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Kessler LG, Comstock B, Aiello Bowles EJ, Mou J, Nash MG, Bravo P, Fleckenstein LE, Pflugeisen C, Gao H, Winer RL, Ornelas IJ, Smith C, Neslund-Dudas C, Shetty P. Protocol to measure validity and reliability of colorectal, breast, cervical and lung cancer screening questions from the 2021 National Health Interview Survey: Methodology and design. PLoS One 2024; 19:e0297773. [PMID: 38437207 PMCID: PMC10911603 DOI: 10.1371/journal.pone.0297773] [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: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 03/06/2024] Open
Abstract
Previous studies demonstrate that self-reports of mammography screening for breast cancer and colonoscopy screening for colorectal cancer demonstrate concordance, based on adherence to screening guidelines, with electronic medical records (EMRs) in over 90% of those interviewed, as well as high sensitivity and specificity, and can be used for monitoring our Healthy People goals. However, for screening tests for cervical and lung cancers, and for various sub-populations, concordance between self-report and EMRs has been noticeably lower with poor sensitivity or specificity. This study aims to test the validity and reliability of lung, colorectal, cervical, and breast cancer screening questions from the 2021 and 2022 National Health Interview Survey (NHIS). We present the protocol for a study designed to measure the validity and reliability of the NHIS cancer screening questions compared to EMRs from four US-based healthcare systems. We planned a randomized trial of a phone- vs web-based survey with NHIS questions that were previously revised based on extensive cognitive interviewing. Our planned sample size will be 1576 validity interviews, and 1260 interviews randomly assigned at 1 or 3 months after the initial interview. We are enrolling people eligible for cancer screening based on age, sex, and smoking history per US Preventive Services Task Force recommendations. We will evaluate question validity using concordance, sensitivity, specificity, positive predictive value, negative predictive value, and report-to-records ratio. We further are randomizing participants to complete a second survey 1 vs 3 months later to assess question reliability. We suggest that typical measures of concordance may need to be reconsidered in evaluating cancer screening questions.
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Affiliation(s)
- Larry G. Kessler
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Bryan Comstock
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Erin J. Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Jin Mou
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Michael G. Nash
- Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Perla Bravo
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Lynn E. Fleckenstein
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Chaya Pflugeisen
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, United States of America
| | - Rachel L. Winer
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - India J. Ornelas
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Seattle, Washington, United States of America
| | - Cynthia Smith
- Institute for Research and Innovation, MultiCare Health System, Tacoma, Washington, United State of America
| | - Chris Neslund-Dudas
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, United States of America
| | - Punith Shetty
- Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, United States of America
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He H, Liu T, Zhao F, Feng X, Lyu J, Gao Y. Nonlinear Relationship Between Age and Likelihood of Undergoing Prostate-Specific Antigen Testing, and the Predictive Factors of Testing at Different Ages. Am J Mens Health 2021; 15:15579883211026515. [PMID: 34167355 PMCID: PMC8246524 DOI: 10.1177/15579883211026515] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 05/27/2021] [Accepted: 05/31/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To investigate the nonlinear relationship between age and the likelihood of undergoing prostate-specific antigen (PSA) testing, and the difference of factors influencing the test likelihood among subjects aged 40-54, 55-69, and ≥70 years. METHODS Data were extracted from the 2018 Behavioral Risk Factor Surveillance System, with the primary outcome defined as receipt of a PSA test within the previous 12 months. Restricted cubic splines were used to assess the relationship between age and the likelihood of undergoing PSA testing. Backward conditional logistic regression analyses were used to identify the predictors of undergoing PSA testing among subjects aged 40-54, 55-69, and ≥70 years. RESULTS Finally, 92,177 people were identified. The likelihood of PSA testing increased up to around 71 years old and then decreased rapidly for higher ages, showing a clear nonlinear inverted U-shaped relationship with age (p < .001). Insurance status, shared decision-making, whether a recommendation for PSA testing had been accepted, income level, smoking status, and age were the common predictors of testing in the three age groups. However, the predictors differed somewhat among the three groups: being overweight or obese was only positively associated with increased testing among people aged 40-54 and ≥70 years, being retired only greatly impacted the test likelihood among those aged 40-54 years, and the general health status, marital status, and race affected people aged ≥55 years. CONCLUSION The factors influencing PSA screening differ with age, which should be fully considered when screening different target age groups.
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Affiliation(s)
- Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China
| | - Tianjie Liu
- Department of Urology, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
| | - Fanfan Zhao
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China
| | - Xiaojie Feng
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China
| | - Jun Lyu
- School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, People’s Republic of China
- Department of Clinical Research, The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong, People’s Republic of China
| | - Ye Gao
- Department of Emergency, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an, Shaanxi, People’s Republic of China
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Margolies L, Chaudhry S. Pushing anxiety as a risk of screening mammography is benevolent sexism and bad for women's health outcomes. Clin Imaging 2020; 68:166-168. [PMID: 32645603 DOI: 10.1016/j.clinimag.2020.05.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/10/2020] [Accepted: 05/27/2020] [Indexed: 11/15/2022]
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4
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Improving breast cancer screening rates in a primary care setting. Breast J 2019; 25:963-966. [DOI: 10.1111/tbj.13377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 12/20/2018] [Accepted: 01/02/2019] [Indexed: 12/01/2022]
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Bessler P, Aung M, Jolly P. Factors Affecting Uptake of Cervical Cancer Screening among Clinic Attendees in Trelawny, Jamaica. Cancer Control 2017; 14:396-404. [PMID: 17914340 DOI: 10.1177/107327480701400410] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Use of the Pap test has resulted in a decline in cervical cancer mortality in developed countries. Yet, despite established cervical cancer screening programs, a significant portion of Jamaican women are not undergoing screening for cervical cancer. This study was carried out to identify factors that affect Jamaican women's decisions to screen for cervical cancer. Methods A population survey was administered to 367 clinic-attending women 25 to 54 years of age in the Parish of Trelawny from May to July of 2005. An interviewer-administered questionnaire assessed the women's knowledge, attitudes, and practices regarding cervical cancer and cervical cancer screening. Results Overall, 11% of the women had never had a Pap smear and only 38% had a Pap test within the last year. Annual visits to a health provider have a strong influence on women's decisions to regularly screen for cervical cancer. Provider recommendation also positively affected initial receipt of a Pap smear as well as continued regular screening. Conclusions Programs that promote annual health checkups, encourage consistent provider recommendations, and emphasize screening as a preventive measure might positively influence women's decisions to screen for cervical cancer.
