The role of the physician as an information source on mammography

Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women

Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.

Preventive Care: How Mammography Utilization Changes as Women Age

OBJECTIVE

To evaluate the impact of comorbid conditions and age on mammography use.

METHODS

We used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P < .05 by two-sided test.

RESULTS

Of the 36,575 women in our study sample, 45.9%, 43.6%, 3.9%, and 5.7% reported a history of hypertension (HTN), hyperlipidemia (HLD), prior heart attack (MI), and prior stroke, respectively. Among women without a comorbid condition, there was 47.3% annual mammography use. HTN and HLD were associated with increased use (2.5 and 6.8 percentage points [pp], P< .01). In comparison, prior MI was associated with decreased annual use (-8.2 pp, P < .01). Prior stroke was not significantly associated with annual mammography (-1.5 pp, P = .42). Results were similar for biennial use. The age trend in use showed that the age with maximum screening use was approximately 60 years.

DISCUSSION

Mammography use was higher in patients with HTN and HLD and lower in patients with prior MI and stroke, which may reflect differences in comorbidity-related general health care use. Use increased until it peaked around age 60. An understanding of how mammography use naturally evolves as people age may help better target specific populations and improve overall use of preventive care.

Adherence to Radiology Recommendations in a Clinical CT Lung Screening Program

BACKGROUND

Assess patient adherence to radiologist recommendations in a clinical CT lung cancer screening program.

METHODS

Patients undergoing CT lung cancer screening between January 12, 2012, and June 12, 2013, were included in this institutional review board-approved retrospective review. Patients referred from outside our institution were excluded. All patients met National Comprehensive Cancer Network Guidelines Lung Cancer Screening high-risk criteria. Full-time program navigators used a CT lung screening program management system to schedule patient appointments, generate patient result notification letters detailing the radiologist follow-up recommendation, and track patient and referring physician notification of missed appointments at 30, 60, and 90 days. To be considered adherent, patients could be no more than 90 days past due for their next recommended examination as of September 12, 2014. Patients who died, were diagnosed with cancer, or otherwise became ineligible for screening were considered adherent. Adherence rates were assessed across multiple variables.

RESULTS

During the study interval, 1,162 high-risk patients were screened, and 261 of 1,162 (22.5%) outside referrals were excluded. Of the remaining 901 patients, 503 (55.8%) were male, 414 (45.9%) were active smokers, 377 (41.8%) were aged 65 to 73, and >95% were white. Of the 901 patients, 772 (85.7%) were adherent. Most common reasons for nonadherence were patient refusal of follow-up exam (66.7%), inability to successfully contact the patient (20.9%), and inability to obtain the follow-up order from the referring provider (7.8%); 23 of 901 (2.6%) were discharged for other reasons.

CONCLUSIONS

High rates of adherence to radiologist recommendations are achievable for in-network patients enrolled in a clinical CT lung screening program.

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.

Ethics, Cultural Competence, and the Changing Face of America

The population in the United States is increasingly multicultural. So, too, is the U.S. physician workforce. The combination of these diversity dynamics sets up the potential for various types of cultural conflict in the nation's examining rooms, including the relationship between religion and medicine. To address the changing patient-physician landscape, we argue for a broad scale intervention: interdisciplinary bioethics training for physicians and other health professionals. This approach seeks to promote a common procedural expectation and language which can lead to an improved, patient-centered approach resulting in better patient-physician relationships that contribute to better health outcomes across the U.S. population. The authors illustrate their thesis and solution using a well-known case of cross-cultural dynamics taken from religion and medicine-Anne Fadiman's The Spirit Catches You And You Fall Down.

