Knowledge, Attitudes, and Interest in Breast-Ovarian Cancer Gene Testing: A Survey of a Large African-American Kindred with a BRCA1 Mutation

BACKGROUND: This study assessed counseling and testing needs from the perspective of adult members of a large African-American kindred with a BRCA1 mutation. METHODS: Interviews were conducted with 95 male and female kindred members to elicit information on sociodemographics, attitudes toward health care providers, breast cancer screening behaviors, and religious/spiritual beliefs, as well as to evaluate psychological distress, beliefs, knowledge, and attitudes related to genetic testing. RESULTS: Knowledge about breast and ovarian cancer genetics was limited. Adherence to screening recommendations was low among females with no personal breast or ovarian cancer history. The majority (67%) wished to discuss risk factors with a health care provider. Most participants (82%) indicated that they would have a genetic test if it were available. Significant predictors of intent to undergo testing were having at least one first-degree relative with breast and/or ovarian cancer (OR = 5.1; 95% CI = 1.2-20.9) and perceived risk of being a gene carrier > or =50% (OR = 64.3; 95% CI = 5.1-803.9) or reporting that they did not know their risk of being a gene carrier (OR = 10.9; 95% CI = 2.1-57.7). Cited barriers to testing included cost and availability. CONCLUSION: There is a high interest level in genetic testing despite limited knowledge about cancer genetics among these high-risk African Americans. Our study provides information for designing a genetic education and counseling intervention for this and similar families.     

Psychological and behavioral impact of receipt of a "normal" ovarian cancer screening test

OBJECTIVE: While cancer screening can reduce morbidity and mortality, screening can also be associated with adverse physical, psychological, and behavioral outcomes, even when no malignancy is detected. Few studies, however, have comprehensively examined the potential positive impact of a normal cancer screening test result. This study examined the effects of receipt of a normal ovarian cancer screening test result on a range of psychosocial outcomes, including screening-related beliefs and intentions, risk knowledge, distress, and positive affect. METHOD: The present study utilized baseline, 2-week, and 4-month data from a sample of 560 asymptomatic women who underwent a routine screening for ovarian cancer and received a normal result as well as 296 controls (Lexington, Kentucky, USA, 2000-2002). RESULTS: Growth curve modeling revealed that receipt of a "normal" test result following ovarian cancer screening was associated with increased beliefs in the efficacy of ovarian cancer screening, decreased ovarian cancer-related distress, increased knowledge of ovarian cancer risk factors, and increased positive affect over the 4-month study period. CONCLUSION: Receipt of a normal ovarian cancer screening test result influences a range of affective and cognitive endpoints. For the most part, these endpoints are either empirically or theoretically linked to likelihood of participation in future cancer screening. Thus, participation in routine ovarian cancer screening with receipt of a normal screening test result may create a set of affective and cognitive conditions that facilitate repeat screening and contribute to the maintenance of appropriate ovarian cancer screening behavior.     

Short-term oral contraceptive use and the risk of epithelial ovarian cancer

Oral contraceptive (OC) use has been consistently linked to a reduction in ovarian cancer in a dose-dependent fashion. Whether short-term OC use is protective remains controversial. In 1994-1998 in the Delaware Valley of Pennsylvania, the authors examined the association between short-term OC use and ovarian cancer in a population-based case-control study comparing 608 incident epithelial ovarian cancer cases with 926 community controls. Using unconditional logistic regression and adjusting for known confounders, they found a significant reduction in ovarian cancer risk for women who had used OCs for < or =6 months (odds ratio = 0.73, 95% confidence interval: 0.54, 0.99). This protective effect was observed in only that group who had used OCs for < or =6 months and stopped because of side effects (odds ratio = 0.59, 95% confidence interval: 0.40, 0.87 for side effects and odds ratio = 0.91, 95% confidence interval: 0.60, 1.37 for non-side-effects). Women who used OCs for >6 months were at a reduced risk independent of their reason for stopping. Results were similar when stratifying by parity and hormone therapy use. Thus, OC use for as little as 6 months provides significant protection against ovarian cancer risk, protection that appears limited to those women who stop using OCs because of side effects. Mediating factors may reflect endogenous hormone levels, OC metabolism, or OC bioactivity.     

