Do Appalachian Women Attending a Mobile Mammography Program Differ from Those Visiting a Stationary Mammography Facility?

To compare the characteristics (demographic, access to care, health-related behavioral, self and family medical history, psychosocial) of women aged 40 years and above who utilize a mobile mammography unit with those women aged 40 years and above who obtain mammography screening at a stationary facility. A cross-sectional study design was used with participant cohorts comprised of women age 40 years and above throughout West Virginia (WV) who utilized mobile mammography unit to get mammogram and those who had mammography screening at the stationary facility and completed the Mammography Screening and Preventive Care Survey. A total of 1,161 women who utilized the mobile mammography unit and 1,104 women who utilized stationary facility were included in the analysis. In logistic regression after adjusting for all the variables, women who utilized mobile mammography unit were more likely to be in age group 40–49, with lower income, with no health insurance coverage, not visit doctor or obstetrician/gynecologist (OB/GYN) in the past year, not adherent to clinical breast exam and mammography screening guidelines, with lower perceived five-year risk of developing breast cancer and with high knowledge about mammography screening. Women who utilize mobile unit are not adherent to mammography screening guidelines thereby suggesting that the mobile mammography unit is indeed reaching a rural vulnerable population who may not routinely access preventive health services. Financial and insurance constraints, as well as access to medical care, restricted WV women from receiving mammography screening from the stationary screening facilities.     

Mammography Screening Among Arab American Women in Metropolitan Detroit

Mammography screening behavior has not been well studied among Middle Eastern immigrant women. We conducted a telephone survey of 365 Arab American women residing in metropolitan Detroit, home to one of the largest populations of Middle Eastern immigrants in the US, to determine prevalence of factors associated with mammography, and attitudes and beliefs regarding mammography screening. Of 365 participants, only five were born in the US. Mean age was 53.2 years (SD 10.8). Two hundred twelve (58.1%) reported having mammogram every 1–2 years; 70% ever had mammogram. Age 50–64 years, having health insurance, married status, being in the US over 10 years, and being Lebanese were associated with mammography every 1–2 years. After adjusting for demographic factors, perceived seriousness of disease, general health motivation, and having fewer barriers were associated with more frequent screening. Appropriate mammography screening is decreased in this group. Targeted outreach regarding screening is appropriate for this population; however, lack of insurance may prevent adequate follow-up.     

Health Care Access and Breast Cancer Screening Among Latinas Along the California–Mexican Border

Latinas are more likely to exhibit late stage breast cancers at the time of diagnosis and have lower survival rates compared to white women. A contributing factor may be that Latinas have lower rates of mammography screening. This study was guided by the Behavioral Model of Health Services Use to examine factors associated with mammography screening utilization among middle-aged Latinas. An academic–community health center partnership collected data from community-based sample of 208 Latinas 40 years and older in the San Diego County who completed measures assessing psychosocial factors, health care access, and recent mammography screening. Results showed that 84.6 % had ever had a mammogram and 76.2 % of women had received a mammogram in the past 2 years. Characteristics associated with mammography screening adherence included a lower acculturation (OR 3.663) a recent physician visit in the past year (OR 6.304), and a greater confidence in filling out medical forms (OR 1.743), adjusting for covariates. Results demonstrate that an annual physical examination was the strongest predictor of recent breast cancer screening. Findings suggest that in this community, improving access to care among English-speaking Latinas and addressing health literacy issues are essential for promoting breast cancer screening utilization.     

Factors Associated with Breast Cancer Screening in Asian Indian Women in Metro-Detroit

Few studies have examined social factors related to breast cancer screening in Asian Indian women in the Midwestern US. This cross-sectional, community-based survey utilized constructs of the Health Belief Model to examine factors associated with breast cancer screening among Asian Indian women in metropolitan Detroit, Michigan. Of the 160 participants, 63.8% reported receiving both a clinical breast exam and mammogram within the past 2 years. Women were more likely to screen for breast cancer if they had a college education, lived in the US for more years, perceived that breast cancer screening is useful in detecting breast cancer early, agreed that mammography was important, and received a recommendation by a healthcare provider to get a mammogram. These findings highlight the need for further research on regional differences in breast cancer screening knowledge, behaviors and predictors among Asian Pacific Islanders subgroups such as Asian Indian women who recently immigrated to the US.     