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Affiliation(s)
- Patricia Bessler
- Department of Epidemiology and International Health, University of Alabama at Birmingham School of Public Health, Alabama 35294, USA
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Koneru A, Jolly PE, Blakemore S, McCree R, Lisovicz NF, Aris EA, Mtesigwa T, Yuma S, Mwaiselage JD. Acceptance of peer navigators to reduce barriers to cervical cancer screening and treatment among women with HIV infection in Tanzania. Int J Gynaecol Obstet 2017; 138:53-61. [PMID: 28391628 PMCID: PMC5482416 DOI: 10.1002/ijgo.12174] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 01/18/2017] [Accepted: 04/06/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To identify barriers to cervical cancer screening and treatment, and determine acceptance toward peer navigators (PNs) to reduce barriers. METHODS A cross-sectional study was conducted among women with HIV infection aged 19 years or older attending HIV clinics in Dar es Salaam, Tanzania, between May and August 2012. Data for sociodemographic characteristics, barriers, knowledge and attitude toward cervical cancer screening and treatment, and PNs were collected by questionnaire. RESULTS Among 399 participants, only 36 (9.0%) reported previous cervical cancer screening. A higher percentage of screened than unscreened women reported being told about screening by someone at the clinic (25/36 [69.4%] vs 132/363 [36.4%]; P=0.002), knew that screening was free (30/36 [83.3%] vs 161/363 [44.4%]; P<0.001), and obtained "good" cervical screening attitude scores (17/36 [47.2%] vs 66/363 [18.2%]; P=0.001). Most women (382/399 [95.7%]) did not know about PNs. When told about PNs, 388 (97.5%) of 398 women said they would like assistance with explanation of medical terms, and 352 (88.2%) of 399 said they would like PNs to accompany them for cervical evaluation and/or treatment. CONCLUSION Use of PNs was highly acceptable and represents a novel approach to addressing barriers to cervical cancer screening and treatment.
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Affiliation(s)
- Alaya Koneru
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Pauline E Jolly
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Shaundra Blakemore
- School of Public Health, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Renicha McCree
- Division of Global Health and Tuberculosis, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Nedra F Lisovicz
- Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Eric A Aris
- Management and Development for Health, Dar es Salaam, Tanzania
| | | | - Safina Yuma
- Reproductive Health Cancer Unit, Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
| | - Julius D Mwaiselage
- Division for Cancer Prevention and Research, Ocean Road Cancer Institute, Dar es Salaam, Tanzania
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Passmore SR, Williams-Parry KF, Casper E, Thomas SB. Message Received: African American Women and Breast Cancer Screening. Health Promot Pract 2017; 18:726-733. [DOI: 10.1177/1524839917696714] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
African American women are more likely than other women to be diagnosed with breast cancer at a young age, to be diagnosed at a late stage, and to die from the disease. Yet we see evidence of irregular screening and follow-up. Previous research on psychosocial factors influencing decisions to screen reveals barriers: fear, fatalistic perceptions of cancer, inaccurate perceptions of risk, and associations with stigma. The current qualitative research with, largely, insured African American women ( n = 26), health navigators ( n = 6), and community stakeholders ( n = 24) indicates both positive and negative factors influencing decision making. The women in our sample believe in the value of early detection and are motivated to screen in response to encouragement from health providers. However, they also report several factors that contribute to their decisions to delay or not screen. These include (1) perceptions that the health community itself is confused about the need for screening, (2) perceptions that White women are the priority population for breast cancer, (3) family roles that prohibit self-care and encourage secrecy, and (4) fear of diagnosis. Participants report not feeling included in national-level health promotion campaigns. It is argued that African American women, in particular, may benefit from more nuanced health information about their risk.
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Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment. J Am Coll Radiol 2016; 13:R89-R97. [PMID: 27814821 DOI: 10.1016/j.jacr.2016.09.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
PURPOSE Anxiety has been called a "harm" of screening mammography. The authors provided direct, interactive education to lay audiences and measured these sessions' impact on anxiety and any increased understanding of breast cancer screening. METHODS Academic breast radiologist provided seven 1-hour sessions of structured lectures and question-and-answer periods. Lay language and radiologic images were used to discuss disease background, screening guidelines, and areas of debate. One hundred seventeen participants (mean age, 45 ± 15 years) completed voluntary, anonymous, institutional review board-approved pre and postsession questionnaires relaying their attitudes regarding screening and the impact of the sessions. Results are summarized descriptively. RESULTS Mean reported anxiety regarding screening (on a scale ranging from 1-5; 1 = no anxiety) was 2.5 ± 1.3. Anxiety was attributed to unknown results (56.4%), anticipation of pain (21.8%), known risk factors (14.5%), general uncertainty (12.7%), waiting for results (9.1%), possibility of more procedures (3.6%), and personal breast cancer history (3.6%). Ninety-seven percent reported that immediate results would lower anxiety (78% of those women indicated a 75%-100% decrease in anxiety); 93% reported that radiologist consultation with images would lower anxiety (75.6% indicated a 75%-100% decrease in anxiety). After the lecture, women reported (on a scale ranging from 1-5) increased understanding of the topic (4.7 ± 0.6), encouragement to screen (4.6 ± 0.7), and reduced anxiety (4.0 ± 1.1). Ninety-seven percent to 100% provided correct responses to these questions: rationale for screening in the absence of family history, recall does not equate to cancer diagnosis, benefit of prior films, and continued importance of physical examination. CONCLUSION Attendees of radiologist-provided direct public lectures reported decreased anxiety and improved knowledge regarding screening mammography. The resultant reduced anxiety ("harm") and educational empowerment help enable informed decision making and may promote screening attendance.