Sociodemographic differences in fears and mistrust contributing to unwillingness to participate in cancer screenings

Effective provider-patient relationships are vital for positive patient health outcomes. This analysis assessed sociodemographic differences in fears and mistrust related to the provider-patient relationship, which may contribute to unwillingness to participate in cancer screenings (CSs). The data are from a stratified, random-digit dial telephone questionnaire of non-institutionalized households in New York, Maryland, and Puerto Rico. Statistically significant results indicate that Hispanics, compared with Whites, were nearly two times more likely to report that fear of being a "guinea pig" and lacking trust in medical people would make them unwilling to participate in CSs. Additionally, those with less education were over two times more likely to indicate a fear of being embarrassed during the screening would make them unwilling to participate in CSs. These results highlight areas where health professionals can improve interactions with their patients and be attentive to their fears and/or mistrusts to promote CSs utilization.

Do physician communication skills influence screening mammography utilization?

Background

The quality of physician communication skills influences health-related decisions, including use of cancer screening tests. We assessed whether patient-physician communication examination scores in a national, standardized clinical skills examination predicted future use of screening mammography (SM).

Methods

Cohort study of 413 physicians taking the Medical Council of Canada clinical skills examination between 1993 and 1996, with follow up until 2006. Administrative claims for SM performed within 12 months of a comprehensive health maintenance visit for women 50–69 years old were reviewed. Multivariable regression was used to estimate the relationship between physician communication skills exam score and patients’ SM use while controlling for other factors.

Results

Overall, 33.8 % of 96,708 eligible women who visited study physicians between 1993 and 2006 had an SM in the 12 months following an index visit. Patient-related factors associated with increased SM use included higher income, non-urban residence, low Charlson co-morbidity index, prior benign breast biopsy and an interval >12 months since the previous mammogram. Physician-related factors associated with increased use of SM included female sex, surgical specialty, and higher communication skills score. After adjusting for physician and patient-related factors, the odds of SM increased by 24 % for 2SD increase in communication score (OR: 1.24, 95 % CI: 1.11 - 1.38). This impact was even greater in urban areas (OR 1.30, 95 % CI: 1.16, 1.46) and did not vary with practice experience (interaction p-value 0.74).

Conclusion

Physicians with better communication skills documented by a standardized licensing examination were more successful at obtaining SM for their patients.

Source credibility and evidence format: examining the effectiveness of HIV/AIDS messages for young African Americans

Using experimental methodology, this study tests the effectiveness of HIV/AIDS prevention messages tailored specifically to college-aged African Americans. To test interaction effects, it intersects source role and evidence format. The authors used gain-framed and loss-framed information specific to young African Americans and HIV to test message effectiveness between statistical and emotional evidence formats, and for the first time, a statistical/emotional combination format. It tests which source--physician or minister--that young African Americans believe is more effective when delivering HIV/AIDS messages to young African Americans. By testing the interaction between source credibility and evidence format, this research expands knowledge on creating effective health messages in several major areas. Findings include a significant interaction between the role of physician and the combined statistical/emotional format. This message was rated as the most effective way to deliver HIV/AIDS prevention messages.

Representations of hysterectomy as a transition process in Finnish women's and health magazines

Representations of hysterectomy as a transition process in Finnish women's and health magazines The purpose of this article was to describe representations of hysterectomy in Finnish women's and health magazines. The data used in the study were obtained from six Finnish women's and health magazines. Using content analysis, 42 articles were analysed. We identified two main categories, information about care and treatment and women's experiences. In the first category, there emerged six subcategories: role of uterus, indications for hysterectomy, operative techniques of hysterectomy, alternative methods of treatment, pros and cons of hysterectomy and patient guidance. The second category consisted of women's experiences of hysterectomy as a period of transition. The components of the transition theory were confirmed by the women's stories. We also wanted to highlight the fact that the result shows that nurses were missing from the media coverage regarding hysterectomy.

A comparison of cancer screening practices in cancer survivors and in the general population: the Korean national health and nutrition examination survey (KNHANES) 2001-2007

OBJECTIVE

This study aimed to describe cancer screening rates for second primary cancer among cancer survivors in Korea, and to compare these rates with those of two control groups: individuals without a history of cancer but with other chronic diseases, and individuals without a history of cancer and without other chronic diseases.