The influence of previous breast cancer upon mammography utilization.

Women with a previous history of breast cancer are at increased risk for developing cancer in the opposite breast. However, the literature is inconsistent regarding whether a previous history of breast cancer is associated positively with mammography utilization. Some studies indicate that women with a previous history of breast cancer are less likely to utilize mammography, although behavioral models of health care theorize that women with a history of breast cancer may be more vigilant regarding the disease. We analyzed responses from 830 women > or =50 years who participated in the 1998 National Health Interview Survey. A significantly greater proportion of women with breast cancer reported had a mammogram in the previous year (73.13%) as compared with women who did not have breast cancer (56.69%). Although a previous history of breast cancer was found to be associated positively with mammography use, women with public sources of health insurance are less likely to report mammography use. Results indicate that women with a previous history of breast cancer appear aware of the necessity for continued screening. However, enabling factors such as type of health insurance continue to exert an influence upon the utilization of mammography.     

Barriers and facilitators related to mammography use among lower educated Mexican women in the USA

This study explores barriers to and facilitators of breast cancer screening and how people in a woman's social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.     

A study guided by the Health Belief Model of the predictors of breast cancer screening of women ages 40 and older

In late 1987, a total of 852 Rhode Island women ages 40 and older were interviewed by telephone (78 percent response rate) to measure their use of breast cancer screening and to investigate potential predictors of use. Predictors included the women's socioeconomic status, use of medical care, a provider's reported recommendations for screening, and the women's health beliefs about breast cancer and mammography. The Health Belief Model guided the construction of the interview questions and data analysis. Logistic regression was used to identify leading independent predictors of breast cancer screening according to contemporary recommendations: reporting that a medical provider had ever recommended a screening mammogram (odds ratio [OR] = 18.77), having received gynecological care in the previous year (OR = 4.92), having a regular source of gynecological care (OR = 2.63), having ever had a diagnostic mammogram (OR = 2.32), and perceiving mammography as safe enough to have annually (OR = 1.93). The findings suggest that programs intended to increase the use of breast cancer screening should include "inreach" and "outreach" elements; inreach to patients with established patient-provider relationships, by assuring that physicians recommend screening to all eligible patients, and outreach to all eligible women, by helping them overcome barriers to effective primary care, and by promoting mammography, emphasizing its effectiveness and safety. The findings also suggest that socioeconomically disadvantaged women, who are less likely to be screened than other women, should become special targets of inreach and outreach interventions.     

Peer Reviewed: Nonadherence to Breast and Cervical Cancer Screening: What Are the Linkages to Chronic Disease Risk?

Background

Several preventive practices that reduce chronic disease risk have been associated with breast and cervical cancer screening, including maintenance of normal weight and avoidance of cigarette smoking. A history of certain chronic illnesses such as diabetes and cardiovascular disease has also been related to cancer screening. Nevertheless, studies that have attempted to identify women who are less likely to have had a recent breast or cervical cancer screening test have infrequently examined the associations of breast and cervical cancer screening with multiple health factors that influence chronic disease risk.

Methods

To clarify relationships between cancer screening and health behaviors and other factors that influence chronic disease risk, we examined the self-reported breast and cervical cancer screening practices of women in the United States by using data from the 1999 Behavioral Risk Factor Surveillance System. The women were described according to their recent use of mammography and the Papanicolaou test, physician visits within the past year, health insurance coverage, and preventive practices that reduce chronic disease risk.

Results

Overall, 74.5% (95% CI, 73.9%-75.1%) of the women in this sample aged 40 years or older (n = 56,528) had received a mammogram within the past 2 years. The percentage of women who had been screened for breast cancer, however, varied widely by factors associated with reducing the risk of chronic disease (e.g., cholesterol check in the past 2 years, blood pressure check in the past 2 years, normal weight, avoidance of cigarette smoking) and having access to health care (e.g., health insurance coverage, recent physician visit). Similarly, 84.4% (95% CI, 83.9%-84.9%) of all women aged 18 years or older who had not undergone a hysterectomy (n = 69,113) had received a Papanicolaou test in the past 3 years, and factors associated with reduced chronic disease risk and health care access were related to having had a recent Papanicolaou test.

