1
|
Young JML, Postula KJV, Duquette D, Gutierrez-Kapheim M, Pan V, Katapodi MC. Accuracy of Perceived Breast Cancer Risk in Black and White Women with an Elevated Risk. Ethn Dis 2022; 32:81-90. [PMID: 35497400 DOI: 10.18865/ed.32.2.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction Perceived breast cancer risk predicts screening behaviors. However, perceived risk is often inaccurate, notably in Black women, who often underestimate their risk despite having higher disease-specific mortality rates. We examined predictors of perceived breast cancer risk, and its impact on surveillance. Methods We used baseline data from a randomized trial targeting unaffected women recruited by relatives with early-onset breast cancer. Data collection occurred between 2012 and 2013. Accuracy of perceived risk was assessed by comparing perceived risk to objective lifetime breast cancer risks, calculated with the Gail and Claus models. A multivariate mixed model regression examined predictors of accuracy of perceived risk. The impact of perceived risk on breast cancer surveillance was assessed with one-way ANOVAS comparing Black to White women. Results Among participants, 21.4% self-identified as Black and 78.6% as White. Overall, 72.9% (n=247/339), 16.2% (n=55/339), and 10.9% (n=37/339) of participants overestimated, accurately perceived, and underestimated, respectively, their lifetime breast cancer risk. Race did not predict the accuracy of risk perception. Younger participants were more likely to overestimate their risk (β=-.455; CI [-.772, -.138]; P=.005). MRI utilization was predicted by a higher objective risk (F 1,263 [= 30.271]; P<.001) and more accurate risk perception (P=.010; Fisher's exact test). Conclusions Most women with a family history of early-onset breast cancer inaccurately perceived their risk for developing the disease. Younger women were more likely to overestimate their risk. Findings can guide the development of tailored interventions to improve adherence to breast cancer surveillance recommendations.
Collapse
Affiliation(s)
| | | | | | | | - Vivian Pan
- University of Illinois Cancer Center, Chicago, IL
| | | |
Collapse
|
2
|
Agrawal P, Chen TA, McNeill LH, Acquati C, Connors SK, Nitturi V, Robinson AS, Martinez Leal I, Reitzel LR. Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168494. [PMID: 34444241 PMCID: PMC8392666 DOI: 10.3390/ijerph18168494] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007-1.023)), having health insurance and ideal patient-provider communication (enabling: OR = 2.388 (1.597-3.570) and OR = 1.485 (1.080-2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058-4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient-provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.
Collapse
Affiliation(s)
- Pooja Agrawal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorna H. McNeill
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
| | - Chiara Acquati
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
- Graduate College of Social Work, University of Houston, Houston, TX 77204, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Angelica S. Robinson
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
| |
Collapse
|
3
|
Orji CC, Kanu C, Adelodun AI, Brown CM. Factors that Influence Mammography Use for Breast Cancer Screening among African American Women. J Natl Med Assoc 2020; 112:578-592. [PMID: 32641257 DOI: 10.1016/j.jnma.2020.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2018] [Revised: 06/03/2019] [Accepted: 05/19/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The purpose of this study was to assess factors that influence use of mammography screening among African American women, with a focus on social and cultural influences using Andersen's behavioral model (ABM), and to assess the methodological quality of the included studies. METHODS A literature review was conducted using PubMed, CINAHL, PSYCINFO, and Web of Science. Search terms included a combination of the following words using Boolean operators: breast cancer screening, mammography, repeat mammography, and African American. Studies that met the following criteria were included in the review: 1) examined factors associated with mammography screening, 2) included African American women as a majority, 3) published in a peer-reviewed English language journal between 2005 and 2017, and 4) conducted in the United States. Literature reviews, commentaries and non-research studies were excluded. Cited references from identified studies were examined for additional, relevant articles. Associated factors were grouped into predisposing, enabling, and need factor domains of ABM. The reviewed studies were rated using a methodological quality score (MQS) ranging from 0 to 20, with higher scores indicating higher methodological quality. RESULTS Twenty-four studies met the inclusion criteria. Fifteen factors that affect breast cancer screening in African American women were identified: predisposing (age, education, knowledge, beliefs, mistrust, religiosity, fears and fatalism), enabling (health insurance, access to care, income, health utilization), and need (physician recommendation, family/personal history, pain/discomfort, family responsibilities) factors. The most common factor was insurance status, although cultural issues (e.g., mistrust) were evident. Most of the identified factors are modifiable. The mean MQS was 12.2, indicating that the studies were slightly above average in quality. CONCLUSIONS Financial and cultural issues were important hindrances to breast cancer screening in African American women. These findings highlight the importance of affordable health care for preventive health services as well as the relevance of culturally embedded issues to health, while the MQS accentuates the need for more rigorous research articles. Breast cancer screening interventions in this population should attend to barriers identified in this review.