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Pérez-Stable EJ, Otero-Sabogal R, Sabogal F, Nápoles-Springer A. Pathways to Early Cancer Detection for Latinas: En Acción Contra el Cáncer. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/109019819602301s05] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Latinas have less breast cancer, have more cervical cancer, and obtain fewer screening tests at recommended intervals. This article reviews the epidemiology and use of screening tests for these cancers and cultural factors that affect screening. En Acción Contra el Cáncer was designed to increase use of breast and cervical cancer screening services by distributing free cancer educational materials in Spanish, implementing a media campaign, conducting community outreach, training lay networkers, and assisting clinicians. A survey of 1,601 Latinas, 20 to 74 years old, ascertained screening behavior and knowledge and attitudes about cancer. Comparison of intervention and control cities showed significant differences in proportion insured, married, born in the United States, and less acculturated. There were no significant differences in mammography and Pap smear use, knowledge, and attitudes. Culturally appropriate prevention interventions that target ethnic-specific concerns arc needed.
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Affiliation(s)
| | | | - Fabio Sabogal
- Medical Effectiveness Research Center for Diverse Populations at UCSF
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Hiatt RA, Pasick RJ, PÉRez-Stable EJ, Mcphee SJ, Engelstad L, Lee M, Sabogal F, D'onofrio CN, Stewart S. Pathways to Early Cancer Detection in the Multiethnic Population of the San Francisco Bay Area. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/109019819602301s03] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Pathways project studied the relationship of race/ethnicity, socioeconomic status, and culture to breast and cervical cancer screening. A multidisciplinary, multicultural team of investigators assessed the knowledge, attitudes, and practices of women from five race/ethnic groups (N = 4,228) and their barriers to screening utilization. A planning framework guided the development of interventions and analyses of the similarities and differences in screening behaviors across race/ethnic groups. Baseline data for women ages 18 to 74 years showed that levels of screening were higher than national averages for Latina, white, and black women but lower for Chinese and Vietnamese women. Analyses revealed the importance of education and insurance in obtaining recommended screening regardless of race/ethnicity. However, race, ethnicity, and culture are important to the tailoring of effective interventions.
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Affiliation(s)
| | | | | | | | - Linda Engelstad
- University of California, San Francisco (UCSF) Linda Engelstad
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Otero-Sabogal R, Stewart S, Sabogal F, Brown BA, Pérez-Stable EJ. Access and Attitudinal Factors Related to Breast and Cervical Cancer Rescreening: Why are Latinas Still Underscreened? HEALTH EDUCATION & BEHAVIOR 2016; 30:337-59. [DOI: 10.1177/1090198103030003008] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
To identify access, attitudes, and health practices of Latina women undergoing regular mammography and Pap smear screening, 977 Latinas aged 40 to 74, residing in four California cities, answered a telephone interview. Forty-one percent of women had regular mammography, and 73% had regular Pap smear screening. Cancer screening maintenance was associated with having health insurance, a regular place of care, and fewer fatalistic attitudes about cancer. Regular mammography and Pap smear screening were also associated with ever being married, attending church, and having taken hormone replacement therapy. Being older than 50, residing in the United States a long time, and having had a hysterectomy predicted mammography maintenance. Pap smear screening maintenance was negatively associated with poverty, old age, and negative attitudes toward physicians. There are structural and attitudinal barriers to regular cancer screening among Latinas. Interventions that increase access to care and address women's attitudes about cancer are needed.
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Abstract
This project facilitated access to mammography screening for older ethnic minority women through health education and coordination of service networks for aging and health care services. Health education sessions were held in senior centers, followed by a mammography screening in a mammography van or at a health care facility. Of the participants in the education sessions, 38% received a mammogram. More women who did not obtain a mammogram believed that cancer treatments were worse than the disease. Also, more African American and White women than Hispanic women did not recognize age as a risk factor for cancer Of the Hispanic women, 30% believed that early diagnosis did not make a difference in one's outcome, compared with 20% of White women and 8% of African American women.
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Lee J, Hardesty LA, Kunzler NM, Rosenkrantz AB. Direct Interactive Public Education by Breast Radiologists About Screening Mammography: Impact on Anxiety and Empowerment. J Am Coll Radiol 2016; 13:12-20. [DOI: 10.1016/j.jacr.2015.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 07/20/2015] [Indexed: 10/22/2022]
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Jalil NAC, Zin AAM, Othman NH. Prevalence of Cancers of Female Organs among Patients with Diabetes Type 2 in Kelantan, Malaysia: Observations over an 11 Year Period and Strategies to Reduce the Incidence. Asian Pac J Cancer Prev 2015; 16:7267-70. [PMID: 26514522 DOI: 10.7314/apjcp.2015.16.16.7267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Kelantan is one of the states in Malaysia which has a high prevalence of type 2 diabetes (DM2). Other than with endometrial carcinoma, the association of DM2 with particular female cancers is not known. OBJECTIVE To determine the proportion of breast, cervical, ovarian and endometrial cancers among females with DM2 diagnosed in Hospital Universiti Sains Malaysia (HUSM) over an 11 year period. MATERIALS AND METHODS All histologically confirmed cases of breast, endometrial, cervical and ovarian carcinomas admitted to the Hospital were included in the study. The patient diabetic status was traced from the hospital medical records. RESULTS There was a total of 860 cases of breast, cervical, ovarian and endometrial carcinomas over this period. Breast carcinoma was the commonest, accounting for 437/860 (50.8%) followed by cervix, 159/860 (18.5%), ovarian, 143/860 (16.6%) and endometrial carcinomas, 121/860 (14.1%). Out of these, 228/860 (26.5%) were confirmed diabetics. Endometrial carcinoma patients showed the highest proportion being diabetics, 42.1% (51/121), followed by ovarian cancer, 25.9% (37/143), breast carcinoma, 23.6% (103/437) and cervical cancer 23.3% (37/159). CONCLUSIONS There is a significant proportion of DM2 among women with these four cancers, endometrial carcinoma being the highest followed by ovarian, breast and cervical carcinoma. The rising trend of these four cancers is in tandem with an increasing trend of DM2 in the community. In populations where diabetes is prevalent, screening for epithelial cancers should be rigourous. Diabetic clinics should include screening for these cancers among their female patients and gynecology clinics should screen the women they treat for their diabetes status.