Age, health beliefs, and attendance to a mammography screening program in the community of Valencia

BACKGROUND: Age has a significant bearing on health beliefs related to participating in breast cancer screening programs. This study is aimed at analyzing the breast cancer-related beliefs and attitudes influencing screening program participation among different age groups. METHODS: In a transversal study, a comparison is drawn between the health-related beliefs of a group of women participating in a screening program and a group of non-participating women, taking into account three age ranges (under age 50 (N = 279), 50-60 age range (N = 463), and over age 60 (N = 271). RESULTS: Some variables significantly differ between the participating and non-participating women solely in certain subgroups: perceived severity (50-60 age group: F = 5.14; p < 0.01); perceived benefits (under age 50: F = 8, 18; p < 0.01; over age 60: F = 4.54; p < .05); mammogram-related attitude (under age 50: F = 56.67; p? .001; over age 60: F = 18.42; p < 0.001); professional health checkups (under age 50: F = 11.30: p < 0.01) and luck or chance (under age 50: F = 3.78; p < 0.05; 50-60 age group: F = 4.29; p < 0.001). More specific beliefs, assessed by items from these scales, are also statistically significant (p < 0.05), although only for certain age groups. CONCLUSIONS: Women's breast cancer prevention program participation related beliefs and/or attitudes differ in terms of their age.     

A randomized controlled trial of a decision aid for women at increased risk of ovarian cancer.

PURPOSE: To carry out a randomized controlled trial of a decision aid for women at increased risk of developing ovarian cancer to facilitate decision making regarding risk management options. METHODS: This randomized trial, conducted through 6 familial cancer centers, compared the efficacy of tailored decision aid to that of a general educational pamphlet in preparing women for decision making. PARTICIPANTS: 131 women with a family history of breast and/or ovarian cancer or of hereditary nonpolyposis colorectal cancer. OUTCOME MEASURES: Decisional conflict, knowledge about ovarian cancer risk management options, and psychological adjustment were reassessed at 3 time points. RESULTS: Compared to those who received the pamphlet (control), women who received the decision aid (intervention) were significantly more likely to report a high degree of acceptability of the educational material at both follow-up assessment time points. Findings indicate neither group experienced significant increases in psychological distress at either follow-up assessment time points relative to baseline. Two weeks postintervention, the intervention group demonstrated a significant decrease in decisional conflict compared to the control group (t = 2.4, P < 0.025) and a trend for a greater increase in knowledge about risk management options (t = 2.1, P = 0.037). No significant differences were found 6 months postintervention. CONCLUSION: This form of educational material is successful in increasing knowledge about risk management options and in reducing decisional conflict in the shorter term. The decision aid is an effective and acceptable strategy for patient education to facilitate an inclusive and informed decision-making process about managing ovarian cancer risk.     

Aggregation of ovarian cancer with breast, ovarian, colorectal, and prostate cancer in first-degree relatives

Epidemiologic studies have demonstrated a tendency for common cancers to aggregate in families. The authors investigated the effects of family history of cancer at multiple sites, including the breast, ovary, colorectum, and prostate, on ovarian cancer risk among 607 controls and 558 ovarian cases in Hawaii and Los Angeles, California, in 1993-1999. A family history of cancer of the breast, ovary, colorectum, or prostate in first-degree relatives was associated with an increased risk of ovarian cancer (odds ratio (OR)=1.7, 95% confidence interval (CI): 1.1, 2.6; OR=3.2, 95% CI: 1.3, 7.9; OR=1.5, 95% CI: 0.9, 2.5; and OR=1.6, 95% CI: 1.0, 2.8, respectively). A greater risk of ovarian cancer was observed for women with parents rather than siblings with a history of breast or prostate cancer and for women with parental colorectal cancer diagnosed at an early age, suggesting a genetic predisposition among these women. The risk of nonmucinous tumors, but not mucinous tumors, was positively associated with a family history of cancer. No significant interaction effects on risk existed between oral contraceptive pill use or pregnancy and family history of breast and/or ovarian cancer. Study findings suggest that ovarian cancer aggregates with several common cancers in family members.     