Conclusion

The results of this study suggest that underscreened women who are at risk for breast and cervical cancer are likely to benefit from programs that identify and address coexisting prevention needs. The identification of coexisting prevention needs might assist in developing interventions that address multiple risks for chronic disease among women and might subsequently help improve the efficiency and effectiveness of prevention programs.     

Determinants of the demand for breast cancer screening among women veterans in the United States

Demand theory has been applied to use of breast exams for cancer prevention, but not since widespread promotion of mammography screening and managed care. Previous economic analyses may be biased due to inclusion of diagnostic exams and generally fail to consider perceived risk and time costs. The objective was to identify and measure the effect of economic, demographic, and behavioral factors that influence the use of mammography screening among US women veterans aged 50 years and older. Data are from a 2000-2001 national mail survey with telephone follow-up of a random sample of women veterans. There were a maximum of 3415 respondents aged 50 and over with no history of breast cancer. Maximum likelihood probit models were used to estimate the effects of the independent variables on the probability that a woman will have had a mammogram in the past year. Education, income, insurance, and perceived risk of breast cancer are directly related to use of mammography screening. Age, smoking, travel and waiting time are inversely related to the likelihood of mammography screening. Mammography use among women veterans is generally consistent with the theory of the demand for health and medical care, and also consistent with previous national studies on the demand for breast exams. Findings highlight the role of perceived risk and non-price barriers to mammography use in the context of widespread insurance coverage for mammography screening.     

Breast cancer risk perception, benefits of and barriers to mammography adherence among a group of Iranian women

The study aimed to assess associations between Health Belief Model variables, stages of change, and participation in mammography for early detection of breast cancer in a sample of Iranian women. A total of 414 women, aged 40 to 73 years, were recruited by random sampling. The study took place in the winter of 2007, using a self-report questionnaire and structured interviews, designed to measure the five Health Belief Model constructs and stages of adoption for mammography. The study indicated that 45.8% of the women were in the pre-contemplation and contemplation stages of a mammogram, and 29% of participants reported having had at least one mammogram. Screening behavior was associated with older age, familial history of breast cancer, history of breast disease, health insurance coverage, and living in an urban area. Furthermore, the perceived susceptibility to breast cancer, perceived benefits and barriers for mammography, and cues to action variables defined by the Health Belief Model were four factors related to having a mammogram. The study concludes that health care professionals must provide women with more fear appeals that outline vulnerability to developing breast cancer, remove cognitive barriers to seeking mammography, and apply effective guidance on the participation of women in breast cancer screening programs.     

Breast Cancer Risk Perception,Benefits of and Barriers to Mammography Adherence Among a Group of Iranian Women

The study aimed to assess associations between Health Belief Model variables, stages of change, and participation in mammography for early detection of breast cancer in a sample of Iranian women. A total of 414 women, aged 40 to 73 years, were recruited by random sampling. The study took place in the winter of 2007, using a self-report questionnaire and structured interviews, designed to measure the five Health Belief Model constructs and stages of adoption for mammography. The study indicated that 45.8% of the women were in the pre-contemplation and contemplation stages of a mammogram, and 29% of participants reported having had at least one mammogram. Screening behavior was associated with older age, familial history of breast cancer, history of breast disease, health insurance coverage, and living in an urban area. Furthermore, the perceived susceptibility to breast cancer, perceived benefits and barriers for mammography, and cues to action variables defined by the Health Belief Model were four factors related to having a mammogram. The study concludes that health care professionals must provide women with more fear appeals that outline vulnerability to developing breast cancer, remove cognitive barriers to seeking mammography, and apply effective guidance on the participation of women in breast cancer screening programs.     

Female employee participation in a worksite mammography screening program.

We conducted a survey of 1,184 women 35 years of age or older who were employees of a company in Los Angeles County, California, to determine why some women participated in a worksite mammography screening program whereas others did not. Of the 111 who accepted a mammogram, 90 responded to the survey; of the 1,073 who declined mammography, 620 responded. The women were predominantly white, were well educated, and had health insurance. Of the 111 women who received mammograms, one was diagnosed with carcinoma. Seventy-three percent of the respondents to the survey 40 years of age or older who declined mammograms had already fulfilled American Cancer Society (ACS) guidelines for mammography screening at the time of the program. Women who accepted a mammogram were more likely to have had at least one previous mammogram than were women who had not met ACS guidelines yet who declined screening. We conclude that many female employees who are white, are well educated, and have health insurance may not participate in a worksite mammography screening program because they have been screened elsewhere. Companies providing worksite mammography screening should target education to women who have not met ACS guidelines, especially those who have never had a mammogram.     