Collapse
Affiliation(s)
- Chinelo C Orji
- Health Outcomes & Pharmacy Practice, University of Texas, Austin, TX, USA.
| | - Chisom Kanu
- Health Outcomes & Pharmacy Practice, University of Texas, Austin, TX, USA
| | | | - Carolyn M Brown
- Health Outcomes & Pharmacy Practice, University of Texas, Austin, TX, USA
| |
Collapse
|
4
|
Aldemir K, Gürkan A, Taskın Yılmaz F, Demirel G. Participation of First-Degree Relatives of Women with Breast Cancer in
Screening Programs. PREVENTIVE CARE IN NURSING AND MIDWIFERY JOURNAL 2019. [DOI: 10.29252/pcnm.9.2.48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
|
5
|
Machirori M, Patch C, Metcalfe A. Black and Minority Ethnic women's decision-making for risk reduction strategies after BRCA testing: Use of context and knowledge. Eur J Med Genet 2018; 62:376-384. [PMID: 30550831 DOI: 10.1016/j.ejmg.2018.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 11/30/2018] [Accepted: 12/08/2018] [Indexed: 12/14/2022]
Abstract
Within the field of breast cancer care, women concerned about their family history are offered genetic testing and subsequent treatment options based on several factors which include but are not limited to personal and family cancer disease histories and clinical guidelines. Discussions around decision-making in genetics in Black and Minority Ethnic (BME) groups are rarely documented in literature, and information regarding interactions with genetics services is usually discussed and linked to lack of scientific knowledge. As such, counselling sessions based only on scientific and medical information miss out the many reasons participants consider in making health decisions, information which can be used to encourage BME women to engage in cancer genetics services. 10 BME women with a mixed personal and family history of breast and ovarian cancer backgrounds, were interviewed in a study exploring issues of knowledge about familial breast cancer syndromes, to understand how they created and used familial knowledge for health decisions, with a particular focus on attitudes towards risk reducing strategies. Study results show that our participants are not unique in the ways they make decisions towards the use of cancer genetics and risk reduction strategies and as such, there are no specific ethnically defined pathways for decision-making. Our participants demonstrated mixed biomedical, social and individual cultural reasons for their decision-making towards risk reduction surgeries and treatment options which are similar to women from different ethnicities and are individual rather than group-specific. Narratives about suspicion of scientific utility of genetic knowledge, the perceived predictive value of mutations for future cancers or the origin of mutations and family disease patterns feature heavily in how participants evaluated genetic information and treatment decisions. The diversity of results shows that our participants are interested in engaging with genetic information but use multiple sources for evaluating the extent of involvement in genetic services and the place of genetic information and treatment options for themselves and their families. Genetic information is considered within various bio-social scenarios before decision-making for risk reduction is undertaken. BME women are shown to undertake evaluative processes which clinicians are encouraged to explore for better patient support. Continuing to focus on links between superficial and un-representative meanings of ethnicity, ethnic identity and attitudes and behaviours by only searching for differences between ethnic groups, are unhelpful in further understanding how women from those diverse backgrounds make decisions towards risk reduction interventions. Future research must find ways of investigating and understanding populations in ways that are not focussed solely on ethnic differences but on how meaning is created out of social circumstances and experiences.