Knowledge about Cervical Cancer Risk Factors,Traditional Health Beliefs,and Pap Testing Among Vietnamese American Women

Introduction: The objective of this paper was to examine knowledge about cervical cancer risk factors and traditional health beliefs in relation to Papanicolaou (Pap) testing among Vietnamese women. Methods: A population-based survey was conducted in Seattle (n<352, response rate=82%) during 2002. Results: The proportions of women who knew that older age, not getting regular Pap tests, and Vietnamese ethnicity are associated with an elevated cervical cancer risk were only 53%, 62%, and 23%, respectively. The majority (87%) incorrectly believed poor women’s hygiene is a risk factor for cervical cancer. Approximately two-thirds (68%) of the women had received a Pap test during the preceding three years. Knowing that lack of Pap testing increases the risk of cervical cancer was strongly associated (p<0.001) with recent Pap smear receipt. Conclusion: Our results confirm that Vietnamese women have lower levels of cervical cancer screening than non-Latina white women. Intervention programs addressing Pap testing in Vietnamese communities should recognize women’s traditional beliefs while encouraging them to adopt biomedical preventive measures into their daily lives.     

Reproductive Risk Factors for Epithelial Ovarian Cancer According to Histologic Type and Invasiveness

PURPOSE: Differences in histology among the subtypes of epithelial ovarian tumors suggest possible differences in their etiologies. We examined reproductive risk factors for epithelial ovarian cancer according to histologic subtype and tumor invasiveness.

METHODS: We conducted a population-based, case-control study of associations between reproductive risk factors and epithelial ovarian cancer in the Delaware Valley from 1994 to 1998. Cases age 20 to 69 years with a recent diagnosis of epithelial ovarian cancer (n = 767) were compared to community controls (n = 1367) frequency matched by age.

RESULTS: With few exceptions, we found significant risk reduction for each histologic subtype of epithelial ovarian cancer by using oral contraceptive, bearing children, and having a tubal ligation; for each subtype, there was significant increased risk associated with a family history of the disease. There were no significant differences among histologic subtypes in the magnitude of the odds ratios for OC use, parity, breastfeeding, tubal ligation, hysterectomy, family history of breast or ovarian cancer, use of noncontraceptive estrogens, age at menarche, and age at menopause. There were also few differences between invasive and borderline tumors, except that women with borderline tumors were significantly younger than women with invasive disease (44.7 years vs. 52.0 years, p < 0.001). Among serous tumors only, women with borderline tumors were more likely to use oral contraceptives than women with invasive tumors (OR = 2.28 95% CI 1.20–4.35).

CONCLUSION: The results of this study suggest that reproductive risk factors do not differ among histologic subtypes of epithelial ovarian cancers.     

Knowledge,attitudes, and practices among Saudi women regarding cervical cancer,human papillomavirus (HPV) and corresponding vaccine

AimTo our knowledge there are no studies exploring Saudi women’s understanding of the importance of the human papillomavirus (HPV) vaccine. In the present study, we examined the awareness of HPV and women’s attitudes toward the HPV vaccine.MethodNine focus groups were formed in Riyadh City, Saudi Arabia, including 77 women between the ages of 18 and 45 years old. Face-to-face interviews were conducted in 58 female healthcare providers to examine women’s awareness of cervical cancer, HPV, barriers, acceptance, beliefs, and attitudes towards the HPV vaccine.ResultsFocus group discussions revealed a lack of knowledge and awareness of cervical cancer, HPV, and the HPV vaccine. Cultural concerns regarding screening and vaccinating for a conventionally known sexually transmitted infection were an emerging theme in addition to not perceiving cervical cancer screening as necessary because women with no signs and symptoms considered themselves not at risk for developing cervical cancer. Approximately 30% of healthcare providers other than physicians were unaware of prevention methods, and 63.3% did not practice any screening methods for cervical cancer and attributed the lack of screening to “no specific reasons at all”.ConclusionBecause of the unfavorable knowledge and attitude of HPV infection and the associated vaccine from the women in the present study, emphasis should be directed to educate and promote awareness of women to the risk factors of cervical cancer and to the need for screening programs and the administration of the vaccine.     

