The Impact of Family History of Breast Cancer on Women's Health Beliefs,Salience of Breast Cancer Family History,and Degree of Involvement in Breast Cancer Issues

ABSTRACT

Prior investigations have employed the Health Belief Model (HBM) to predict health care utilization and cancer screening behaviors. The HBM is expanded in the current investigation to include issue involvement with breast cancer and salience of breast cancer family history. Differences in the constructs of this expanded HBM, as they relate to mammography screening, between women with positive and negative family histories of breast cancer were assessed in 378 women. Perceived benefits and barriers were found to be similar for women with positive and negative family histories of breast cancer. However, susceptibility, cues to action, salience of family history, and issue involvement were found to be more relevant for women with a positive family history of breast cancer. These findings have implications for interventions directed at increasing compliance with recommendations for breast cancer screening.     

Talking about breast symmetry in the breast cancer clinic: What can we learn from an examination of clinical interaction?

BackgroundBreast asymmetry is a common post‐operative outcome for women with breast cancer. Quality of cosmetic result is viewed clinically as a critical endpoint of surgery. However, research suggests that aesthetic standards governing breast reconstruction can be unrealistic and may problematically enforce feminine appearance norms. The aim of reconstructive procedures is to help women live well with and beyond breast cancer. Therefore, understanding how patients and clinicians talk about surgical outcomes is important. However, we lack evidence about such discussions.ObjectiveTo examine clinical communication about breast symmetry in real‐time consultations in a breast cancer clinic.DesignSeventy‐three consultations between 16 clinicians and 47 patients were video‐recorded, transcribed and analysed using conversation analysis.ResultsIn most cases, patients do considerable interactional work to persuade clinicians of the validity of their concerns regarding breast asymmetry, and clinicians legitimize these concerns, aligning with patients. In a significant minority of cases, patients appear more accepting of their treatment outcome, but clinicians prioritize symmetry or treat symmetry with the presence of breast tissue as normative, generating misalignment between clinician and patient.ConclusionCurrent clinical communication guidelines and practices may inadvertently reinforce culturally normative assumptions regarding the desirability of full, symmetrical breasts that are not held by all women. Clinicians and medical educators may benefit from detailed engagement with recordings of clinical communication like those analysed here, to reflect on which communicative practices may work best to attend to a patient''s individual stance on breast symmetry, and optimize doctor‐patient alignment.     

The influence of socio-cultural factors on breast cancer screening behaviors in Lagos,Nigeria

Culture has been shown to influence health beliefs and health-related behaviors by influencing the type of health information to which women have been exposed and shapes health and illness perceptions and practices. To increase screening rates, cultural influences should be considered as important correlates of screening behaviors for breast cancer. This study used semi-structured interviews of women attending a cancer screening facility in Lagos, Nigeria guided by the PEN-3 model to describe culturally relevant factors that shape attitudes toward breast cancer and breast cancer screening. Religion was the most prominent theme and was shown to have positive, negative and existential effect on breast cancer perceptions. Other major themes observed were related to family and traditional beliefs. The results from this study could be used to develop and implement culturally relevant cancer prevention interventions, strategies, and recommendations to overcome screening barriers in an effort to increase breast cancer participation and awareness among Nigerian women.     

Breast and cervical cancer screening: exploring perceptions and barriers with Hmong women and men in Oregon

Background. Hmong women are reported to have very low rates of breast and cervical cancer screening compared to other Asian and White women in the USA. Reasons for low cancer screening rates among this population are not well understood.

Methods. This qualitative study (n=83) explored Hmong women and men's perceptions of breast and cervical cancer and cancer screening, women's experiences with breast and cervical cancer screening, and health care system barriers to screening.

Results. Hmong women and men perceived breast cancer to be more severe than other types of cancers. Participants believed that breast cancer is curable if detected early. Cervical cancer was not well understood and was of greater concern than breast cancer because of its location within the body and its consequences for reproduction. In general, few participants had personal experiences with breast and/or cervical cancer. Overall, women and men had positive things to say about screenings for breast and cervical cancer, expressing that screenings offered a ‘proof of illness.’ The majority of women did not report any concerns with the exams themselves, although some discussed embarrassment, pain, and discomfort. Barriers to screening included lack of health insurance, making co-payments, language, and issues related to scheduling appointments. Barriers differed for younger and older women.

Conclusion. Results of this study provide new insight into perceptions, experiences, and barriers to breast and cervical cancer screening among Hmong women and men. These findings have implications for developing culturally appropriate interventions to increase breast and cervical cancer screening in this population.     