METHODS

The study is a cross-sectional analysis of 15,556 adults ≥ 30 years old who participated in the 2001, 2005, and 2007 Korean National Health and Nutrition Examination Surveys (KNHANES). The prevalence of breast, cervical, gastric, and colorectal cancer screening examinations according to national guidelines was assessed and compared to two control groups.

RESULTS

Screening rates among cancer survivors were 48.5, 54.7, 34.7, and 28.6% for breast, cervical, gastric, and colorectal cancer screening, respectively. Cancer survivors showed higher screening rates for all four cancer sites compared with both control groups, but breast cancer screening was only statistically significant after adjusting gender, age, marital status, education, income, working status, health insurance, smoking and drinking status, and self-reported health status.

CONCLUSIONS

Cancer survivors were more likely than individuals without a cancer history to obtain screening examinations according to recommended guidelines. Still, screening rates even among survivors were suboptimal, emphasizing the need for a more systematic approach to second primary cancer screening and prevention.

Health disparities in receipt of screening mammography in Latinas: a critical review of recent literature

BACKGROUND

Increased use of screening mammography is associated with lower death rates from breast cancer in the United States. Despite recommendations that women over 40 years of age should obtain regular screening mammography at least every 2 years, many women do not adhere to these guidelines. Historically, women from underserved and minority populations have been less likely to receive screening mammography.

METHODS

A critical review of recent research literature was conducted to evaluate whether Latinas are less likely to receive screening mammography, determine whether disparities in screening mammography persist when controlling for other variables, and examine what other variables are associated with screening mammography. The articles were obtained from a search of the PubMed database.

RESULTS

Fifteen published articles met the inclusion criteria and were critically reviewed. The unadjusted odds ratios (ORs) of the association between Hispanic ethnicity and screening mammography ranged from 0.40 to 0.93. For the most part, the ORs adjusted for other variables in multiple logistic regression analyses increased (range: 0.3 to 1.67). Age, education, income, health insurance, having a usual source of care, and having a recent visit to a physician were consistently related to screening mammography in multiple logistic regression analysis.

CONCLUSIONS

Hispanic ethnicity is a risk factor for lack of adherence to screening mammography. However, other demographic, socioeconomic, and health system variables account for some of the disparity related to Hispanic ethnicity.

Screening practices in cancer survivors

INTRODUCTION

Ten percent of all new cancers are diagnosed in cancer survivors and second cancers are the sixth leading cause of cancer deaths. Little is known, however, about survivors' screening practices for other cancers. The purpose of this study was to examine the impact of a cancer diagnosis on survivors' screening beliefs and practices compared to those without a cancer history.

MATERIALS AND METHODS

This study examined cancer survivors' (n = 619) screening beliefs and practices compared to those without cancer (n = 2,141) using the National Cancer Institute's 2003 Health Information National Trends Survey (HINTS).

RESULTS

The typical participant was Caucasian, employed, married, and female with at least a high school education, having a regular health care provider and health insurance. Being a cancer survivor was significantly associated with screening for colorectal cancer but not for breast or prostate cancer screening. Screening adherence exceeded American Cancer Society recommendations, national prevalence data, and Healthy People 2010 goals for individual tests for both groups. Physician recommendations were associated with a higher level of screening but recommendations varied (highest for breast cancer and lowest for colorectal cancer screening).

CONCLUSIONS

Cancer survivors had different health beliefs and risk perceptions for screening compared to the NoCancer group. While there were no differences between survivors' screening for breast and prostate cancer, survivors were more likely to screen for colorectal cancer than the comparison group. Screening adherence met or exceeded recommendations for individual tests for both cancer survivors and the comparison group.