Psychosocial factors influencing breast cancer risk appraisal among older women

Although the incidence of breast cancer increases with age, many older women are uninformed about the increased risk and have lower mammography screening rates than younger women. Understanding older women's perceptions of risk might assist health care providers in offering appropriate resources that result in screening. In this study, we explored psychosocial components influencing older women's breast cancer risk appraisal. To identify key psychosocial components of breast cancer risk appraisal, we conducted focus group interviews. Data saturation occurred with four groups (N = 36) of older Black (58%) and White (42%) women with no prior history of breast cancer. On analysis of the data, we found three themes representing psychosocial factors influencing breast cancer risk appraisal with this cohort. Our findings revealed that worry/fear/anxiety, self-regulating empowerment, and realistic optimism were psychosocial mechanisms older Black and White women in this sample used in appraising breast cancer risk.     

Attitudes, beliefs, and knowledge as predictors of nonattendance in a Swedish population-based mammography screening program

BACKGROUND: The effectiveness of mammography screening could be improved if factors that influence nonattendance were better understood. METHODS: We examined attitudes, beliefs, and knowledge in relation to nonattendance in a population-based mammography screening program, using a case-control design. Data were collected from November 1997 to March 1998 through telephone interviews with 434 nonattenders and 515 attenders identified in a population-based mammography register in central Sweden. The questions asked drew primarily upon the components constituting the Health Belief Model. RESULTS: Multivariate analysis showed that nonattendance was most common among women within the highest quartile of perceived emotional barriers, compared to women within the lowest quartile (OR = 4.81; 95% CI 2.96-7.82). Women who worried most about breast cancer were more likely to attend than those who worried least (OR = 0.09; 95% CI 0.02-0.31). Women with the highest scores of perceived benefits were more likely to attend than women with the lowest ones (OR = 0.35; 95% CI 0.08-0.75). Other factors associated with nonattendance were less knowledge about mammography and breast cancer, lack of advice from a health professional to participate, and very poor trust in health care. CONCLUSIONS: Our findings suggest that increased participation in outreach mammography screening programs can be achieved through enhancement of breast cancer awareness and possibly by reducing some of the modifiable barriers. mammography; mass screening; breast cancer; attitudes; Sweden.     

Cervical cancer screening: knowledge of Pap smear benefits and utilization in Mexico

OBJECTIVE: To identify and evaluate the predisposing factors regarding the utilization of the Pap smears in the population seen in the Cervical Cancer Screening Program in Mexico METHODS: A cross-sectional study was conducted from January 1997 through December 1998 in Mexico city. A questionnaire was applied to a total of 2,107 women of reproductive age who attended a family planning program and data was collected regarding the following topics: social-demographics, reproductive risk factors associated with cervical cancer, sexual behavior and partner history, birth control, knowledge about Pap smear' benefits, and its utilization. Statistic analysis was conducted using Student' s test and non-conditional multiple logistic regression model for determining significance. RESULTS: The predisposing factors were: knowledge about Pap smear's benefits (OR=6.00, CI 95% 4.70-7.67), history of using at least two birth control methods (OR=2.38, CI 95% 1.75-3.24), previous history of vaginal infection (OR=2.18, CI 95% 1.73-2.75), sexual partner's approval of gynecological examinations (OR=1.56, CI 95% 1.07-2.29). CONCLUSIONS: Educational programs on cancer prevention in this population should include the benefits of screening tests. Pap smears for Mexican women of reproductive age are mostly offered opportunely. The previous use of health services is a determinant factor for the utilization of the Cervical Cancer Screening Program. These results show the need to strengthen health promotion programs to women at high risk of cervical cancer and their sexual partners.     

Communicating breast cancer risk: patient perceptions of provider discussions

This study investigated the relationship between breast cancer risk communication delivered by providers and patient knowledge, perceptions, and screening practices. Telephone interviews were conducted with 141 African American (n = 71) and white (n = 70) first-degree relatives of breast cancer patients who received medical services at 2 university medical centers in North Carolina during 1994-95. Multiple items assessed subjects' reports of discussions with providers about family history and personal risk, knowledge of breast cancer risk factors, risk perceptions, breast cancer concerns, and screening practices. African American (AA) women were less likely than white women to report being informed of their increased personal risk of breast cancer because of family history. After controlling for education level, AA women aged > or = 50 years were less likely than white women to have ever had a mammogram. Both AA and white women who discussed family history and risk with their providers were significantly more likely to have had a mammogram within the past 2 years. Although these discussions seemed to increase participants' perceived risk of developing breast cancer, they did not promote knowledge of risk factors or increase levels of cancer concern. Study results indicate that provider discussions about family history and personal risk, accompanied by increases in risk perception, promote patient compliance with screening goals. Findings suggest that accurate knowledge about specific breast cancer risk factors may not be necessary to achieve screening compliance. However, additional studies are needed to investigate the relationship between knowledge of breast cancer risk factors and the adoption of behaviors associated with reducing breast cancer risk.     