Collapse
Affiliation(s)
- Mavis Machirori
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom.
| | - Christine Patch
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom
| | - Alison Metcalfe
- King's College London, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, London, United Kingdom; Faculty of Health and Wellbeing, Sheffield Hallam University, Sheffield, United Kingdom
| |
Collapse
|
6
|
Amutah-Onukagha N, Mahadevan M, Opara I, Rodriguez M, Trusdell M, Kelly J. Project THANKS: Examining HIV/AIDS-Related Barriers and Facilitators to Care in African American Women: A Community Perspective. AIDS Patient Care STDS 2018; 32:119-128. [PMID: 29630851 PMCID: PMC5972771 DOI: 10.1089/apc.2017.0215] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Project THANKS, (Turning HIV/AIDS into Knowledge for Sisters), is an evidence-based intervention that utilizes a community-based participatory and empowerment building approach for African American female substance abusers living with HIV and other chronic diseases. This qualitative study sought to gain insight from women living with HIV on how to improve Project THANKS. African American women living with substance abuse disorders, HIV, and other comorbidities were recruited from three community based health centers in New Jersey (N = 31). Ninety minute focus group sessions were implemented in each health center. The focus group sessions were designed to understand the perceived factors influencing the participants' ability to self-manage their health conditions and challenges they are currently facing regarding their diagnoses. The barriers and suggestions presented by participants included addressing stigmatization, managing mental health symptoms, improving physician-patient trust, accessing health education, educating community members, and proper nutrition. In addition, an engaged and trusting relationship with their healthcare provider and having positive sources of support were cited as motivators to adhering to their HIV treatment regimen. Participants living with HIV/AIDS also expressed more concern with difficulty treating their comorbidities than participants with only HIV/AIDS. Receiving input from African American women living with HIV related comorbidities was essential in improving the intervention to include a behavioral and primary health approach. Future programmatic interventions of Project THANKS will include a targeted focus on addressing mental health needs in women by offering meditation services and mental health referrals. In addition, Project THANKS will incorporate activities to improve communication with physicians, families, and media outlets to empower women to take an active role in their primary and social support needs.
Collapse
Affiliation(s)
- Ndidiamaka Amutah-Onukagha
- Department of Public Health and Community Medicine, Tufts University School of Medicine, Boston, Massachusetts
| | - Meena Mahadevan
- Department of Nutrition and Food Studies, Montclair State University, Montclair, New Jersey
| | - Ijeoma Opara
- Department of Family Science and Human Development, Montclair State University, Montclair, New Jersey
| | - Monica Rodriguez
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Megan Trusdell
- Department of Public Health, Montclair State University, Montclair, New Jersey
| | - Jessica Kelly
- Department of Public Health, Montclair State University, Montclair, New Jersey
| |
Collapse
|
7
|
Allicock M, Graves N, Gray K, Troester MA. African American women's perspectives on breast cancer: implications for communicating risk of basal-like breast cancer. J Health Care Poor Underserved 2014; 24:753-67. [PMID: 23728042 DOI: 10.1353/hpu.2013.0082] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
African American women suffer a disproportionately high burden of basal-like breast cancer, an aggressive subtype that has no targeted therapy. While epidemiologic research has identified key prevention strategies, little is known about how best to communicate risk to this population. This study explored women's knowledge, beliefs, and attitudes about breast cancer to learn about risk perceptions. Six focus groups were conducted in North Carolina with 57 women (ages 18-49). Age, race (especially perceptions of cancer as a "White disease"), and lack of family history of breast cancer were all shown to contribute to women's perceptions of low breast cancer susceptibility. Perceptions of low risk were also attributed to conflicting risk information from family, media, and health providers. Women had little to no knowledge of breast cancer subtypes, and emphasized that health communications should be personally relevant, culturally appropriate, and convenient. These findings will assist in developing health communication tools that encourage prevention.
Collapse
Affiliation(s)
- Marlyn Allicock
- University of North Carolina, Department of Nutrition, Schools of Medicine and Public Health, Chapel Hill, NC 27599, USA.