IMPLICATIONS FOR CANCER SURVIVORS

Cancer survivors should continue to work with their health care providers to receive age and gender appropriate screening for many types of cancers. Screening for other cancers should also be included in cancer survivorship care plans.

Hispanic women's preferences for breast health information: subjective cultural influences on source, message, and channel

The purpose of this study was to investigate the influence of 3 subjective cultural variables--self-construals (independence and interdependence), ethnic identity (bicultural, assimilation, traditional, and marginal), and cultural health attributions (equity and behavioral-environmental attributions)--on source, message, and channel preferences for receiving breast health information by Hispanic women age 35 or older. Subjective cultural variables collectively accounted for 2% to 28% of the variance in communication preferences. In addition, several associations were discovered: (a) having an interdependent self-construal was associated positively with preferences for significant other as a source, family sources, fear messages, media channels, and face-to-face channels; (b) having a bicultural identity was associated positively with preferences for family sources and media channels, but negatively with a desire for no information; and (c) having a marginal identity and equity attributions were associated positively with preferences for fear messages and a desire for no information, but negatively with preferences for expert sources. These findings are discussed in the context of tailoring breast health information to Hispanic women using computer technology and entertainment-education.

Breast cancer early detection among Chinese women in the Philadelphia area

BACKGROUND

Breast cancer is the most frequently diagnosed cancer and the second leading cause of cancer death among Chinese American women. Previous studies identified disparities in breast cancer screening between Asian and Caucasian women. This study describes breast cancer awareness, attitudes, and knowledge, as well as barriers and facilitators of early detection among Chinese women in Philadelphia.

METHODS

A cross-sectional, translated survey was conducted among a convenience sample of 111 Chinese women from the greater Philadelphia area. Data were analyzed using descriptive statistics to describe participant experiences and attitudes, and Pearson correlation coefficients, chi-square tests, and multiple regressions were used to identify significant predictors of breast cancer screenings.

RESULTS

Of respondents, 53.2% had ever performed breast self-examination (BSE). Among women aged >or=40, 53.6% had ever had clinical breast examination (CBE), and 71.1% had ever had mammogram. Knowledge (p < 0.001) and self-efficacy (p = 0.001) predicted BSE ever performance. Having a doctor as information source of CBE (p = 0.001) and belief in family history as a risk factor of breast cancer (p = 0.002) were significant predictors of having ever had a CBE. Having a doctor as information source of mammogram (p = 0.002) was the only significant predictor of having ever had mammogram screening.

CONCLUSIONS

This study laid a foundation for developing culturally sensitive breast cancer education and screening programs for Chinese women in the Philadelphia area. Recommendations include a call for physician education to improve breast cancer screening rates in this population.

News media coverage of a women's health contraversy: how newspapers and TV outlets covered a recent debate over screening mammography

Over the past decade, there have been several highly visible debates about mammography that have captured professional, public and media attention. This paper looks at newspaper and television news coverage of a controversial research letter in The Lancet by Gøtzsche and Olsen (2001) that concluded that screening mammography did not prevent deaths from breast cancer. The news pieces examined for this project were published between October 2001 and March 2002 in one of eight U.S. newspapers or aired on one of six national or cable news networks. The six-month period was divided into one-week segments; the numbers of articles published or stories aired in each week were graphed to examine patterns. Each newspaper article and television transcript was then reviewed to identify its main content area and the amount of coverage for each major event was quantified. The highest number of newspaper articles appeared to result from several events during the end of January through the beginning of February. These events included the publication of another meta-analysis of mammography that disputed the original letter's conclusion and a full-page New York Times advertisement paid for by major medical organizations stating their continued support for mammography. The greatest amount of television news coverage was devoted to the announcement of the official federal guidelines by the Secretary of Health and Human Services in late February. We conclude by discussing how the flow of news coverage of medical controversies can potentially impact the actions and reactions of the public, the medical community and health policy makers.