Patient navigation to improve breast cancer screening in Bosnian refugees and immigrants

Refugee women have low breast cancer screening rates. This study highlights the culturally competent implementation and reports the outcomes of a breast cancer screening patient navigation program for refuge/immigrant women from Bosnia. Refugees/immigrant women from Bosnia age 40–79 were contacted by a Serbo-Croatian speaking patient navigator who addressed patient-reported barriers to breast cancer screening and, using individually tailored interventions, helped women obtain screening. The proportion of women up-to-date for mammography was compared at baseline and after 1-year using McNemar’s Chi-Square test. 91 Serbo-Croatian speaking women were eligible for mammography screening. At baseline, 44.0% of women had a mammogram within the previous year, with the proportion increasing to 67.0% after 1-year (P = 0.001). A culturally-tailored, language-concordant navigator program designed to overcome specific barriers to breast cancer screening can significantly improve mammography rates in refugees/immigrants.     

Factors Influencing Adherence to Mammography Screening Guidelines in Appalachian Women Participating in a Mobile Mammography Program

The objectives of this study were to evaluate the characteristics (demographic, access to care, health-related behavioral, self and family medical history, psychosocial) of women age 40 years and above who participated in a mobile mammography screening program conducted throughout West Virginia (WV) to determine the factors influencing their self-reported adherence to mammography screening guidelines. Data were analyzed using the Andersen Behavioral Model of Healthcare Utilization framework to determine the factors associated with adherence to mammography screening guidelines in these women. Of the 686 women included in the analysis, 46.2% reported having had a mammogram in the past 2 years. Bivariate analyses showed predisposing factors such as older age and unemployed status, visit to a obstetrician/gynecologist (OB/GYN) in the past year (an enabling factor) and need-related factors such as having a family history of breast cancer (BC), having had breast problems in the past, having had breast biopsy in the past, having had a Pap test in past 2 years, and having had all the screenings for cholesterol, blood glucose, bone mineral density and high blood pressure in past 2 years to be significant predictors of self-reported adherence to mammography guidelines. In the final model, being above 50 years (OR = 2.132), being morbidly obese (OR = 2.358), having BC-related events and low knowledge about mammography were significant predictors of self-reported adherence. Breast cancer related events seem to be associated with mammography screening adherence in this rural Appalachian population. Increasing adherence to mammography screening may require targeted, community-based educational interventions that precede and complement visits by the mobile mammography unit.     

Screening mammography among Chinese Canadian women

BACKGROUND: Though breast cancer is the most common malignancy among Chinese women, screening mammography is underutilized. This study examined barriers and facilitators of screening mammography among Chinese Canadian women. METHODS: Using community-based sampling, Chinese women in British Columbia were interviewed in 1999 about multiple preventive health behaviours. We included 213 women in the mammography analysis; main outcome measures were ever having a mammogram and routine mammography. RESULTS: Seventy-five percent of women 50 to 79 years old reported ever having had a mammogram, and 53% had two or more mammograms within the last five years. Receiving a recommendation for a mammogram from medical personnel or from a family member, and believing that cancer cannot be prevented by faith were independently associated with both screening outcomes. CONCLUSIONS: A multifaceted approach to screening mammography promotion in Chinese Canadian women is suggested. Interventions that include education of and by medical providers and family members should be considered.     

Correlates of Breast Cancer Screening Among Asian Americans Enrolled in ENCORE plus

This study examines the correlates of mammogram utilization among predominantly low income Asian American women using cross sectional data of women recruited through the ENCORE^plus program (n = 1695) between July 1996 and June 1998. Logistic regression was used to examine the independent effect of variables corresponding to Andersen’s behavioral model of health services utilization on mammography screening behavior. Foreign-born women living in the U.S. < 5 years and between 5 and 10 years were significantly less likely to have ever had a mammogram than women who were born in the U.S. (OR 0.22; CI 0.12, 0.40 and OR 0.48; CI 0.27, 0.86, respectively). Women 40–49 years old were half as likely to adhere to mammography screening recommendations as women 50–64 years (CI 0.33, 0.76). Health insurance was positively associated with adherence to mammography screening guidelines (OR 1.59; CI 1.02, 2.48). The results of this study highlight the need for health education about breast cancer and mammography among Asian American women. Policy work also needs to be directed toward improving access to health care in this community.     

