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Dickson-Swift V, Adams J, Spelten E, Blackberry I, Wilson C, Yuen E. Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review. BMC Womens Health 2024; 24:256. [PMID: 38658945 PMCID: PMC11040767 DOI: 10.1186/s12905-024-03094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 04/15/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND This scoping review aimed to identify and present the evidence describing key motivations for breast cancer screening among women aged ≥ 75 years. Few of the internationally available guidelines recommend continued biennial screening for this age group. Some suggest ongoing screening is unnecessary or should be determined on individual health status and life expectancy. Recent research has shown that despite recommendations regarding screening, older women continue to hold positive attitudes to breast screening and participate when the opportunity is available. METHODS All original research articles that address motivation, intention and/or participation in screening for breast cancer among women aged ≥ 75 years were considered for inclusion. These included articles reporting on women who use public and private breast cancer screening services and those who do not use screening services (i.e., non-screeners). The Joanna Briggs Institute (JBI) methodology for scoping reviews was used to guide this review. A comprehensive search strategy was developed with the assistance of a specialist librarian to access selected databases including: the Cumulative Index to Nursing and Allied Health Literature (CINAHL), Medline, Web of Science and PsychInfo. The review was restricted to original research studies published since 2009, available in English and focusing on high-income countries (as defined by the World Bank). Title and abstract screening, followed by an assessment of full-text studies against the inclusion criteria was completed by at least two reviewers. Data relating to key motivations, screening intention and behaviour were extracted, and a thematic analysis of study findings undertaken. RESULTS A total of fourteen (14) studies were included in the review. Thematic analysis resulted in identification of three themes from included studies highlighting that decisions about screening were influenced by: knowledge of the benefits and harms of screening and their relationship to age; underlying attitudes to the importance of cancer screening in women's lives; and use of decision aids to improve knowledge and guide decision-making. CONCLUSION The results of this review provide a comprehensive overview of current knowledge regarding the motivations and screening behaviour of older women about breast cancer screening which may inform policy development.
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Affiliation(s)
- Virginia Dickson-Swift
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Joanne Adams
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia.
| | - Evelien Spelten
- Violet Vines Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, P.O. Box 199, Bendigo, VIC, 3552, Australia
| | - Irene Blackberry
- Care Economy Research Institute, La Trobe University, Wodonga, Australia
| | - Carlene Wilson
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Melbourne School of Population and Global Health, Melbourne University, Melbourne, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
| | - Eva Yuen
- Olivia Newton-John Cancer Wellness and Research Centre, Austin Health, Melbourne, Australia
- Institute for Health Transformation, Deakin University, Burwood, Australia
- Centre for Quality and Patient Safety, Monash Health Partnership, Monash Health, Clayton, Australia
- School of Psychology and Public Health, La Trobe University, Bundoora, Australia
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Brown GP, Greco C. The Well-Being of Older Offenders on Release in the Community. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2024:306624X231219222. [PMID: 38270097 DOI: 10.1177/0306624x231219222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
In Canada and internationally the number of older offenders on parole and living in the community is increasing rapidly. Older offenders in the community are a vulnerable population at high risk for lack of well-being. Semi-structured interviews were conducted with N = 64 offenders aged 50 years and older on conditional release from custody in Canada, including long-term, recidivist, and first-time older offenders. Compared to their non-offender counterparts, older offenders in the community experience many of the same problems of aging and well-being, but are at greater risk for mental health problems, traumatic injuries, and for recidivists, substance abuse. Most long-term and first-time older offenders find themselves living at or below the poverty line. One third of older offenders experience social isolation from community and family due to their criminal history and incarceration. For those with Indigenous ancestry, Indigenous communities, and cultural organizations play a significant role in supporting older offenders.