| | | | | | | |
Collapse
|
8
|
Hoskins LM, Werner-Lin A, Greene MH. In their own words: treating very young BRCA1/2 mutation-positive women with care and caution. PLoS One 2014; 9:e87696. [PMID: 24586286 PMCID: PMC3938837 DOI: 10.1371/journal.pone.0087696] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2013] [Accepted: 01/03/2014] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Young women who have been identified as carrying a deleterious mutation in BRCA1 or BRCA2 face a unique set of challenges related to managing cancer risk during a demographically-dense stage of life. They may struggle with decision-making in the absence of clear age-specific guidelines for medical management and because they have not yet fully developed the capacity to make life-altering decisions confidently. This study sought a patient-centered perspective on the dilemmas faced by 18-24 year olds who completed BRCA1/2 gene mutation testing prior to their 25(th) birthdays. PATIENTS AND METHOD This study integrated qualitative data from three independent investigations of BRCA1/2-positive women recruited through cancer risk clinics, hospital-based research centers, and online organizations. All 32 participants were women aged 21-25 who tested positive for a BRCA1/2 gene mutation between 2 and 60 months prior to data collection. Investigators used techniques of grounded theory and interpretive description to conduct both within and cross-study analysis. RESULTS Participants expressed needs for (1) greater clarity in recommendations for screening and prevention before age 25, especially with consideration of early and regular exposure to radiation associated with mammography or to hormones used in birth control, and (2) ongoing contact with providers to discuss risk management protocols as they become available. CONCLUSIONS Health care needs during the young adult years evolve with the cognitive capacity to address abrupt and pressing change. Specific needs of women in this population include a desire to balance autonomous decision-making with supportive guidance, a need for clear, accurate and consistent medical recommendations. Optimally, these women are best cared for by a team of genetically-oriented providers as part of a sustained program of ongoing support, rather than seen in an episodic, crisis-driven fashion. A discussion of insurance issues and provider-patient cultural differences is presented.
Collapse
Affiliation(s)
- Lindsey M. Hoskins
- Clinical Genetics Branch, National Cancer Institute, Bethesda, Maryland, United States of America
| | - Allison Werner-Lin
- Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Mark H. Greene
- Clinical Genetics Branch, National Cancer Institute, Bethesda, Maryland, United States of America
| |
Collapse
|
9
|
Lages RB, Oliveira GDP, Simeão Filho VM, Nogueira FM, Teles JBM, Vieira SC. Inequalities associated with lack of mammography in Teresina-Piauí-Brazil, 2010-2011. REVISTA BRASILEIRA DE EPIDEMIOLOGIA 2014; 15:737-47. [PMID: 23515770 DOI: 10.1590/s1415-790x2012000400006] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 05/23/2012] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Randomized studies have shown that screening for breast cancer with mammography reduces the breast cancer mortality. However there are signs of a great inequality in access to mammography in Brazil. OBJECTIVES To analyze the percentage of women who did not undergo mammography according to socioeconomic and demographic variables in women aged from 40 to 69 years in Teresina, Piauí State, Brazil. METHODS This was a cross-sectional population-based study in women aged 40-69 years in Teresina-Piauí in 2010/2011. The sampling was randomly conducted in five stages. The data were processed by SPSS 19.0 and it was performed univariate and multivariate analysis. RESULTS Among 433 women who answered the questionnaire, 75,3% had a mammography and 17,2% of these women had not a mammography over the last two years. The lack of breast cancer screening was associated with non-white skin color (p = 0,030), never being married (p = 0,041), low levels of education (p = 0,010), low family income (p < 0,001), smoking (p = 0,006), having no private health insurance (p < 0,001). The Unified National Health System (SUS) performed 56,3% of reported mammograms. CONCLUSION About 24.7% of women in the sample never had a mammography. According to the findings, the lack of breast cancer screening is associated with social and racial inequalities.
Collapse
|
10
|
Subramanian P, Oranye NO, Masri AM, Taib NA, Ahmad N. Breast Cancer Knowledge and Screening Behaviour among Women with a Positive Family History: A Cross Sectional Study. Asian Pac J Cancer Prev 2013; 14:6783-90. [DOI: 10.7314/apjcp.2013.14.11.6783] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
11
|
Sheppard VB, Graves KD, Christopher J, Hurtado-de-Mendoza A, Talley C, Williams KP. African American women's limited knowledge and experiences with genetic counseling for hereditary breast cancer. J Genet Couns 2013; 23:311-22. [PMID: 24186304 DOI: 10.1007/s10897-013-9663-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 10/02/2013] [Indexed: 12/14/2022]
Abstract
Genetic counseling and testing for hereditary breast cancer have the potential benefit of early detection and early interventions in African American women. However, African American women have low use of these services compared to White women. We conducted two focus groups with African American women diagnosed with breast cancer (affected group, n = 13) and women with at least one first-degree relative with breast/ovarian cancer (unaffected group, n = 8). A content analysis approach was employed to analyze interview data. Breast cancer survivors had more knowledge about genetic counseling and testing than participants who were unaffected with cancer. However, knowledge about genetic counseling was limited in both groups. Barriers to pursuing genetic counseling and testing included poor understanding of the genetic counseling and testing process, fear of carrying the mutation, concerns about discrimination, and cost. Motivators to participate in genetic counseling and testing included desire to help family members, insurance coverage, and potential of benefiting the larger African American community. Education efforts are needed to increase genetic counseling and testing awareness in the African American community.