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Affiliation(s)
- Nur Asyilla Che Jalil
- Department of Pathology, School of Medical Sciences, Health Campus, Universiti Sains Malaysia, Malaysia E-mail :
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Preventive care utilization among the uninsured by race/ethnicity and income. Am J Prev Med 2015; 48:13-21. [PMID: 25442235 DOI: 10.1016/j.amepre.2014.08.029] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2014] [Revised: 07/08/2014] [Accepted: 08/29/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Health insurance status affects access to preventive services. Effective use of preventive services is a key factor in the reduction of important health concerns and has the potential to enable adults to live longer, healthier lives. PURPOSE To analyze the use of U.S. Preventive Services Task Force (USPSTF)-recommended preventive services among uninsured adults, with a focus on variation across race, ethnicity, and household income. METHODS Using pooled 2004-2011 Medical Expenditure Panel Survey data, this study conducted multivariate logistic regressions to estimate variation in receipt of eight USPSTF-recommended preventive services by race/ethnicity among adults aged 18 years and older uninsured in the previous year. Stratified analyses by household income were applied. Data were analyzed in 2013. RESULTS Uninsured adults received preventive services far below Healthy People 2020 targets. Among the uninsured, African Americans had higher odds of receiving Pap tests, mammograms, routine physical checkups, and blood pressure checks according to guidelines than whites. Moreover, compared to whites, Hispanics had higher odds of receiving Pap tests, mammograms, influenza vaccinations, and routine physical checkups and lower odds of receiving blood pressure screening and advice to quit smoking. When results were stratified by household income, racial/ethnic differences persisted except for the highest income levels (≥400% Federal Poverty Level), where they were largely non-significant. CONCLUSIONS Generally, uninsured African American and Hispanic populations fare better than uninsured whites in preventive service utilization. Future research should examine reasons behind these racial/ethnic differences to inform policy interventions aiming to increase preventive service utilization among the uninsured.
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Gjelsvik A, Rogers ML, Clark MA, Ombao HC, Rakowski W. Continuum of mammography use among US women: classification tree analysis. Am J Health Behav 2014; 38:492-500. [PMID: 24636111 DOI: 10.5993/ajhb.38.4.2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVES To identify women with low mammography utilization. METHODS We used Classification Tree Analysis among women aged 42-80 from the 2008 Behavioral Risk Factor Surveillance System (N = 169,427) to identify sub-groups along a continuum of screening. RESULTS Women with neither a primary care provider nor health insurance had the lowest utilization (33.9%) and were 2.8% of the sample. Non-smoking women aged 55-80, with a primary care provider, health insurance, and income of $75,000 or more had the highest utilization (90.7%) and comprised 5% of the sample. CONCLUSION As access to primary care providers and health insurance increases with the Affordable Care act, classification tree analyses may help to identify women of high priority for intervention.
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Affiliation(s)
- Annie Gjelsvik
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA.
| | - Michelle L Rogers
- Brown University School of Public Health, Center for Population Health and Clinical Epidemiology, Providence, RI, USA
| | - Melissa A Clark
- Brown University School of Public Health, Department of Epidemiology, Providence, RI, USA
| | - Hernando C Ombao
- University of California at Irvine, Department of Statistics, Irvine, CA, USA
| | - William Rakowski
- Brown University School of Public Health, Department of Behavioral and Social Sciences, Providence, RI, USA
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Helvie MA, Chang JT, Hendrick RE, Banerjee M. Reduction in late-stage breast cancer incidence in the mammography era: Implications for overdiagnosis of invasive cancer. Cancer 2014; 120:2649-56. [DOI: 10.1002/cncr.28784] [Citation(s) in RCA: 87] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2014] [Revised: 03/20/2014] [Accepted: 04/03/2014] [Indexed: 11/07/2022]
Affiliation(s)
- Mark A. Helvie
- Department of Radiology and Comprehensive Cancer Center; University of Michigan Health System; Ann Arbor Michigan
| | - Joanne T. Chang
- Department of Epidemiology; University of Michigan School of Public Health; Ann Arbor Michigan
| | - R. Edward Hendrick
- Department of Radiology; University of Colorado at Denver School of Medicine; Aurora Colorado
| | - Mousumi Banerjee
- Center for Healthcare Outcomes and Policy and Comprehensive Cancer Center; University of Michigan School of Public Health; Ann Arbor Michigan
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Preventive services for adults: how have differences across subgroups changed over the past decade? Med Care 2013; 51:999-1007. [PMID: 24036996 DOI: 10.1097/mlr.0b013e3182a97bc0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A large literature documents cross-sectional differences in adult preventive services across population subgroups. Less is known, however, about how these differences have changed over time. OBJECTIVES This study tracks changes over time in the distribution of preventive services use across groups defined by poverty status, race/ethnicity, insurance coverage, Census region, and urbanicity. METHODS Data from the 1996-2008 Medical Expenditure Panel Survey are used to examine 5 preventive services: general checkups, blood pressure screening, blood cholesterol screening, Pap smears, and mammograms. Multivariate logistic regression models of preventive services use are used to compute adjusted utilization for each subgroup of adults aged 19-64 in 1996/1998, 2002/2003, and 2007/2008. We then examine the extent to which percentage point gaps in utilization rates across subgroups have changed between 1996/1998 and 2007/2008. RESULTS Our analysis of utilization rates across subgroups and over time identified only rare cases in which subgroup differences narrowed or widened between 1996/1998 and 2007/2008. Rather, differences across subgroups tended to persist over time. Some of the largest (adjusted) gaps are between adults with and without coverage, and only for blood cholesterol screening do we observe significant narrowing of the gap between the uninsured and the privately insured. Regional differences persisted or widened over the study period. CONCLUSIONS On the eve of health reform implementation, a key challenge facing the Affordable Care Act will be to address persistent differences in preventive services use within the US population.
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Royak-Schaler R, Cheuvront B, Wilson KR, Williams CM. Addressing women's breast cancer risk and perceptions of control in medical settings. J Clin Psychol Med Settings 2013; 3:185-99. [PMID: 24226756 DOI: 10.1007/bf01993905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Many women with family histories of breast cancer deal with two distinct but related issues: their objective physical risk and the emotions this risk engenders. Studies indicate that approximately 70% of African American and white women are concerned about their chances of developing breast cancer someday and perceive themselves to be at risk. Health care providers, including psychologists, need to be aware of the special needs and psychosocial concerns of high-risk women with family histories of breast cancer, since perceptions of breast cancer risk influence screening practices. Providers need training in understanding the significance of specific family patterns of breast cancer, screening guidelines appropriate for women at risk, and the benefits and risks of available prevention options, including genetic screening. Delivering accurate information about both established risk factors known to elevate personal risk, such as age and family history, and factors which women associate with breast cancer, such as bumping and bruising a breast, smoking, and oral contraceptive use, is essential for promoting accurate risk perceptions and appropriate screening schedules.