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Wolfson EA, Schonberg MA, Eliassen AH, Bertrand KA, Shvetsov YB, Rosner BA, Palmer JR, LaCroix AZ, Chlebowski RT, Nelson RA, Ngo LH. Validating a model for predicting breast cancer and nonbreast cancer death in women aged 55 years and older. J Natl Cancer Inst 2024; 116:81-96. [PMID: 37676833 PMCID: PMC10777669 DOI: 10.1093/jnci/djad188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 07/24/2023] [Accepted: 08/29/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND To support mammography screening decision making, we developed a competing-risk model to estimate 5-year breast cancer risk and 10-year nonbreast cancer death for women aged 55 years and older using Nurses' Health Study data and examined model performance in the Black Women's Health Study (BWHS). Here, we examine model performance in predicting 10-year outcomes in the BWHS, Women's Health Initiative-Extension Study (WHI-ES), and Multiethnic Cohort (MEC) and compare model performance to existing breast cancer prediction models. METHODS We used competing-risk regression and Royston and Altman methods for validating survival models to calculate our model's calibration and discrimination (C index) in BWHS (n = 17 380), WHI-ES (n = 106 894), and MEC (n = 49 668). The Nurses' Health Study development cohort (n = 48 102) regression coefficients were applied to the validation cohorts. We compared our model's performance with breast cancer risk assessment tool (Gail) and International Breast Cancer Intervention Study (IBIS) models by computing breast cancer risk estimates and C statistics. RESULTS When predicting 10-year breast cancer risk, our model's C index was 0.569 in BWHS, 0.572 in WHI-ES, and 0.576 in MEC. The Gail model's C statistic was 0.554 in BWHS, 0.564 in WHI-ES, and 0.551 in MEC; IBIS's C statistic was 0.547 in BWHS, 0.552 in WHI-ES, and 0.562 in MEC. The Gail model underpredicted breast cancer risk in WHI-ES; IBIS underpredicted breast cancer risk in WHI-ES and in MEC but overpredicted breast cancer risk in BWHS. Our model calibrated well. Our model's C index for predicting 10-year nonbreast cancer death was 0.760 in WHI-ES and 0.763 in MEC. CONCLUSIONS Our competing-risk model performs as well as existing breast cancer prediction models in diverse cohorts and predicts nonbreast cancer death. We are developing a website to disseminate our model.
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Affiliation(s)
- Emily A Wolfson
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mara A Schonberg
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - A Heather Eliassen
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA
| | - Kimberly A Bertrand
- Slone Epidemiology Center at Boston University and Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Yurii B Shvetsov
- University of Hawaii Cancer Center, University of Hawaii at Manoa, Honolulu, HI, USA
| | - Bernard A Rosner
- Department of Epidemiology, Harvard School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Harvard School of Public Health, Boston, MA, USA
| | - Julie R Palmer
- Slone Epidemiology Center at Boston University and Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Andrea Z LaCroix
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, CA, USA
| | | | - Rebecca A Nelson
- Department of Computational and Quantitative Medicine, City of Hope, Duarte, CA, USA
| | - Long H Ngo
- Division of General Medicine and Primary Care, Department of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
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Padamsee TJ, Muraveva A, Meadows RJ, Hils M, Yee LD, Wills CE, Paskett ED. Racial differences in prevention decision making among U.S. women at high risk of breast cancer: A qualitative study. PLoS One 2023; 18:e0278742. [PMID: 36857397 PMCID: PMC9977014 DOI: 10.1371/journal.pone.0278742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2021] [Accepted: 11/19/2022] [Indexed: 03/02/2023] Open
Abstract
PURPOSE Women at high risk of breast cancer face complex decisions about how to manage those risks. Substantial gaps in current knowledge include how women make these decisions and how decision making may differ across sub-populations. Among these critical gaps are the questions of (a) whether racial differences exist between the experiences of high-risk women navigating breast cancer risk, and (b) what consequences those racial differences might have on women's ability to manage their cancer risks. The present study is designed to address these questions directly. METHODS Fifty semi-structured interviews were conducted with high-risk Black (n = 20) and white women (n = 30) between May 2015 and March 2016 in person in Ohio and by phone. Transcribed data were analyzed using grounded theory methods. MAIN FINDINGS Our analyses suggest that many of the core decision-making dynamics high-risk women navigate differ by race. The experiences of white and Black women in our study differ in terms of (a) contextualizing risk-how women make sense of their own breast cancer risk, the degree to which they worry about risk, and how they prioritize risk within the contexts of their broader lives; (b) conceptualizing risk management-how, how much, and from whom women learn about and conceptualize their options for preventing cancer and/or ensuring that cancer gets diagnosed early; and (c) constraints-the external barriers women face throughout their decision-making and risk-management processes. In sum, the Black women we interviewed reported feeling less well-situated to consider and cope actively with breast cancer risk, less well-informed about risk-management options, and more constrained in their use of these options. CONCLUSIONS High-risk women's accounts of the complex dynamics that shape breast cancer prevention decisions suggest that these dynamics vary substantially by race, such that Black women may experience disadvantages relative to whites.