Physician Recommendation for Papanicolaou Testing Among U.S. Women, 2000

OBJECTIVE

Many women in the U.S. undergo routine cervical cancer screening, but some women have rarely or never had a Papanicolaou (Pap) test. Studies of other cancer screening tests (for example, mammograms) have shown that physician recommendation to get a screening test is one of the strongest predictors of cancer screening.

METHODS

In this study, we examined whether women in the U.S. had received a physician recommendation to get a Pap test using data from the 2000 National Health Interview Survey. Reported reasons for not receiving a Pap test were also explored.

RESULTS

Among women aged > or =18 years who had no history of hysterectomy, 83.3% [95% confidence interval (CI), 82.4-84.1%] of the 13,636 women in this sample had had a Pap test in the last 3 years. Among 2,310 women who had not had a recent Pap test, reported reasons for not receiving a Pap test included: "No reason/never thought about it" (48.0%; 95% CI, 45.5-50.7), "Doctor didn't order it" (10.3%; 95% CI, 8.7-12.0), "Didn't need it/didn't know I needed this type of test" (8.1%; 95% CI, 6.7-9.6), "Haven't had any problems" (9.0%; 95% CI, 7.6-10.5), "Put it off" (7.4%; 95% CI, 6.2-8.7), "Too expensive/no insurance" (8.7%; 95% CI, 7.3-10.2), "Too painful, unpleasant, embarrassing" (3.5%; 95% CI, 2.5-4.6), and "Don't have doctor" (1.7%; 95% CI, 1.2-2.4). Among women who had had a doctor visit in the last year but who had not had a recent Pap test, about 86.7% (95% CI, 84.5-88.6) reported that their doctor had not recommended a Pap test in the last year. African-American women were as likely as White women to have received a doctor recommendation to get a Pap test. Hispanic women were as likely as non-Hispanic women to have received a doctor recommendation to get a Pap test. In multivariate analysis, factors positively associated with doctor recommendation to get a Pap test included being aged 30 to 64 years, having been born in the U.S., and having seen a specialist or general doctor in the past year.

CONCLUSION

These findings suggest that lack of a physician recommendation contributes to underuse of Pap screening by many eligible women. Given research that shows the effectiveness of physician recommendations in improving use, increased physician recommendations could contribute significantly to increased Pap screening use in the U.S.

Women's preferences for doctor's involvement in decisions about mammography screening

OBJECTIVES

To assess women's preferences for doctor's involvement in mammography screening decisions.

METHODS

Mail survey of 50- to 69-year-old women residing in Geneva, Switzerland (N = 2216).

RESULTS

Women considered that the decision to undergo mammography screening should be made by the doctor alone (5.6%), doctor primarily (42.6%), shared equally between woman and doctor (45.0%), woman primarily (4.2%), and woman alone (2.4%). These subgroups differed considerably. Compared to women in the shared equally group, doctor alone respondents were more likely to be older, to be born outside Switzerland, and to wish to know as late as possible about having cancer. In contrast, woman alone respondents were more likely to report no previous mammogram, to expect bad news from mammograms, and to feel nervous about screening.

CONCLUSIONS

Most women wished to see their doctor involved in the decision to undergo a screening mammogram. Nevertheless, notable minorities held other opinions.

Predictors of adherence to screening mammography among Korean American women

BACKGROUND

Breast cancer is the most commonly diagnosed cancer among Korean American women (KAW). Many KAW are not aware of the importance of regular screening. This research estimates the rates of regular breast cancer screening and examines the predictors and barriers to obtaining regular mammograms.

METHODS

Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing.

RESULTS

About 33% had regular mammograms. In multiple logistic regression analyses, the strongest correlate of regular mammograms was knowledge of screening guidelines. Age, spoken English proficiency, and physician recommendations were associated with regular mammograms. Employment interacted with insurance: Employed women without insurance had lower rates of mammograms than those employed with insurance. The most frequent reason for not having regular mammograms was a woman's belief that she was at low risk for breast cancer.