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Affiliation(s)
- R Royak-Schaler
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
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Molina Y, Martínez-Gutiérrez J, Püschel K, Thompson B. Plans to obtain a mammogram among Chilean women: the roles of recommendations and self-efficacy. HEALTH EDUCATION RESEARCH 2013; 28:784-92. [PMID: 23515116 PMCID: PMC3772330 DOI: 10.1093/her/cyt047] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2012] [Accepted: 02/14/2013] [Indexed: 05/23/2023]
Abstract
Social factors may heavily influence cancer screening decisions and practices among Latinas, given the importance their culture places on close, interpersonal relationships. Recommendations by healthcare providers, family and friends have been associated with early detection strategies among US-based Latina populations, but little is known about other Latin American populations. Furthermore, less is known about mechanisms underlying this relationship. In this study, we sought to (i) understand if different types of recommendations were associated with subsequent plans to obtain a mammogram and (ii) assess the potential mediating roles of perceived importance of these recommendations and self-efficacy. Our sample included 250 women residing in a low-income, urban area of Santiago, Chile, and who had participated in a 6-month intervention to increase mammography screening, but remained non-compliant. Women who received family recommendations were more likely to indicate they planned to receive a mammogram in the next 6 months. Perceived self-efficacy mediated this relationship, such that women who received a family recommendation appeared to be more likely to plan to get a mammogram because of increased perceived capabilities to do so. Future research should consider the cultural context of family and self-efficacy in the development of screening interventions for Latinas.
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Affiliation(s)
- Yamile Molina
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA, Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile and Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Javiera Martínez-Gutiérrez
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA, Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile and Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Klaus Püschel
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA, Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile and Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
| | - Beti Thompson
- Cancer Prevention Program, Fred Hutchinson Cancer Research Center, Seattle, WA, USA, Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois-Chicago, Chicago, IL, USA, Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile and Department of Health Services, School of Public Health, University of Washington, Seattle, WA, USA
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Ibrayev Y, Oda K, Fraser GE, Knutsen SF. Utilization of prostate cancer screening according to dietary patterns and other demographic variables. The adventist health study-2. J Cancer 2013; 4:416-26. [PMID: 23833686 PMCID: PMC3701811 DOI: 10.7150/jca.6442] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2013] [Accepted: 06/05/2013] [Indexed: 11/07/2022] Open
Abstract
Background: Prostate-specific antigen test and digital rectal examination are considered important screening methods for early detection of prostate cancer. However, the utilization of prostate cancer screening varies widely and there is limited knowledge of the predictors of utilization. Methods: Self-reported prostate cancer screening utilization within the last 2 years was investigated among 11,162 black and non-black North American Seventh-day Adventist men, aged 50-75 years, with different dietary patterns and lifestyle characteristics. Results: Blacks were more likely to screen for prostate cancer than non-blacks (Odds Ratio (OR)=1.38 (95% confidence interval (CI): 1.20-1.57). Those with a vegetarian diet, especially vegans, were less likely to follow screening guidelines, particularly among non-Blacks: vegans (OR=0.47, 0.39-0.58), lacto-ovo-vegetarians (OR=0.75, 0.66-0.86), and pesco-vegetarians (OR=0.74, 0.60-0.91) compared to non-vegetarians after adjusting for age, BMI, marital status, education, income, and family history of cancer. Trends for dietary patterns remained unchanged after stratification on age, family history of cancer, education, personal income, marital status, and BMI. Among black men, diet patterns showed no significant associations with utilization of prostate cancer screening, although vegans tended to underutilize screening compared to non-vegetarians (OR=0.70, 0.44-1.10). Conclusions: Vegetarians, especially non-black vegans, are less likely to follow recommended prostate cancer screening guidelines. The effect of diet was attenuated, and not statistically significant, among black men. Impact: Since only about 60% of US men follow prostate cancer screening guidelines, it is important to study reasons for non-compliance in order to increase utilization of preventive measures against prostate cancer.
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Affiliation(s)
- Yermek Ibrayev
- Department of Epidemiology, Biostatistics, and Population Medicine, Loma Linda University, Loma Linda, CA 92350, USA
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Roetzheim RG, Ferrante JM, Lee JH, Chen R, Love-Jackson KM, Gonzalez EC, Fisher KJ, McCarthy EP. Influence of primary care on breast cancer outcomes among Medicare beneficiaries. Ann Fam Med 2012; 10:401-11. [PMID: 22966103 PMCID: PMC3438207 DOI: 10.1370/afm.1398] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We used the Surveillance Epidemiology and End Results (SEER)-Medicare database to explore the association between primary care and breast cancer outcomes. METHODS Using a retrospective cohort study of 105,105 female Medicare beneficiaries with a diagnosis of breast cancer in SEER registries during the years 1994-2005, we examined the total number of office visits to primary care physicians and non-primary care physicians in a 24-month period before cancer diagnosis. For women with invasive cancers, we examined the odds of diagnosis of late-stage disease, according to the American Joint Commission on Cancer (AJCC) (stages III and IV vs stages I and II), and survival (breast cancer specific and all cause) using logistic regression and proportional hazards models, respectively. We also explored whether including noninvasive cancers, such as ductal carcinoma in situ (DCIS), would alter results and whether prior mammography was a potential mediator of associations. RESULTS Primary care physician visits were associated with improved breast cancer outcomes, including greater use of mammography, reduced odds of late-stage diagnosis, and lower breast cancer and overall mortality. Prior mammography (and resultant earlier stage diagnosis) mediated these associations in part, but not completely. Similar results were seen for non-primary care physician visits. Results were similar when women with DCIS were included in the analysis. CONCLUSIONS Medicare beneficiaries with breast cancer had better outcomes if they made greater use of a primary care physician's ambulatory services. These findings suggest adequate primary medical care may be an important factor in achieving optimal breast cancer outcomes.
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Affiliation(s)
- Richard G Roetzheim
- Department of Family Medicine, Morsani College of Medicine, University of South Florida, Tampa, Florida 33612, USA.