Cancer/health communication and breast/cervical cancer screening among Asian Americans and five Asian ethnic groups

ABSTRACT

Objectives: This paper is an examination of cancer/health communication factors (i.e. cancer/health information seeking, patient-provider communication (PPC), cancer screening information from providers) and screening for breast and cervical cancer among Asian Americans and five Asian ethnic groups (Chinese, Filipinos, Japanese, Koreans, Vietnamese) in comparison to Whites. Additionally, the relationship between cancer/health communication disparity and cancer screening gaps between Asian Americans and Whites was investigated.

Design: Data comes from a nationally representative sample of 2011–2014 Health Information National Trends Surveys (HINTS).

Results: Asian Americans and most Asian ethnic-groups reported significantly lower rates of cancer/health information seeking and lower evaluations for PPC as compared to Whites, though differences within Asian ethnic groups were observed (Koreans’ greater cancer/health information seeking, Japanese’ higher PPC evaluation). When the cancer/health communication factors were controlled, Asian Americans’ odds of cancer screening were increased. Especially, Asian Americans’ odds of adhering to the breast cancer screening guideline became nearly 1.4 times greater than Whites.

Conclusion: This research demonstrates that health organizations, providers, and Asian American patients’ collaborative efforts to increase the access to quality cancer information, to make culturally competent but straightforward screening recommendations, and to practice effective communication in medical encounters will contribute to diminishing cancer disparities among Asian Americans.     

Factors associated with breast cancer screening behaviors in a sample of Jamaican women in 2013

ABSTRACT

In this study authors aimed to investigate the barriers to participation of a sample of Jamaican women in mammography screening. The data were obtained from a previous survey that was conducted in Jamaica from June to August 2013 in the four parishes (Hanover, St. James, Trelawny, and Westmoreland) served by the Western Regional Health Authority (WRHA). WRHA served four hospitals, five non-randomized health centers, and five sites of community events. The sample consisted of women ranging in age between 35 and 83 years, with the mean age of 50.2 (SD = 10.6). The authors used a logistic regression to determine the extent to which variables were associated with breast cancer screening. The level of significace was 0.1 for the bivariate and multivariable analysis. The main factors associated with the lack of breast cancer screening among the women were: being less than 50 years old, single, never thought about breast cancer screening, in need of childcare, and having more than three children. We identified significant barriers to participation in mammography screening experienced by a sample of Jamaican women. Our results suggest that it is necessary to increase the awareness of the importance of breast screening importance among the women who may never have thought about mammography.     

A mixed-method assessment of beliefs and practice around breast cancer in Ethiopia: Implications for public health programming and cancer control

Abstract

A large proportion of breast cancer patients in Ethiopia present for biomedical care too late, or not at all, resulting in high mortality. This study was conducted to better learn of beliefs and practices among patients accessing breast cancer services in a large referral centre in Ethiopia. Using a mixed-method design, we interviewed 69 breast cancer patients presenting for care at Tikur Anbessa Hospital in Addis Ababa, Ethiopia, about their beliefs, experiences and perspectives on breast cancer. Awareness of breast cancer is low in Ethiopia and even among those who are aware of the disease, a sense of hopelessness and fatalism is common. Early signs/symptoms are frequently ignored and patients often first present to traditional healers. Breast cancer is perceived as being caused typically from humoral anomalies or difficulties resulting from breast feeding, and study participants indicate that stigmatisation and social isolation complicate discussion and action around breast cancer. Consistent with other studies, this study shows that traditional beliefs and practices are common around breast cancer and that numerous barriers exist to identification and treatment in Ethiopia. Integrating health beliefs and practice into public health action in innovative ways may reduce stigma, increase awareness and promote survivability among breast cancer patients.     

Mammogram uptake and barriers among Palestinian women attending primary health care in North Palestine

BackgroundBreast cancer affects women''s lives worldwide, yet early detection is an effective strategy for reducing mortality. The participation of women in mammography screening is linked to their knowledge, attitudes and perceived barriers.ObjectivesOur study aims to assess mammography screening uptake and barriers among women attending primary healthcare centres (PHCs) in northern Palestine.MethodsUsing an interviewer administered questionnaire, we used a cross-sectional study design to determine mammography screening uptake, knowledge and barriers among 357 women attending PHCs in Northern Palestine between December 2018 and March 2019.ResultsThe mean age was 50 years. The majority (69.2%) were considered to have adequate knowledge about breast cancer and mammography screening. Mammography screening uptake among the participants was 37%. Almost 85% of the women had a positive attitude towards breastfeeding as a prophylaxis factor against breast cancer, while the most frequent barrier to mammography screening was that the participants believed they did not have any symptoms (28.6%), followed by 22.1% of them who did not want to know if they had breast cancer.ConclusionThe findings of this study highlighted the low mammography uptake among Palestinian women despite the adequate knowledge of those women and the fully accessible and free screening programme. Hence, interventional strategies should be implemented at several levels to enhance mammogram uptake.     