CONCLUSIONS

Results indicate that knowledge of screening guidelines and physician recommendations for screening are important in this minority population. Culturally relevant educational programs about breast cancer screening should be developed for less acculturated women and recent immigrants.

Awareness of breast cancer incidence and risk factors among healthy women

The efficacy of early breast cancer detection programmes seems to be mainly influenced by the awareness of breast cancer in general among healthy women. This study aimed to provide information about women's understanding of breast cancer incidence and risk of disease. Based on a newly developed questionnaire 2108 healthy women were asked about their knowledge and perceptions in relation to breast cancer incidence, risk factors, risk perception and level of concern. Of these women 78.8% were well aware of breast cancer in general terms. However, there were major aspects such as incidence or risk factors that were poorly understood. Only one-third correctly estimated the incidence of breast cancer; 95% understood breast cancer in the familial history as a risk factor, but only 57% understood the age risk; 37.1% of women perceived hormonal contraceptives and 35.9% hormonal replacement therapy as risk factors of breast cancer. The latter estimation was significantly higher in women above 40 years. Recommendations for the improvement of cancer prevention programmes include targeting understanding of lifetime risk of breast cancer, age as a risk factor, survival from breast cancer or hormonal factors. There is a need to separately address the perceptions of women depending on age, social status and educational levels.

Delivery of HIV prevention counseling by physicians at HIV medical care settings in 4 US cities

OBJECTIVES

We investigated physicians' delivery of HIV prevention counseling to newly diagnosed and established HIV-positive patients.

METHODS

A questionnaire was developed and mailed to 417 HIV physicians in 4 US cities.

RESULTS

Overall, rates of counseling on the part of physicians were low. Physicians reported counseling newly diagnosed patients more than established patients. Factors associated with increased counseling included having sufficient time with patients and familiarity with treatment guidelines. Physicians who perceived their patients to have mental health and substance abuse problems, who served more male patients, and who were infectious disease specialists were less likely to counsel patients.

CONCLUSIONS

Intervention strategies with physicians should be developed to overcome barriers to providing counseling to HIV-positive patients.

Screening adherence in BRCA1/2 families is associated with primary physicians' behavior

This study provides an assessment of long-term breast and ovarian cancer screening behaviors and the variables associated with adherence with screening among women with or at 50% for having a BRCA1/2 mutation. Participants in the study included 112 women (33 mutation carriers and 79 at 50% risk). Data was collected through a mailed questionnaire, which included items to assess screening behaviors in the last 2 years, risk perception, cancer specific distress, adherence determinants, specific barriers, and cancer history. Statistical analysis included descriptive statistics and non-parametric tests to describe bivariate associations and regression analysis. Adherence rates were 72% for annual mammography, 21% for semi-annual clinical breast exam (CBE), 29% for monthly breast self-exam (BSE), and 19% for annual transvaginal ultrasound (US). Only one participant was adherent with semi-annual CA125. Variables that had a significant association (P < 0.05) with at least one screening modality included: a lack of time, marital status, education, cancer history, provider concern, perceived screening utility, confidence in ability to overcome barriers, cancer specific distress, and risk perception. Primary physician behavior, either in terms of screening recommendations or screening performance in the case of CBE, had significant independent association with adherence to mammography, CBE, and US screening recommendations. The results of this study highlight the essential role that primary physicians play in supporting their very high-risk patients' adherence.

Predictors of regular Pap smears among Korean-American women

BACKGROUND

Many Korean-American women (KAW) are unaware of the importance of regular cancer screening. This research estimates rates and examines predictors of regular cervical cancer screening among KAW.

METHODS

Face-to-face surveys were conducted with 459 KAW residing in Maryland. Study participants were recruited through Korean churches and senior housing.

