model Sub-Dimension scores which are sensibility, health motivation,BSE (Breast self-examination) self-efficient perception and negative correlation between mammography barrierscore and BSE barrier score (p 0.05). When factors for not having BSE were examined, it was determined thatthe women who do not have information about breast cancer and the women who smoke have a higher risk ofnot having BSE. Conclusions: It is important to determine health beliefs and breast cancer risk levels of womento increase the frequency of early diagnosis. Women’s health beliefs are thought to be a good guide for planninghealth education programs for nurses working in this area.     

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.     

Do We Need to Maximise the Breast Cancer Screening Awareness?: Experience with an Endogamous Society with High Fertility

Background: In the State of Qatar, breast cancer has become the most common form of cancer amongwomen. The aim of this study was to explore knowledge, attitude and practice about breast cancer and toidentify potential barriers to screening procedures among women. Methods: This multistage sampling crosssectional survey in primary health care centers and the outpatient department of the Women’s Hospital in theState of Qatar targeted a representative sample of 1,200 Qatari women aged between 30 to 55 years of ageduring the period from December 2008 to April 2009. A total 1,002 subjects (83.5%) consented to participation.Face to face interviews were conducted with a designed questionnaire covering knowledge about breast cancer,attitudes and practices of breast cancer screening. Socio-demographic variables were included. Results: Themajority of Qatari women demonstrated an adequate knowledge about breast cancer, with a significant relationto education status. Almost three quarters were aware that breast cancer is the most common cancer in women.A good proportion knew that nipple retraction (81.2%) and discharge of blood (74.6%) are warning signs. Ofthe studied Qatari women, 24.9% identified breast self examination, 23.3% clinical breast examination (CBE)and 22.5% mammography as methods for detection of breast cancer. The frequently reported barriers amongthe Qatari women were asking any doctor/nurse how to perform breast self examination (57.3%), embarrassmentabout CBE (53.3%) and fear of mammography results (54.9%). Univariate and multivariate logistic regressionanalysis showed that family history, level of education, living in an urban area and having medical check-upswhen healthy were significant predictors for CBE and mammography. Conclusion: The study findings revealedthat although Qatari women had adequate general knowledge about breast cancer, the screening rates for BSE,CBE and mammography were low, these being performed most frequently by young Qatari women with ahigher level of education.     

Impact of Educational Level and Family income on Breast Cancer Awareness among College-Going Girls in Shillong (Meghalaya), India

Background: Breast cancer (BC) is the most common cancer among women in India and shows an increasing trend. The mammography screening seems unfeasible as a public health service in India. Thus, breast self-examination (BSE), followed by clinical breast examination (CBE), is the affordable method to downstage BC. A cross-sectional study was conducted with senior school and college-going girls in Shillong (Meghalaya) to study the impact of girls’ academic level and family income on breast cancer knowledge and the prevalence of BC’s known risk factors in girls.  Methods: A self-administered questionnaire was employed to collect relevant information. The data were analysed using statistical software SPSS version 22. The categorical data presented as frequency (%) and the comparison made using Chi-square or Fisher exact test. Results: (i) 78.2% girls knew about breast cancer, 19.2% of these were aware of BSE, and 22.9% of BSE knowing ever performed it (ii) Awareness of breast cancer and BSE, and its practice is significantly associated with their academic level and family income (iii) The consumption of alcohol beverages and physical activity of girls was positively associated with educational level and family income (iv) Body mass index (BMI) was weakly associated with family income with an insignificant relationship with academic level (v) oily food consumption related inversely with the level of education irrespective of family income (vi) there was a positive correlation between parents education and family income. Conclusions: The results show a severe lack of breast cancer knowledge in senior school and college-going girls under the survey. To spread community awareness, we suggest a public health policy-driven educational intervention through culturally relevant mass/social media on the risk factors of breast cancer and practice of BSE. It is also recommended that dedicated facilities be created for breast cancer early diagnosis in the public health system.