Breast cancer and screening information needs and preferred communication medium among Iranian immigrant women in Toronto

Few studies have investigated what information women from minority immigrant groups need about breast cancer and screening. Nor has much research been conducted about how such women would prefer to receive this information. Mere translation of breast cancer and screening information from generic materials, without considering and respecting women's unique historical, political, and cultural experiences, is insufficient. This study explored breast cancer and screening information needs and preferred methods of communication among Iranian immigrant women. A convenience sample of 50 women was recruited and interviewed over a 4-month period (June-September 2008); all resided in Toronto Canada, and had no history of breast cancer. Tape-recorded interviews were transcribed and analysed using a thematic analysis technique. While generic breast health communication focusing on physiological risk information meets some of the needs of Iranian immigrant women, results showed that the needs of this group go beyond this basic information. This group is influenced by historical, sociopolitical, and cultural experiences pre- and post-immigration. Their experiences with chemical war, unsafe physical environment (air and water pollution), and their sociopolitical situation appear to have limited their access to accurate and reliable breast cancer and screening information in their homeland. Moreover, the behavioural and psychosocial changes they face after immigration appear to have a strong influence on their breast cancer and screening information needs. Considering their limited time due to their multiple demands post-migration, multi-media methods were highly preferred as a communication means by this group. The results of this study can be used to guide the design and implementation of culturally sensitive breast health information. For instance, video presentations conducted by a trusted Iranian healthcare professional focusing on socioculturally relevant breast cancer risk factors, symptoms, and screening methods, as well as a list of available breast health resources, could improve Iranian women's knowledge and uptake of breast health practices.     

Breast and cervical cancer screening in Hispanic women: a literature review using the health belief model.

The aim of this study was to review published studies that examined factors influencing breast and cervical cancer screening behavior in Hispanic women, using the Health Belief Model (HBM). MEDLINE and PsycINFO databases and manual search were used to identify articles. Cancer screening barriers common among Hispanic women include fear of cancer, fatalistic views on cancer, linguistic barriers, and culturally based embarrassment. In addition, Hispanic women commonly feel less susceptible to cancer, which is an important reason for their lack of screening. Positive cues to undergo screening include physician recommendation, community outreach programs with the use of Hispanic lay health leaders, Spanish print material, and use of culturally specific media. Critical review of the literature using the theoretical framework of the Health Belief Model identified several culturally specific factors influencing cancer screening uptake and compliance among Hispanic women. Future interventions need to be culturally sensitive and competent.     

Correlates of misperception of breast cancer risk among Korean-American Women

ABSTRACT

In this study, the authors investigate the factors associated with misperception of breast cancer risk, including unrealistic optimism and unrealistic pessimism, among Korean-American women (KAW). Baseline data were collected between March 2010 and October 2011 from 421 KAW aged 40–65 years who participated in a community-based randomized intervention trial designed to promote breast and cervical cancer screening. Multivariate multinomial regression was performed to identify correlates of misperception of breast cancer risk among KAW. A total of 210 KAW (49.9%) had breast cancer risk perception consistent with their objective risk, whereas 50.1% of KAW in the study had some form of misperception of risk. Specifically, 167 participants (39.7%) were unrealistically optimistic about their own breast cancer risk; 44 (10.5%) were unrealistically pessimistic. In multivariate multinomial logistic regression analysis, living with a partner and higher education were significantly associated with higher odds of having unrealistic optimism. High social support is associated with a lower likelihood of having a pessimistic risk perception. Higher worry is associated with a higher likelihood of having unrealistic pessimism. Misperception of breast cancer risk among KAW and related factors must be considered when developing behavioral interventions for this population.     