RESULTS

Thirty-nine percent of women had regular Pap smears. Regular Pap smear rates varied with age, with women 65 years and older least likely to have regular Pap smears. In multiple logistic regression, the strongest correlate of regular Pap smear was knowledge of guidelines. Physician recommendation, having health insurance, and having friends or family members receiving Pap smears were also important facilitators. Spoken English proficiency interacted with education for an outcome; women with a low level of education and low English proficiency had lower rates of Pap smears than those who had a high level of education and high proficiency. The most frequently given reason for lack of a regular Pap smear was a belief that screening was unnecessary if a woman had no symptoms of cervical cancer.

CONCLUSIONS

Strategies for education on screening guidelines, along with physician referrals, should be implemented. Culturally appropriate educational programs about cervical cancer screening should be developed for less educated and less acculturated immigrant women.

Effect of physician specialty on counseling practices and medical referral patterns among physicians caring for disadvantaged human immunodeficiency virus-infected populations

Data regarding the care and management of human immunodeficiency virus (HIV)-infected patients provided by infectious diseases (ID)-trained physicians, compared with data for care and management provided by other specialists, are limited. Here, we report results of a self-administered survey sent to 317 physicians (response rate, 76%) in 4 metropolitan areas of the United States who were identified as providing care to disadvantaged HIV-infected patients. ID-trained physicians who responded that they strongly agreed or somewhat agreed that they had enough time to care for their HIV-infected patients were more likely than were non-ID-trained physicians to provide therapy-adherence counseling. Physicians with >or=50 patients in care and ID-trained physicians were less likely to always discuss condom use and risk reduction for HIV transmission. Factors significantly associated with referring rather than treating HIV-infected patients with hypertension or diabetes included having <50 patients in care, being an ID-trained physician, and practicing in a private practice. These results suggest the need for targeted physician training on the importance of HIV transmission prevention counseling, increasing the duration of patient visits, and improving strategies for generalist-specialist comanagement of HIV-infected patients.

Screening for colorectal cancer on the front line

OBJECTIVE

The aim of this study was to assess knowledge, beliefs, and practices of primary care clinicians regarding colorectal cancer screening.

METHODS

We surveyed 77 primary care providers in six clinics in central Massachusetts to evaluate several factors related to colorectal cancer screening.

RESULTS

Most agreed with guidelines for fecal occult blood test (97%) and sigmoidoscopy (87%), which were reported commonly as usual practice. Although the majority (86%) recommended colonoscopy as a colorectal cancer screening test, it was infrequently reported as usual practice. Also, 36% considered barium enema a colorectal cancer screening option, and it was rarely reported as usual practice. Despite lack of evidence supporting effectiveness, digital rectal examinations and in-office fecal occult blood test were commonly reported as usual practice. However, these were usually reported in combination with a guideline-endorsed testing option. Although only 10% reported that fecal occult blood test/home was frequently refused, 60% reported sigmoidoscopy was. Frequently cited patient barriers to sigmoidoscopy compliance included fear the procedure would hurt and that patients assume symptoms occur if there is a problem. Perceptions of health systems barriers to sigmoidoscopy were less strong.

CONCLUSIONS

Most providers recommended guideline-endorsed colorectal cancer screening. However, patient refusal for sigmoidoscopy was common. Results indicate that multiple levels of intervention, including patient and provider education and systems strategies, may help increase prevalence.

Women's knowledge of new regulations about publicly funded medications for osteoporosis

To provide adequate and updated information regarding changes in health care regulations or policies can be a challenging task for policy makers. The aim of the present study was to examine knowledge about new regulations regarding publicly funded drugs for the treatment of osteoporosis in a group of 109 Israeli women. Participants were interviewed between 3 and 6 months after the new regulations were enacted. Although participants were aware of their eligibility, moderate levels of knowledge were found regarding the content of the regulations. Especially low levels of knowledge were found regarding the scope of services and the definition of osteoporosis according to the regulations. High-risk participants (i.e. older participants and those with lower T score or who had suffered a fracture) had no better knowledge of the regulations. The development of multifaceted information programs aimed at disseminating the content of policy changes is encouraged.