Collapse
Affiliation(s)
- Vanessa B Sheppard
- Breast Cancer Program, Lombardi Cancer Center, Department of Oncology, Georgetown University Medical Center, 3300 Whitehaven Street, Suite 4100, Washington, DC, 20007, USA,
| | | | | | | | | | | |
Collapse
|
12
|
Werner-Lin A, Hoskins LM, Doyle MH, Greene MH. 'Cancer doesn't have an age': genetic testing and cancer risk management in BRCA1/2 mutation-positive women aged 18-24. Health (London) 2012; 16:636-54. [PMID: 22547552 DOI: 10.1177/1363459312442420] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increasingly, 18-24-year-old women from hereditary breast/ovarian cancer (HBOC) families are pursuing genetic testing, despite their low absolute risks of breast and ovarian cancer and the fact that evidence-based management options used with older high-risk women are not generally available. Difficult clinical decisions in older carriers take on substantially more complexity and value-laden import in very young carriers. As a result, many of the latter receive highly personal and emotionally charged cancer risk information in a life context where management strategies are not well defined. We analyzed 32 in-depth interviews with BRCA1/2 mutation-positive women aged 18-24 using techniques of grounded theory and interpretive description. Participants described feeling vulnerable to a cancer diagnosis but in a quandary regarding their care because evidence-based approaches to management have not been developed and clinical trials have not been undertaken. Our participants demonstrated a wide range of genetic and health literacy. Inconsistent recommendations, surveillance fatigue, and the unpredictability of their having health insurance coverage for surgical risk-reducing procedures led several to contemplate risk-reducing mastectomy before age 25. Parents remained a primary source of emotional and financial support, slowing age-appropriate independence and complicating patient privacy. Our findings suggest that, for 18-24-year-olds, readiness to autonomously elect genetic testing, to fully understand and act on genetic information, and to confidently make decisions with life-long implications are all evolving processes. We comment on the tensions between informed consent, privacy, and the unique developmental needs of BRCA1/2 mutation-positive women just emerging into their adult years.
Collapse
|
13
|
McDonald JA, Weathers B, Barg FK, Troxel AB, Shea JA, Bowen D, Guerra CE, Halbert CH. Donation intentions for cancer genetics research among African Americans. Genet Test Mol Biomarkers 2012; 16:252-8. [PMID: 22224593 DOI: 10.1089/gtmb.2011.0119] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
AIMS Scientific agencies rely on individuals to donate their DNA to support research on chronic conditions that disproportionately affect African Americans; however, donation is variable in this population. The purpose of this study was to identify sociodemographic characteristics, health care variables, and cultural values having significant independent associations with intentions to donate blood or saliva samples for cancer genetics research among African American adults. METHOD Cross-sectional survey of donation intentions. RESULTS The majority of respondents (73%) were willing to donate a biological sample for cancer genetics research. The results of the multivariate regression model found that respondents who received care at a facility other than a doctor's office (e.g., community center) were about five times more likely to be willing to donate a sample for cancer genetics research (odds ratio [OR]=5.28, 95% confidence interval [CI]=1.16-24.12, p=0.03); whereas, greater levels of religiosity (OR=0.09, 95% CI=0.01-0.75, p=0.02) and present temporal orientation (OR=0.23, 95% CI=0.06-0.79, p=0.02) were associated with a lower likelihood of donating a sample. CONCLUSION Efforts to enhance donation of biological samples for cancer genetics research may need to target diverse clinical sites for recruitment. Additionally, recruitment materials may need to address cultural values related to religiosity and present temporal orientation.