Characteristics of women using organized or opportunistic breast cancer screening in France. Analysis of the 2006 French Health,Health Care and Insurance Survey

BackgroundThis study aimed at (i) estimating the 2-year self-reported breast cancer screening coverage rate; and (ii) analyzing the relationships between sociodemographic characteristics and healthcare access of women and breast cancer screening (opportunistic or organized) practices.MethodsFrom a 2006 French health survey, 2056 women aged 50 to 74 years were selected and divided into three groups according to their breast cancer screening practices during the previous 2 years: organized screening, opportunistic screening, or no screening. The three groups were compared according to self-reported sociodemographic status, healthcare access, screening behaviors, and perceived health, using polytomic regression.ResultsThe 2-year self-reported coverage rate was 75.8%. It was high among women aged 50 to 69 years and lower among older women. Questions relating to medical access (i.e. having consulted a GP in the last 12 months, having consulted a gynecologist in the last 12 months, and having had a Pap smear in the last 3 years) were the variables most commonly associated with a recent mammogram. Women having a regular follow-up by a gynecologist or having had cervical cancer screening within the last three years used organized breast cancer screening more often and used opportunistic breast cancer screening even more often than other women.ConclusionThe study confirmed the key role of gynecologists and general practitioners in encouraging women to have a mammogram. Awareness among healthcare professionals and women of the benefits of organized breast cancer screening compared to opportunistic screening should be sustained and strengthened.     

Uptake of screening for breast cancer in South Lancashire

Study objective: To describe and explain variation among general practices in the uptake of screening for breast cancer.Design: Analysis of the variation in uptake of screening by general practice. Uptake rates are calculated and related to a social deprivation score created for each practice, and to the presence of at least one female general practitioner.Setting: South Lancashire Health Authority, England.Patients: All women aged 50–64 y registered with Lancashire Family Health Services Authority and resident in South Lancashire in 1988–1995.Main results: Variation in the uptake of screening for breast cancer during Round 1 of the national programme is explained partly by a deprivation score for each practice and by the presence of at least one female general practitioner. In Round 2 the deprivation index continues to explain variation, but the effect of a female GP has diminished. The number of hours worked by practice nurses has no effect on uptake of breast screening.Conclusions: Variation in the uptake of breast cancer screening is closely related to social deprivation. Results suggest that the presence of a female general practitioner has a beneficial effect on uptake.     

Cost-Effectiveness of Targeted Genetic Testing for Breast and Ovarian Cancer: A Systematic Review

BackgroundTargeted genetic testing is a tool to identify women at increased risk of gynaecological cancer.ObjectiveThis systematic review evaluates the results and quality of cost-effectiveness modeling studies that assessed targeted genetic-based screen-and-treat strategies to prevent breast and ovarian cancer.MethodsUsing MEDLINE and databases of the Centre for Reviews and Dissemination, we searched for health economic modeling evaluations of targeted genetic-based screen-and-treat strategies to prevent inheritable breast and ovarian cancer (until August 2020). The incremental cost-effectiveness ratios (ICERs) were compared. Methodological variations were addressed by evaluating the model conceptualizations, the modeling techniques, parameter estimation and uncertainty, and transparency and validation of the models. Additionally, the reporting quality of each study was assessed.ResultsEighteen studies met our inclusion criteria. From a payer perspective, the ICERs of (1) BRCA screening for high-risk women without cancer ranged from dominating the no test strategy to an ICER of $21 700/quality-adjusted life years (QALY). In studies that evaluated (2) BRCA cascade screening (ie, screening of women with cancer plus their unaffected relatives) compared with no test, the ICERs were between $6500/QALY and $50 200/QALY. Compared with BRCA alone, (3) multigene testing in women without cancer had an ICER of $51 800/QALY (one study), while for (4) multigene-cascade screening the ICERs were $15 600/QALY, $56.500/QALY, and $69 600/QALY for women in the United Kingdom, Norway, and the United States, respectively (2 studies). More recently published studies showed a higher methodological and reporting quality.ConclusionsTargeted BRCA or multiple gene screening is likely to be cost-effective. Methodological variations could be decreased by the development of a reference model, which may serve as a tool for validation of present and future cost-effectiveness models.     

Traditionality and cancer screening practices among American Indian women in Vermont

The study purpose was to examine the relationship between cancer screening and traditionality, using a culturally specific survey instrument. American Indian (AI) women were randomly selected from the Vermont Breast Cancer Surveillance System (VBCSS), a statewide mammography database. The 13 items that assessed traditionality examined identity, cultural beliefs, customs, and health practices. The sample of 115 was predominately married, educated, middle class, insured, and rural. Significant associations were found between traditionality and past mammography and clinical breast examination (CBE) behavior, as well as future mammography intention. Results suggest that traditionality scales can be useful for identifying differences in screening behavior, with further testing of traditionality items with other AI women recommended. International implications of the study findings are also addressed.     