Cervical cancer screening: Women's knowledge,attitudes, and practices in the region of Monastir (Tunisia)

BackgroundIn Tunisia, cervical cancer is considered the second leading cancer in women and causes high morbidity and mortality. This study aimed to investigate women's knowledge, attitudes, and practices of cervical cancer screening in the region of Monastir (Tunisia).MethodsWe conducted a cross-sectional study exploring the cervical cancer screening knowledge, attitudes, and practices of women in the region of Monastir. The study was conducted in health centers in this region from 1st March to 30th June 2009. Data were collected using a structured questionnaire containing 15 items on demographic status, knowledge of risk factors and screening methods, and attitudes toward the relevance and effectiveness of cervical cancer screening.ResultsA total of 900 women agreed to take part in the study. Their mean age was 41.6 ± 12.4 years and 64% did not exceed the primary level of education. According to the constructed scores, 22.8% of the participants had good knowledge of cervical cancer risk factors and 38.2% had good knowledge of screening methods. Multiple logistic regression analysis showed that women aged 45 and older, married, with good knowledge of risk factors and screening methods were more likely to undergo cervical cancer screening (P-value < 0.01).ConclusionThis study provides useful information that could be utilized by both researchers and those involved in public health programs. The results show the need for educational programs to enhance women's adherence to cervical cancer screening programs in Tunisia.     

Deciding about Prophylactic Oophorectomy: What Is Important to Women at Increased Risk of Ovarian Cancer?

BACKGROUND: Little is known about the factors that women at increased risk of ovarian cancer consider to be important when deciding about prophylactic oophorectomy, surgery to remove the ovaries before they develop cancer. METHODS: Women who had undergone prophylactic oophorectomy (surgical group; n = 30) were compared with women who remained on the ovarian screening program (nonsurgical group; n = 28) on their importance ratings for a number of relevant decision-making factors. RESULTS: The most important decision-making factor across all subjects was reducing risk of ovarian cancer, but the single best predictor of group membership was the importance attributed to reducing cancer worry. Women who rated this factor as more important were more likely to be in the surgical group. No women identified the increased risk of heart disease and osteoporosis as issues for consideration. CONCLUSIONS: The desire to reduce cancer worry is likely to be the most important factor in a woman's decision to proceed to prophylactic oophorectomy. In view of the current imprecision in risk estimates given to women considering this option, cancer worry may override a more rational consideration of the costs and benefits of surgery.     

Influences on Breast Cancer Screening Behaviors in Tamil Immigrant Women 50 Years Old and Over

Objective To investigate, using the Health Belief Model as a theoretical framework, the incentives and barriers to breast cancer screening in a recent immigrant group, older Tamil women from Sri Lanka. Method Tamil women who had had a mammogram and Tamil women who had never had a mammogram were compared on the following variables: socio-demographics, personal risk estimates for breast cancer, risk-reduction expectancies, beliefs and knowledge about breast cancer and screening recommendations, and acculturation. Results Groups differed significantly in terms of education, years living in North America, acculturation, and beliefs/knowledge about breast cancer. When education and acculturation were controlled, perceived barriers to mammography were most predictive of mammography utilization. Discussion Results are discussed with a view to developing culture-appropriate educational campaigns.     

Combined oral contraceptive use and epithelial ovarian cancer risk: time-related effects

BACKGROUND: Although the protective effect of oral contraceptives (OCs) use against epithelial ovarian cancer is well-established, there remain gaps in our understanding of the contributions of time-related characteristics of OC use to risk. METHODS: This population-based case-control study, carried out in Hawaii and Los Angeles 1993-2006, included 813 cases of epithelial ovarian cancer and 992 controls. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated using unconditional logistic regression. RESULTS: Epithelial ovarian cancer risk was reduced 5 or more years after initiation of OC use (OR = 0.18; CI = 0.08-0.39). Each year of use provided a 5% reduction (CI = 2%-8%) in risk. A positive gradient in risk with time since first OC use was independent of duration of OC use. The inverse association of OCs with risk was attenuated decades after last use, but was not affected by age at first or last use. OC use for <1 year was associated with decreased ovarian cancer risk (OR = 0.45; CI = 0.26-0.79) only among recent users (< or =20 years from diagnosis/interview). Women who used OCs for a year or more were protected for at least 3 decades after they stopped use. CONCLUSIONS: Reduction in epithelial ovarian cancer risk associated with OC use became apparent after a short latency period and short duration of use, and was long-lasting. Time since first use and time since last use seem to modify the association of OCs with ovarian cancer risk independently of duration of use.     