Collapse
Affiliation(s)
- Jasmine A McDonald
- Center for Community-Based Research and Health Disparities, Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania 19104, USA
| | | | | | | | | | | | | | | |
Collapse
|
14
|
Ponce NA, Tsui J, Knight SJ, Afable-Munsuz A, Ladabaum U, Hiatt RA, Haas JS. Disparities in cancer screening in individuals with a family history of breast or colorectal cancer. Cancer 2011; 118:1656-63. [PMID: 22009719 DOI: 10.1002/cncr.26480] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 06/29/2011] [Accepted: 06/29/2011] [Indexed: 12/17/2022]
Abstract
BACKGROUND Understanding racial/ethnic disparities in cancer screening by family history risk could identify critical opportunities for patient and provider interventions tailored to specific racial/ethnic groups. The authors evaluated whether breast cancer (BC) and colorectal cancer (CRC) disparities varied by family history risk using a large, multiethnic population-based survey. METHODS By using the 2005 California Health Interview Survey, BC and CRC screening were evaluated separately with weighted multivariate regression analyses, and stratified by family history risk. Screening was defined for BC as mammogram within the past 2 years for women aged 40 to 64 years; for CRC, screening was defined as annual fecal occult blood test, sigmoidoscopy within the past 5 years, or colonoscopy within the past 10 years for adults aged 50 to 64 years. RESULTS The authors found no significant BC screening disparities by race/ethnicity or income in the family history risk groups. Racial/ethnic disparities were more evident in CRC screening, and the Latino-white gap widened among individuals with family history risk. Among adults with a family history for CRC, the magnitude of the Latino-white difference in CRC screening (odds ratio [OR], 0.28; 95% confidence interval [CI], 0.11-0.60) was more substantial than that for individuals with no family history (OR, 0.74; 95% CI, 0.59-0.92). CONCLUSIONS Knowledge of their family history widened the Latino-white gap in CRC screening among adults. More aggressive interventions that enhance the communication between Latinos and their physicians about family history and cancer risk could reduce the substantial Latino-white screening disparity in Latinos most susceptible to CRC.
Collapse
Affiliation(s)
- Ninez A Ponce
- Department of Health Services, University of California at Los Angeles, Los Angeles, California, USA.
| | | | | | | | | | | | | |
Collapse
|
15
|
Murthy VS, Garza MA, Almario DA, Vogel KJ, Grubs RE, Gettig EA, Wilson JW, Thomas SB. Using a family history intervention to improve cancer risk perception in a black community. J Genet Couns 2011; 20:639-49. [PMID: 21773879 DOI: 10.1007/s10897-011-9389-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2011] [Accepted: 06/23/2011] [Indexed: 12/12/2022]
Abstract
Few studies examine the use of family history to influence risk perceptions in the African American population. This study examined the influence of a family health history (FHH) intervention on risk perceptions for breast (BRCA), colon (CRC), and prostate cancers (PRCA) among African Americans in Pittsburgh, PA. Participants (n = 665) completed pre- and post-surveys and FHHs. We compared their objective and perceived risks, classified as average, moderate, or high, and examined the accuracy of risk perceptions before and after the FHH intervention. The majority of participants had accurate risk perceptions post-FHH. Of those participants who were inaccurate pre-FHH, 43.3%, 43.8%, and 34.5% for BRCA, CRC, and PRCA, respectively, adopted accurate risk perceptions post-FHH intervention. The intervention was successful in a community setting. It has the potential to lead to healthy behavior modifications because participants adopted accurate risk perceptions. We identified a substantial number of at-risk individuals who could benefit from targeted prevention strategies, thus decreasing racial/ethnic cancer disparities.
Collapse
Affiliation(s)
- Vinaya S Murthy
- Department of Clinical Genetics, The Permanente Medical Group, San Jose, CA 95123, USA
| | | | | | | | | | | | | | | |
Collapse
|
16
|
Abstract
PURPOSE To describe African American women's experience of being at high risk for breast cancer. DESIGN A hermeneutic phenomenological approach was used to guide in-depth interviews and analysis. Methods to ensure trustworthiness and rigor were included. METHODS Open interviews were conducted with 20 African American women who were at high risk for breast cancer (family history, personal history, genetic mutation). They were recruited from a cancer risk clinic and community-based settings. Data were transcribed verbatim, and themes were labeled among and between all interviews. FINDINGS Five themes were identified: (a) life-changing experience; (b) relationships: fears, support, and concerns; (c) the healthcare experience; (d) raising awareness; and (e) strong faith. CONCLUSIONS Young women at high risk for breast cancer have unique emotional and support needs that are shaped by stage in life, relationships with significant others, their faith, and interactions with the healthcare delivery system. CLINICAL RELEVANCE Breast cancer does occur in young women. This highlights the need for timely and sensitive approaches to care when young women present with breast health concerns or abnormal breast findings.