Breast cancer knowledge and practices among D/deaf women

BackgroundLimited scientific evidence is available regarding D/deaf women's breast cancer knowledge and early detection practices, as well as about how to increase D/deaf women's breast cancer control practices.Objective/hypothesisTo assess baseline breast cancer knowledge and practices among a sample of D/deaf women recruited into a randomized controlled trial of a breast cancer education program developed for this population.MethodsA written and signed (American Sign Language) survey was administered to a racially/ethnically diverse sample of 209 D/deaf women, 40+ years old, with lower levels of education, recruited in California between October 2008 and May 2009.ResultsThere were misconceptions about breast cancer risk factors, screening, and treatment; only 64.2% of respondents correctly identified the purpose of mammography. Mammography in the prior 2 years was reported by 57.3% of the sample, by 69.8% of White women, and by 43.5% of women from other racial/ethnic groups. Rates also varied by education, having seen a physician in the prior year, and type of insurance.ConclusionsThis study underscores significant gaps in breast cancer screening knowledge and practices, communication issues in health care settings, and unmet needs for tailored health information and materials in this population. Challenges faced in conducting the research needed to develop and test such programs are noted.     

Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature

ABSTRACT

Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers’ training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients’ receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.     

Ethnicity and cultural models of recovery from breast cancer

Objective. Recovery narratives describe the culturally shared understandings about the ideal or desirable way to recover from an illness experience. This paper examines ethnic differences in recovery narratives among women participating in breast cancer support groups in Central Florida, USA. It compares groups serving African-American, Latina, and European American women, with the objective of better understanding the appeal of ethnic-specific illness support groups for culturally diverse populations.

Design. A mixed-method study design combined qualitative and quantitative measures, including in-depth interviews, participant observation at support group meetings, collection of printed documents, and a structured survey.

Results. Core elements of the recovery narrative drew from the dominant societal cancer discourse of optimism and personal transformation through adversity; however, important ethnic differences were evident in the meaning assigned to these themes. Groups gave distinctive salience to themes of faith and spirituality, empowerment through the migration experience, and becoming a better person through the journey of recovery.

Conclusion. The findings suggest that ethnic cancer support groups draw upon dominant societal discourses about cancer, but they espouse distinctive recovery narratives that are consonant with the groups’ cultural models of illness. Similarity between ethnic members’ individual recovery narratives and that of the group may contribute to the appeal of ethnic illness support groups for culturally diverse populations.     

The impact of family history of breast cancer on women's health beliefs, salience of breast cancer family history, and degree of involvement in breast cancer issues.

Prior investigations have employed the Health Belief Model (HBM) to predict health care utilization and cancer screening behaviors. The HBM is expanded in the current investigation to include issue involvement with breast cancer and salience of breast cancer family history. Differences in the constructs of this expanded HBM, as they relate to mammography screening, between women with positive and negative family histories of breast cancer were assessed in 378 women. Perceived benefits and barriers were found to be similar for women with positive and negative family histories of breast cancer. However, susceptibility, cues to action, salience of family history, and issue involvement were found to be more relevant for women with a positive family history of breast cancer. These findings have implications for interventions directed at increasing compliance with recommendations for breast cancer screening.     

Breast cancer health promotion model for older Puerto Rican women: results of a pilot programme

This article focuses on the development of a health promotion model programme for elderly Puerto Rican women intended to minimize barriers for early detection of breast cancer and to increase women's compliance with recommended guidelines. The programme was designed based on the findings of a national sample to assess knowledge, beliefs and practices of breast cancer early detection in Puerto Rican elderly women and their perceptions of barriers associated with non-compliance. It involves the combination of educational and environmental support for actions and conditions conducive to health behaviour and consists of the following components: (i) a culture- and cohort-sensitive health education programme for elderly women on breast cancer screening and assertive strategies for client-physician relationship; (ii) training for primary-care providers on current guidelines and barriers affecting compliance among older women in Puerto Rico; and (iii) coordination of necessary support services to facilitate access to clinical breast exams and mammograms. Programme implementation considers appropriate theories for health promotion and education in the older population. Evaluation measured progress in the plan implementation by assessing immediate products and long-term impact of the programme. Results of the pilot programme revealed a slight increase in knowledge and a significant decrease (p < 0.05) in beliefs after the health education sessions. Interventions in breast cancer early detection practices showed significant changes (p < 0.05) for mammogram and clinical breast examination. Different strategies must be combined to increase older women's compliance with breast cancer screening. Health system and access barriers to preventive care must be addressed.