Perceptions of cervical cancer threat, benefits, and barriers of Papanicolaou smear screening programs for women in Iran

OBJECTIVES: The main purpose was to assess associations between HBM variables and participation in cervical cancer screening programs in a sample of Iranian women. METHODS: A total of 333 married women of childbearing age were recruited with cluster sampling. The study was conducted from spring 2002 to spring 2003 and a self-report questionnaire and structured interview were designed to measure the four HBM constructs and Iranian women's knowledge about Pap smear screening. RESULTS: A total of 68.5% reported having undergone at least one Pap test. Women were more likely to participate in Pap smears when they had access to knowledge about cervical cancer and screening programs. Furthermore, the perceived benefit and barrier variables of the Health belief model were two factors related to participation in Pap smear testing. CONCLUSIONS: Health care professionals must provide women with more information about cervical cancer and the benefits of participating in cervical cancer screening programs.     

Breast cancer screening: effect of physician specialty, practice setting, year of medical school graduation, and sex.

We surveyed physicians of different specialties in a large metropolitan area to determine how their characteristics affected their performance and beliefs about breast cancer screening. Of 664 general internists, obstetrician-gynecologists, and cardiologists surveyed, we received 298 responses (45%). We found significant differences in reported performance of breast cancer screening and physicians' beliefs about mammography screening among practicing obstetrician-gynecologists, internists, and cardiopulmonary specialists. Cardiopulmonary specialists performed the fewest breast examinations and screening mammograms and were most likely to believe annual mammography screening unnecessary even for women in their 50s. We observed no difference between physicians graduating before 1960 and those graduating afterward and no differences according to physician sex. We found similar screening practices and beliefs in the three types of practice settings examined: community-based, private practices, a large health maintenance organization (HMO), and academic medical centers. Obstetrician-gynecologists and internists differed only in the frequency with which they performed breast examinations. Physicians graduating before 1960 in these two groups reported somewhat poorer performance and knowledge of breast cancer screening than those graduating more recently. A majority of all respondents disagreed with American Cancer Society guidelines for mammography screening. Physicians of all specialties reported performing far more breast examinations than screening mammograms on women of all ages, even for those 50-59 years of age. We conclude that all physicians need to improve their screening rates. However, intervention programs should first target those physicians with the greatest deficiencies in breast cancer screening performance and knowledge; these include medical specialists and older physicians in primary care specialties.     

An intervention study on screening for breast cancer among single African-American women aged 65 and older

BACKGROUND: Older African-American women with single marital status are least likely to use screening procedures. This study aimed to evaluate a breast screening intervention program conducted in this population. METHODS: Ten public housing complexes were randomly assigned to either the intervention or the control group. African-American women aged 65 and over were recruited into the study if they were widowed, divorced, separated, or never married and did not have a history of breast cancer (n = 325). The intervention program was delivered by lay health educators at the participant's apartment and was designed to increase knowledge about breast screening, reduce psychological problems, and increase support from significant others. Breast-screening-related cognition and behavior were measured at baseline and at 1 and 2 years postintervention. RESULTS: Comparisons of the preintervention and postintervention measurements showed that while the proportion of women who had a clinical breast examination or mammogram in the preceding year was decreased at 1 year postintervention in the control group, it was increased in the intervention group. However, the differences did not reach a significant level. No consistent patterns could be found in changes of breast self-examination and variables in knowledge, attitudes, and beliefs. When analyses were restricted to women whose significant others had provided information or help on breast screening, results were better, but the differences between the intervention and control groups still did not reach statistical significance. CONCLUSIONS: These results did not suggest significant effects of an intervention program that used lay health educators to promote breast cancer screening in older single African-American women.