Collapse
Affiliation(s)
- Janice Phillips
- Center for Clinical Cancer Genetics and Global Health, University of Chicago Medical Center, Chicago, IL, USA.
| | | |
Collapse
|
17
|
Laing SS, Makambi K. Predicting regular breast cancer screening in African-American women with a family history of breast cancer. J Natl Med Assoc 2008; 100:1309-17. [PMID: 19024228 DOI: 10.1016/s0027-9684(15)31510-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate the impact of socioeconomic, personal and affective factors on regular breast cancer screening in at-risk African-American women. METHODS The study was a cross-sectional analysis assessing socioeconomic and affective predictors of breast cancer screening practices. Unaffected African-American women ages 40-64 with a family history of breast cancer were recruited from community settings. The main outcome measures were recent mammography, regular mammography and regular breast self-examinations. RESULTS The majority of women reported having a recent mammogram (73%) and yearly mammograms (71%). More than half (56%) reported monthly breast self-examinations (BSEs). Available health insurance and risk perception had significant independent associations with regular mammography screening so that women having a mammogram every 6-12 months were more likely to have health insurance [odds ratio (OR)=4.99, 95% confidence interval (CI): 1.05-23.52], and women not engaged in regular screenings were less likely to perceive future breast cancer risk (OR=0.10, 95% CI: 0.01-0.96). Access to regular healthcare had a significant independent association with recent mammography so that women having a mammogram in the past 12 months were more likely to have access to regular healthcare (OR=6.59, 95% CI: 1.01-42.79). CONCLUSIONS A significant majority of this subset of African-American women engage in repeat mammography screenings with cognitive and economic factors predicting noncompliance. Additional research with repeat mammography users is required so that regular screening practices can be encouraged among all at-risk women.
Collapse
Affiliation(s)
- Sharon S Laing
- Department of Psychology, Howard University, Washington, DC, USA.
| | | |
Collapse
|
18
|
FUNKE L, KRAUSE-BERGMANN B, PABST R, NAVE H. Prospective analysis of the long-term effect of teaching breast self-examination and breast awareness. Eur J Cancer Care (Engl) 2008; 17:477-82. [DOI: 10.1111/j.1365-2354.2007.00889.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
19
|
Ford ME, Havstad SL, Fields ME, Manigo B, McClary B, Lamerato L. Effects of baseline comorbidities on cancer screening trial adherence among older African American men. Cancer Epidemiol Biomarkers Prev 2008; 17:1234-9. [PMID: 18463399 DOI: 10.1158/1055-9965.epi-08-0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The purpose of this study was to examine the effects of baseline comorbidities on screening adherence in a sample of older African American men (ages >or=55 years) enrolled in a case management intervention in a cancer screening trial. METHODS Baseline comorbidity data were obtained from 683 African American men who were randomly assigned to a case management intervention group (n = 344) or to a case management control group (n = 339). The effects of comorbidities on the screening adherence rates of each group were then assessed. RESULTS No statistically significant interactions were found between each health history characteristic and the intervention. Therefore, analyses were not stratified by intervention status. In general, participants with comorbidities were no less likely to adhere to trial screening than participants without comorbidities. Exceptions were current smokers and participants with chronic bronchitis. Current smokers were less likely than others to adhere to the prostate-specific antigen test (P = 0.02) and the digital rectal examination for prostate cancer screening (P = 0.01), to the chest X-ray for lung cancer screening (P < 0.01), and to the flexible sigmoidoscopy for colorectal cancer screening (P = 0.04). Participants with chronic bronchitis had lower rates of adherence to the chest X-ray (P = 0.06). Having a relative with cancer positively influenced adherence to the digital rectal examination (P = 0.05). CONCLUSIONS Overall, older African American men with comorbidities appear to be very good candidates for participation in longitudinal cancer screening trials. However, smoking had a statistically significant and deleterious effect on adherence to all types of screening.
Collapse
Affiliation(s)
- Marvella E Ford
- Department of Biostatistics, Bioinformatics, and Epidemiology, Medical University of South Carolina, PO Box 250955, Charleston, SC 29425, USA.
| | | | | | | | | | | |
Collapse
|