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Affiliation(s)
- Tasleem J. Padamsee
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, and Faculty Affiliate of the James Comprehensive Cancer Center, Columbus, OH, United States of America
- * E-mail:
| | - Anna Muraveva
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Rachel J. Meadows
- Center for Epidemiology & Healthcare Delivery Research JPS Health Network, Ft. Worth, TX, United States of America
| | - Megan Hils
- Division of Health Services Management and Policy at the Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Lisa D. Yee
- City of Hope National Medical Center, Duarte, CA, United States of America
| | - Celia E. Wills
- The Ohio State University College of Nursing, Columbus, OH, United States of America
| | - Electra D. Paskett
- The Ohio State University College of Medicine and James Comprehensive Cancer Center, Columbus, OH, United States of America
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Carter BJ, Chen TA, Cho D, Connors SK, Siddiqi AD, McNeill LH, Reitzel LR. Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13004. [PMID: 36293643 PMCID: PMC9602462 DOI: 10.3390/ijerph192013004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
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.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
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Cadet T, Aliberti G, Karamourtopoulos M, Jacobson A, Gilliam EA, Primeau S, Davis R, Schonberg MA. Evaluation of a mammography decision aid for women 75 and older at risk for lower health literacy in a pretest-posttest trial. PATIENT EDUCATION AND COUNSELING 2021; 104:2344-2350. [PMID: 33637391 PMCID: PMC8364563 DOI: 10.1016/j.pec.2021.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 01/16/2021] [Accepted: 02/09/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE The evaluation of the effect of a mammography decision aid (DA) designed for older women at risk for lower health literacy (LHL) on their knowledge of mammography's benefits and harms and decisional conflict. METHODS Using a pretest-posttest design, women > 75 years at risk for LHL reviewing a mammography DA before and after their [B] primary care provider visit. Women were recruited from an academic medical center and community health centers and clinics. RESULTS Of 147 eligible women approached, 43 participated. Receipt of the DA significantly affected knowledge of mammography's benefits and harms [B] (pre-test (M = 3.75, SD = 1.05) to post-test (M = 4.42, SD = 1.19), p = .03). Receipt of the DA did not significantly affect decisional conflict (pre-test (M = 3.10, SD = .97) to post-test (M = 3.23, SD = 1.02), p = .71, higher scores = lower decisional conflict). The majority of the women (97%) indicated that the DA was helpful. CONCLUSIONS Women found a mammography screening DA helpful and its use was associated with these women having increased knowledge of mammography's benefits and harms. PRACTICE IMPLICATIONS With the shift toward shared decision-making for women > 75 years, there is a need to engage women of all literacy levels to participate in these decisions and have tools such as the one tested in this study.