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Ni XJ, Xia TS, Zhao YC, Ma JJ, Zhao J, Liu XA, Ding Q, Zha XM, Wang S. Postmenopausal Hormone Therapy is Associated with in Situ Breast Cancer Risk. Asian Pac J Cancer Prev 2012; 13:3917-25. [DOI: 10.7314/apjcp.2012.13.8.3917] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Miller SJ, O'Hea EL, Lerner JB, Moon S, Foran-Tuller KA. The relationship between breast cancer anxiety and mammography: experiential avoidance as a moderator. Behav Med 2011; 37:113-8. [PMID: 22168327 DOI: 10.1080/08964289.2011.614291] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Although mammography can aid in the early detection and prevention of breast cancer, many women do not receive annual mammograms. It remains unclear whether anxiety about breast cancer inhibits or promotes mammography rates. The way in which women regulate their anxiety (ie, level of experiential avoidance) may play a role in predicting mammography adherence. A community sample of women (N = 84) completed a questionnaire which assessed mammography rates, experiential avoidance, and breast cancer anxiety. The results suggest that, while controlling for breast cancer anxiety, experiential avoidance (β = .31, p < .01) significantly predicted mammography rates. When examining experiential avoidance as a moderator, a multiple regression analysis approached significance (R2 Δ = .04, p = .07), suggesting that a woman's level of experiential avoidance influences the relationship between anxiety and mammography. These findings will help enable health care practitioners to better identify women at risk of non-adherence to mammography recommendations.
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Affiliation(s)
- Sarah J Miller
- Mount Sinai School of Medicine, New York, NY 10029-6574, USA.
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Consedine NS. The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-Immigrant Women. J Immigr Minor Health 2011; 14:570-82. [DOI: 10.1007/s10903-011-9524-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Engelman KK, Daley CM, Gajewski BJ, Ndikum-Moffor F, Faseru B, Braiuca S, Joseph S, Ellerbeck EF, Greiner KA. An assessment of American Indian women's mammography experiences. BMC Womens Health 2010; 10:34. [PMID: 21159197 PMCID: PMC3018433 DOI: 10.1186/1472-6874-10-34] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2010] [Accepted: 12/15/2010] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Mortality from breast cancer has increased among American Indian/Alaskan Native (AI/AN) women. Despite this alarming reality, AI/AN women have some of the lowest breast cancer screening rates. Only 37% of eligible AI/AN women report a mammogram within the last year and 52% report a mammogram within the last two years compared to 57% and 72% for White women. The experiences and satisfaction surrounding mammography for AI/AN women likely are different from that of women of other racial/ethnic groups, due to cultural differences and limited access to Indian Health Service sponsored mammography units. The overall goals of this study are to identify and understand the mammography experiences and experiential elements that relate to satisfaction or dissatisfaction with mammography services in an AI/AN population and to develop a culturally-tailored AI/AN mammography satisfaction survey. METHODS AND DESIGN The three project aims that will be used to guide this work are: 1) To compare the mammography experiences and satisfaction with mammography services of Native American/Alaska Native women with that of Non-Hispanic White, Hispanic, and Black women, 2) To develop and validate the psychometric properties of an American Indian Mammography Survey, and 3) To assess variation among AI/AN women's assessments of their mammography experiences and mammography service satisfaction. Evaluations of racial/ethnic differences in mammography patient satisfaction have received little study, particularly among AI/AN women. As such, qualitative study is uniquely suited for an initial examination of their experiences because it will allow for a rich and in-depth identification and exploration of satisfaction elements. DISCUSSION This formative research is an essential step in the development of a validated and culturally tailored AI/AN mammography satisfaction assessment. Results from this project will provide a springboard from which a maximally effective breast cancer screening program to benefit AI/AN population will be developed and tested in an effort to alter the current breast cancer-related morbidity and mortality trajectory among AI/AN women.
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Affiliation(s)
- Kimberly K Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS, USA.
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Breen N, Gentleman JF, Schiller JS. Update on mammography trends: comparisons of rates in 2000, 2005, and 2008. Cancer 2010; 117:2209-18. [PMID: 21523735 DOI: 10.1002/cncr.25679] [Citation(s) in RCA: 108] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2010] [Revised: 07/05/2010] [Accepted: 08/25/2010] [Indexed: 11/07/2022]
Abstract
BACKGROUND Mammography screening allows for the early detection of breast cancer, which helps reduce mortality from breast cancer, especially in women aged 50 to 69 years. For this report, the authors updated a previous analysis of trends in mammography using newly available data from the National Health Interview Survey (NHIS). METHODS NHIS data from 2008 were used to update trends in rates of US women who had a mammogram within the 2 years before their interview, and 2 methods of calculating rates were compared. The authors focused particularly on the 2000, 2005, and 2008 mammography rates for women aged ≥ 40 years, 40 to 49 years, 50 to 64 years, and ≥ 65 years according to selected sociodemographic and healthcare access characteristics. RESULTS For women aged 50 to 64 years and ≥ 65 years, the patterns were similar: Rates rose rapidly from 1987 to 2000, declined, or were stable and then declined, from 2000 to 2005, and increased from 2005 to 2008. Rates for women aged 40 to 49 years rose rapidly from 1987 to 1992 and were relatively stable through 2008. There were large increases in mammography rates among immigrants who had been in the United States for <10 years, non-Hispanic Asian women, and women aged ≥ 65 years who were without ambulatory care insurance. CONCLUSIONS Overall, mammography rates did not continue to decline between 2005 and 2008. Even so, in 2008, the percentage of women aged ≥ 40 years who had a recent mammogram fell below the Healthy People 2010 objective of 70%, which was met in 2000. However, women aged 50 to 64 years exceeded the Healthy People objective in 2000, 2005, and 2008; and some groups with very low mammography rates currently are catching up. These are important public health achievements.
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Affiliation(s)
- Nancy Breen
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Studies, National Cancer Institute, National Institutes of Health, Rockville, Maryland, USA.