Racial differences in breast cancer screening among women from 65 to 74 years of age: trends from 1987-1993 and barriers to screening

Breast cancer mortality is decreasing for elderly white women but increasing for elderly black women. National surveys were used to study racial differences in breast cancer screening and effects of Medicare funding for mammography and to examine explanatory fac- tors. A total of 13,545 women, aged 65-74, from the Health Care Finance Administration's Master Beneficiary File participated. After Medicare funding for screening mammography, the percent reporting a mammogram increased for white women, but not for black women. Clinical breast examination and breast self-examination decreased. Physician's recommendation, geographic area, education level and health status were the variables significantly affecting mammography usage for both races. Physicians recommended mammography more often if women were white, married, educated beyond high school and had an annual income greater than $20,000. These results support the need to design and test strategies specifically for black women and interventions to emphasize physician recommendations for breast cancer screening.

Mammography utilization among california women age 40-49 in a managed care environment

OBJECTIVE

To examine the utilization of screening mammography and the relationship between risk factors and mammography use in women age 40-49 in a managed care environment.

DESIGN

Retrospective observational study based on a mailed survey.

SETTING

A large HMO in California.

PATIENTS/PARTICIPANTS

The study population included respondents age 40-49 who completed a breast health assessment questionnaire mailed to all women age 34-49 and enrolled in a California HMO in early 1997.

MAIN RESULTS

About 67.6% of the 20,391 women age 40-49 had at least one mammogram during 1995 and 1996. Logistic regression revealed that women age 40-44 were less likely (odds ratio: 0.83-0.90) than women age 45-49 to obtain mammography. Family history of breast cancer (odds ratio: 1.12-1.16), breast biopsy (odds ratio: 1.14-1.18), and a mammogram in the previous three years (odds ratio: 1.15-1.18) were associated with an increased likelihood of taking a mammogram. However, monthly breast self-exams (odds ratio: 0.996-1.04), having a child at or after age 30 (odds ratio: 0.97-1.02), and having menarche at age 12 or younger (odds ratio: 0.96-1.01) had no significant effect on the screening mammography rates.

CONCLUSION

A relatively higher percentage of younger HMO members receive screening mammography than that of general population. However, some higher-risk groups, especially women whose first pregnancies were late in life, do not show a higher rate of using mammography.

Breast and cervical cancer screening among Chinese American women

PURPOSE

The purpose of this study was to describe breast and cervical cancer screening knowledge and practices of a representative sample of Chinese American women and to examine the factors associated with screening practices.

DESCRIPTION OF STUDY

A random sample of 332 Chinese American women, 40 to 69 years of age, from the Chinatown area of Chicago, Illinois, were interviewed face to face, using both Chinese Mandarin (or Putunghua) and Cantonese versions of the National Health Interview Survey (NHIS) Cancer Control Supplement Questionnaire. Knowledge and use of mammogram, clinical breast examination (CBE), breast self-examination (BSE), and Pap smear test were assessed.

RESULTS

The results showed a low level of knowledge of cancer screening tests and low use rates. Multiple logistics regression analysis showed that women with spoken English fluency were more likely to have knowledge and use of CBE, BSE, Pap test, and mammograms. Women with better than an elementary education were more likely to have knowledge and use of CBE, BSE, and Pap test. The source of medical care was statistically significant for having had a mammogram. Knowledge of cancer warning signs and symptoms was significant for knowledge of mammogram and BSE and for the use of BSE.

CLINICAL IMPLICATIONS

Multiple strategies are needed. These might include the following: 1) integration of research with population-based care by physicians and scientists; 2) coordinated public health education on cancer screening and postscreening support in Chinese languages; and 3) replication of the NHIS survey methodology and adaptive application of these instruments across several states and regions, combined with the assessment of screening performance in Chinese American populations.