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Affiliation(s)
- Tamara Cadet
- Simmons University College of Social Sciences and Policy Practice, School of Social Work, 300 The Fenway, Boston, MA, USA.
| | - Gianna Aliberti
- Beth Israel Deaconess Medical Center, 1309 Beacon St, Ste 202, Brookline, MA, USA
| | | | - Alicia Jacobson
- Beth Israel Deaconess Medical Center, 1309 Beacon St, Ste 202, Brookline, MA, USA
| | - Elizabeth A Gilliam
- Beth Israel Deaconess Medical Center, 1309 Beacon St, Ste 202, Brookline, MA, USA
| | - Sara Primeau
- Cambridge Health Alliance, 1493 Cambridge Street, Cambridge, MA, USA
| | - Roger Davis
- Beth Israel Deaconess Medical Center, 1309 Beacon St, Ste 202, Brookline, MA, USA
| | - Mara A Schonberg
- Beth Israel Deaconess Medical Center, 1309 Beacon St, Ste 202, Brookline, MA, USA
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Rozbroj T, Haas R, O'Connor D, Carter SM, McCaffery K, Thomas R, Donovan J, Buchbinder R. How do people understand overtesting and overdiagnosis? Systematic review and meta-synthesis of qualitative research. Soc Sci Med 2021; 285:114255. [PMID: 34391966 DOI: 10.1016/j.socscimed.2021.114255] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 11/15/2022]
Abstract
RATIONALE The public should be informed about overtesting and overdiagnosis. Diverse qualitative studies have examined public understandings of this information. A synthesis was needed to systematise the body of evidence and yield new, generalisable insights. AIM Synthesise data from qualitative studies exploring patient and public understanding of overtesting and overdiagnosis. METHODS We searched Scopus, CINAHL, Ovid MEDLINE and PsycINFO databases from inception to March 18, 2020. We included published English-language primary studies exploring the perspectives of patients/the public about overtesting/overdiagnosis from any setting, year and relating to any condition. Only qualitative parts of mixed-methods studies were synthesised. We excluded studies that only examined overtreatment or sampled people with specialised medical knowledge. Two authors independently selected studies, extracted data, assessed the methodological quality of included studies using the CASP tool, and assessed confidence in the synthesis findings using the GRADE-CERQual approach. Data was analysed using thematic meta-synthesis, utilising descriptive and interpretive methods. RESULTS We synthesised data from 21 studies, comprising 1638 participants, from 2754 unique records identified. We identified six descriptive themes, all graded as moderate confidence (indicating they are likely to reasonably represent the available evidence): i) high confidence in screening and testing; ii) difficulty in understanding overuse; iii) acceptance that overuse can be harmful; iv) rejection or problematisation of overuse; v) limited impacts of overuse information on intended test and screening uptake; vi) desire for information and shared decision-making regarding overuse. The descriptive themes were underpinned by two analytic themes: i) perceived intrinsic value of information and information gathering, and; ii) differences in comprehension and acceptance of overuse concepts. CONCLUSIONS This study identified novel and important insights about how lay people interpret overuse concepts. It will guide the development of more effective public messages about overuse, highlighting the importance of interpretative frameworks in these communications.
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Affiliation(s)
- Tomas Rozbroj
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia.