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Federico C, Alleyn J, Dola C, Tafti S, Galandak J, Jacob C, Bhuiyan A, Cheng J. Relationship among age, race, medical funding, and cervical cancer survival. J Natl Med Assoc 2010; 102:199-205. [PMID: 20355349 DOI: 10.1016/s0027-9684(15)30526-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine the impact of age, race, and medical funding on cervical cancer survival. MATERIALS AND METHODS Study design was a retrospective chart review of cervical cancer patients. Charts were abstracted for demographic characteristics, Pap smear history, clinical presentation, treatment, and survival. Descriptive studies, Spearman correlation, and Cox's proportional hazards regression model were performed. RESULTS One hundred-twenty-five cervical cancer patients were included. Mean age at diagnosis was 46.1 +/- 13.2 years, and median survival time from cervical cancer was 31 months; 11.2% of the study population was aged greater than 65 years; 63.4% were African American; and 44.6% had no medical funding. Diagnosis at age of at least 65 years was significantly correlated with suboptimal cervical cancer screening pattern (r = 0.36, p = .0003). Women aged at least 65 years old had a 3.39 time increased hazard of death compared to younger patients (p = .02; OR, 3.39; 95% CI, 1.20-9.56) after adjusting for advanced stage of disease and treatment modality. There was no significant association between medical funding or race on cervical cancer screening pattern, stage at diagnosis, or survival. CONCLUSION Age at diagnosis (> or = 65 years), but not medical funding or race, was correlated with suboptimal cervical cancer screening pattern and poor survival.
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Jerome-D’Emilia B, Merwin E, Stern S. Feasibility of Using Technology to Disseminate Evidence to Rural Nurses and Improve Patient Outcomes. J Contin Educ Nurs 2010; 41:25-32. [DOI: 10.3928/00220124-20091222-08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zhang J, Oldenburg B, Turrell G. Measuring factors that influence the utilisation of preventive care services provided by general practitioners in Australia. BMC Health Serv Res 2009; 9:218. [PMID: 19954549 PMCID: PMC2797786 DOI: 10.1186/1472-6963-9-218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 12/03/2009] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Relatively little research attention has been given to the development of standardised and psychometrically sound scales for measuring influences relevant to the utilisation of health services. This study aims to describe the development, validation and internal reliability of some existing and new scales to measure factors that are likely to influence utilisation of preventive care services provided by general practitioners in Australia. METHODS Relevant domains of influence were first identified from a literature review and formative research. Items were then generated by using and adapting previously developed scales and published findings from these. The new items and scales were pre-tested and qualitative feedback was obtained from a convenience sample of citizens from the community and a panel of experts. Principal Components Analyses (PCA) and internal reliability testing (Cronbach's alpha) were then conducted for all of the newly adapted or developed scales utilising data collected from a self-administered mailed survey sent to a randomly selected population-based sample of 381 individuals (response rate 65.6 per cent). RESULTS The PCA identified five scales with acceptable levels of internal consistency were: (1) social support (ten items), alpha 0.86; (2) perceived interpersonal care (five items), alpha 0.87, (3) concerns about availability of health care and accessibility to health care (eight items), alpha 0.80, (4) value of good health (five items), alpha 0.79, and (5) attitudes towards health care (three items), alpha 0.75. CONCLUSION The five scales are suitable for further development and more widespread use in research aimed at understanding the determinants of preventive health services utilisation among adults in the general population.
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Affiliation(s)
- Jianzhen Zhang
- School of Medicine, University of Queensland, Herston Road, Herston, Brisbane QLD 4006, Australia
| | - Brian Oldenburg
- School of Public Health and Preventive Medicine, Monash University, Victoria, Australia
| | - Gavin Turrell
- School of Public Health, Queensland University of Technology, Queensland, Australia
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Borrayo EA, Hines L, Byers T, Risendal B, Slattery ML, Sweeney C, Baumgartner KB, Giuliano A. Characteristics associated with mammography screening among both Hispanic and non-Hispanic white women. J Womens Health (Larchmt) 2009; 18:1585-894. [PMID: 19754247 PMCID: PMC2825680 DOI: 10.1089/jwh.2008.1009] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This study explores whether certain population characteristics are associated with adherence to mammography screening guidelines among Hispanic and non-Hispanic white (NHW) women living in the southwestern United States. METHODS Participants in a population-based study (4-Corners' Breast Cancer Study) included in this analysis were 790 Hispanic women and 1,441 NHW women. Multivariate logistic regression was used to compute the ethnic-specific adjusted odds ratios (OR) and 95% confidence intervals (CI) for the association of the outcome variable (adherent vs. nonadherent) and its correlates. Women were adherent if they had obtained their first mammogram between 41 and 50 years of age and had received at least one mammogram per 2 years or less. RESULTS Ethnic-specific associations were observed with certain population characteristics and mammography adherence. Specifically, characteristics that were significantly associated with adherence among Hispanic women were younger age (50-59 years), having a family history of breast cancer, nulliparity, hormone replacement therapy (HRT) use, nonsteroidal anti-inflammatory drug (NSAID) use, and performing regular breast self-examinations (BSE). Among NHW women, younger age (50-59 years), family history of breast cancer, obesity, consuming moderate amounts of alcohol, and taking HRT were associated with mammography adherence. When adjusting for the evaluated population characteristics, the relationship between ethnicity and mammography adherence was no longer apparent. CONCLUSIONS Ethnic-specific characteristics appear to explain differences in mammography adherence among Hispanic and NHW women. Disparities in screening rates, late-stage disease and breast cancer mortality that impact Hispanic women could potentially be addressed more effectively by interventions that specifically target the unique characteristics of the Hispanic population.
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Affiliation(s)
- Evelinn A Borrayo
- Department of Psychology, University of Colorado Denver, Colorado 80217, USA.
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Impact of geography on mammography use in California. Cancer Causes Control 2009; 20:1339-53. [DOI: 10.1007/s10552-009-9355-6] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Accepted: 03/19/2009] [Indexed: 10/20/2022]
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Liang W, Wang J, Chen MY, Feng S, Yi B, Mandelblatt JS. Cultural views, language ability, and mammography use in Chinese American women. HEALTH EDUCATION & BEHAVIOR 2009; 36:1012-25. [PMID: 19233947 DOI: 10.1177/1090198109331669] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Mammography screening rates among Chinese American women have been reported to be low. This study examines whether and how culture views and language ability influence mammography adherence in this mostly immigrant population. Asymptomatic Chinese American women (n = 466) aged 50 and older, recruited from the Washington, D.C. area, completed a telephone interview. Regular mammography was defined as having two mammograms at age-appropriate recommended intervals. Cultural views were assessed by 30 items, and language ability measured women's ability in reading, writing, speaking, and listening to English. After controlling for risk perception, worry, physician recommendation, family encouragement, and access barriers, women holding a more Chinese/Eastern cultural view were significantly less likely to have had regular mammograms than those having a Western cultural view. English ability was positively associated with mammography adherence. The authors' results imply that culturally sensitive and language-appropriate educational interventions are likely to improve mammography adherence in this population.