Breast cancer screening among American Samoan women

BACKGROUND: Little is known about breast cancer screening practices or predictors of age-specific screening for Samoan women. METHODS: Through systematic, random sampling procedures, we identified and interviewed 720 adult (> or =30 years) Samoan women residing in American Samoa, Hawaii, and Los Angeles. Multivariate logistic regressions were performed to determine independent predictors for recent age-specific screening. RESULTS: Only 55.6% of women (> or =30 years) had ever had a CBE and 32.9% of women (> or =40 years) had ever had a mammogram. Furthermore, only 24.4 and 22.4% of Samoan women (> or =40 years) residing in Hawaii and Los Angeles, respectively, had an age-specific mammogram within the prior year. Independent predictors of age-specific CBE screening included age, education, health insurance, ambulatory visit, and being a resident of Hawaii or Los Angeles; those for mammography included ambulatory visit and awareness of screening guidelines. CONCLUSION: Population-based estimates of age-specific breast cancer screening among Samoan women are lower than the national objectives and those reported for other minorities. Targeted efforts that address doctor-patient communication on preventive behavior, improved access to health care services (especially in American Samoa), and focused educational awareness programs are needed to improve the dismal screening rates observed in this indigenous population.     

Integrating behavior and intention regarding mammography by respondents in the 1990 National Health Interview Survey of Health Promotion and Disease Prevention.

Achieving and maintaining high rates of screening mammography are major public health priorities. This report examines data from the 1990 National Health Interview Survey of Health Promotion and Disease Prevention on the utilization of mammography among women ages 40-75. Results show that progress is being made in some areas--57.7 percent of women "ever had" a mammogram; 50.3 percent, in previous 2 years. However, those not having repeated regular screening appear to be a sizable proportion. Only 28.6 percent of women ages 40-75 had been both screened on the recommended age-specific schedule and expressed an intention to continue screening; another 29.2 percent indicated no intention to have a mammogram in the near future. Income, clinical breast examination, and Pap (Papanicolaou''s) test, having no regular source of care, region of the country and residential variables, smoking status, not exercising, not knowing how to do breast self-examination, and race were among the variables having the strongest associations with mammography status. Several groups in the population therefore remain at risk of not receiving regular screening. The combination of mammography status to date and future intention to have the examination provides an important perspective on efforts to reach public health screening objectives and appears to provide a strategy for targeting interventions.     

Correlates of mammography screening among Hispanic women living in lower Rio Grande Valley farmworker communities.

Factors contributing to the underuse of mammography screening by female Hispanic farmworkers aged 50 years and older in the Lower Rio Grande Valley were determined through home-based, Spanish-language personal interviews (N = 200). Questions covered adherence to screening mammography guidelines (mammogram within 2 years), healthcare access, sociodemographic characteristics, and theoretical constructs related to breast cancer screening in the literature. Multivariate findings indicated that adherent women were 3.6 times more likely to have health insurance. Self-efficacy for obtaining a mammogram and decisional balance were also significantly related to adherence; age, income, and education variables were not associated, perhaps because of restricted variation. Results indicate continuing efforts are needed to ensure that medically underserved migrant farmworker women have access to health care services. In addition, efforts to increase their self-efficacy in obtaining a mammogram and to counter negative attitudes and opinions by stressing the positive prognosis associated with early detection are warranted.     

Mammography Screening Among Mexican, Central-American, and South-American Women

Cancer and cancer screening disparities exist across Latino subgroups; however the reasons for these disparities are not fully known. This study examines (1) mammography screening among Latinas born in Mexico, Central-America and South-America and (2) the impact of birthplace and acculturation on mammography screening. Data were derived from the California Health Interview Survey 2007. Analyses included 1,675 Latina women 40 years of age and older. Multivariate logistic regression examined predictors of mammography screening. Mexican and Central-American women were less likely to report ever receiving a mammogram while Mexican women were less likely to report a recent mammogram. Low-acculturated women were less likely to report ever receiving a mammogram and less likely to report recent mammography. Different screening patterns across Latina subgroups were observed. Differences in screening patterns and the factors associated with screening highlight the need for unique intervention strategies tailored specifically to Latinas.