| | - Romi Haas
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Denise O'Connor
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
| | - Stacy M Carter
- Australian Centre for Health Engagement, Evidence and Values, University of Wollongong, NSW 2500, Australia
| | - Kirsten McCaffery
- Sydney Health Literacy Lab, School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Rae Thomas
- Institute for Evidence-Based Healthcare, Bond University, Gold Coast, QLD, Australia
| | - Jan Donovan
- Consumers Health Forum of Australia, 7B/17 Napier Close, Deakin, ACT 2600, Australia
| | - Rachelle Buchbinder
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, 154 Wattletree Rd, Malvern, VIC 3144, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Rd, VIC 3004, Australia
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Pappadis MR, Volk RJ, Krishnan S, Weller SC, Jaramillo E, Hoover DS, Giordano SH, Tan A, Sheffield KM, Housten AJ, Goodwin JS. Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis. BMJ Open 2018; 8:e022138. [PMID: 29903800 PMCID: PMC6009543 DOI: 10.1136/bmjopen-2018-022138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Current research on the perceptions of overdiagnosis or overdetection of breast cancer has largely been conducted outside of the USA and with women younger than 70 years.Therefore, we explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. DESIGN Mixed-methods analysis using purposive sampling based on race/ethnicity, age and educational level. Semistructured interviews, including two hypothetical scenarios illustrating benefits and harms of screening and overdetection, were analysed using inductive and deductive thematic approaches. An inferential clustering technique was used to assess overall patterns in narrative content by sociodemographic characteristics, personal screening preferences or understanding of overdetection. SETTING Houston/Galveston, Texas, USA. PARTICIPANTS 59 English-speaking women aged 70 years and older with no prior history of breast cancer. RESULTS Very few women were familiar with the concept of overdetection and overtreatment. After the scenarios were presented, half of the women still demonstrated a lack of understanding of the concept of overdetection. Many women expressed suspicion of the concept, equating it to rationing. Women who showed understanding of overdetection were more likely to express an intent to discontinue screening, although 86% of the women stated that hearing about overdetection did not influence their screening decision. Themes identified did not differ by race/ethnicity, education, age or screening preferences. Differences were identified between women who understood overdetection and women who did not (r=0.23, p<0.001). CONCLUSIONS Many older women did not understand the concept of overdetection, in addition to being suspicious of or resistant to the concept. Providing older women with descriptions of overdetection may not be sufficient to influence screening intentions.
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Affiliation(s)
- Monique R Pappadis
- Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston, Texas, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Susan C Weller
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, USA
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Elizabeth Jaramillo
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Internal Medicine and Division of Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Diana Stewart Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kristin M Sheffield
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ashley J Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James S Goodwin
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Internal Medicine and Division of Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
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9
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Housten AJ, Pappadis MR, Krishnan S, Weller SC, Giordano SH, Bevers TB, Volk RJ, Hoover DS. Resistance to discontinuing breast cancer screening in older women: A qualitative study. Psychooncology 2018; 27:1635-1641. [PMID: 29575590 PMCID: PMC5986612 DOI: 10.1002/pon.4708] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 03/07/2018] [Accepted: 03/09/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE Screening mammography is associated with reduced breast cancer-specific mortality; however, among older women, evidence suggests that the potential harms of screening may outweigh the benefits. We used a qualitative approach to examine the willingness of older women from different racial/ethnic groups to discontinue breast cancer screening. METHODS Women ≥70 years of age who reported having a screening mammogram in the past 3 years and/or reported that they intended to continue screening in the future were recruited for in-depth interviews. Participants who intended to continue screening were asked to describe how the following hypothetical scenarios would impact a decision to discontinue screening: health concerns or limited life expectancy, a physician's recommendation to discontinue, reluctance to undergo treatment, and recommendations from experts or governmental panels to stop screening. Semi-structured, face-to-face interviews were audio-recorded. Data coding and analysis followed inductive and deductive approaches. RESULTS Regardless of the scenario, participants (n = 29) expressed a strong intention to continue screening. Based on the hypothetical physician recommendations, intentions to continue screening appeared to remain strong. They did not envision a change in their health status that would lead them to discontinue screening and were skeptical of expert/government recommendations. There were no differences observed according to age, race/ethnicity, or education. CONCLUSIONS Among older women who planned to continue screening, intentions to continue breast cancer screening appear to be highly resilient and resistant to recommendations from physicians or expert/government panels.
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Affiliation(s)
- Ashley J Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Monique R Pappadis
- Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
| | - Shilpa Krishnan
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Occupational Therapy, School of Health Professions, The University of Texas Medical Branch, Galveston, TX, USA
| | - Susan C Weller
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, TX, USA
- Department of Family Medicine, University of Texas Medical Branch, Galveston, TX, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Therese B Bevers
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Diana S Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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