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Affiliation(s)
- Wenchi Liang
- Cancer Control Program, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, D.C., USA.
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Gerend MA, Pai M. Social determinants of Black-White disparities in breast cancer mortality: a review. Cancer Epidemiol Biomarkers Prev 2009; 17:2913-23. [PMID: 18990731 DOI: 10.1158/1055-9965.epi-07-0633] [Citation(s) in RCA: 205] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States.
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Affiliation(s)
- Mary A Gerend
- Department of Medical Humanities and Social Sciences, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL 32306-4300, USA.
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Yang R, Cheung MC, Franceschi D, Hurley J, Huang Y, Livingstone AS, Koniaris LG. African-American and low-socioeconomic status patients have a worse prognosis for invasive ductal and lobular breast carcinoma: do screening criteria need to change? J Am Coll Surg 2009; 208:853-68; discussion 869-70. [PMID: 19476849 DOI: 10.1016/j.jamcollsurg.2008.10.038] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2008] [Accepted: 10/07/2008] [Indexed: 12/15/2022]
Abstract
BACKGROUND Determine the effect of race, socioeconomic status (SES) and other demographic variables on outcomes of patients with invasive ductal and lobular breast cancer. STUDY DESIGN Florida cancer registry and inpatient hospital data were queried for patients diagnosed with invasive breast cancer from 1998 to 2002. RESULTS A total of 63,472 patients with breast cancer were identified. Overall, 90.5% of patients were Caucasian, 7.6% African American, and 8.7% Hispanic. African-American patients presented at a younger age and with more-advanced disease, 10.5% presented with breast cancer before the age of 40 years, and 22.4% before 45 years of age. African-American patients were less likely to undergo operations. Similarly, low-SES patients were less likely to have operations and presented more often with larger tumors. Stepwise multivariate analysis revealed a substantial drop in the hazard ratio for African-American patients once correction for stage of presentation was made, suggesting that disparities in breast cancer outcomes are, in part, a result of advanced stage at presentation. Race and low SES were independent predictors of worse prognosis when controlling for patient comorbidities and treatment. CONCLUSIONS Dramatic disparities by patient race and SES exist in breast cancer. Our study integrates previous smaller studies, providing comprehensive insight into African-American patients and their outcomes for breast cancer. Earlier screening programs and greater access to cancer care for the poor and African Americans are needed. Successful institution of such programs will not completely erase disparities in outcomes for breast cancer in African-American patients.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Aged
- Aged, 80 and over
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/mortality
- Breast Neoplasms/prevention & control
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/mortality
- Carcinoma, Ductal, Breast/prevention & control
- Carcinoma, Lobular/epidemiology
- Carcinoma, Lobular/ethnology
- Carcinoma, Lobular/mortality
- Carcinoma, Lobular/prevention & control
- Female
- Hispanic or Latino/statistics & numerical data
- Humans
- Male
- Mass Screening
- Middle Aged
- Multivariate Analysis
- Prognosis
- Social Class
- Survival Analysis
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
- Relin Yang
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miller School of Medicine, Miami, FL 33136, USA
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Schueler KM, Chu PW, Smith-Bindman R. Factors Associated with Mammography Utilization: A Systematic Quantitative Review of the Literature. J Womens Health (Larchmt) 2008; 17:1477-98. [DOI: 10.1089/jwh.2007.0603] [Citation(s) in RCA: 273] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Kristin M. Schueler
- Department of Radiology, Santa Clara Valley Medical Center; San Jose, California
| | - Philip W. Chu
- Department of Radiology, University of California, San Francisco, California
| | - Rebecca Smith-Bindman
- Department of Radiology, Santa Clara Valley Medical Center; San Jose, California
- Department of Radiology, University of California, San Francisco, California
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California
- Department of Obstetrics, Gynecology and Reproductive Medicine, University of California, San Francisco, California
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Lian M, Jeffe DB, Schootman M. Racial and geographic differences in mammography screening in St. Louis City: a multilevel study. J Urban Health 2008; 85:677-92. [PMID: 18622709 PMCID: PMC2527433 DOI: 10.1007/s11524-008-9301-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2008] [Accepted: 06/11/2008] [Indexed: 10/21/2022]
Abstract
To examine racial differences in mammography use and its determinants in the City of St. Louis, MO, USA, we recruited women age 40 or older using random-digit dialing to (1) examine the difference in mammography use between white women and African American women and (2) identify individual- and census-tract-level risk factors of nonadherence to mammography. During telephone interviews, we inquired about mammography use and several demographic, psychosocial, and health behavior variables. We determined the residential census tracts of study subjects using a geographic information system. The rate of mammography use was 68.0% among white women and 74.7% among African American women (P = 0.022). African American women were more likely to have mammograms than white woman (adjusted odds ratio [OR] = 1.71; 95% confidence interval [CI] = 1.09-2.69). System-level barriers to mammography and heavy smoking were associated with lower mammography use among both white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography use among white women. White women residing within a historic geographic cluster area of late-stage breast cancer were less likely to have mammograms (adjusted OR = 0.42, 95% CI = 0.22-0.80), while African American women residing within a historic geographic cluster area of late-stage breast cancer were equally likely to have mammograms (adjusted OR = 0.79, 95% CI = 0.28-2.24). Neither individual- nor census-tract-level socioeconomic status was associated with mammography screening. These findings suggest that there may be a greater need for increasing mammography use among white women, especially in the historic cluster area of late-stage breast cancer in St. Louis.
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Affiliation(s)
- Min Lian
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
| | - Donna B. Jeffe
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO USA
| | - Mario Schootman
- Department of Medicine, Washington University School of Medicine, St. Louis, MO USA
- Alvin J. Siteman Cancer Center, Barnes-Jewish Hospital, Washington University School of Medicine, St. Louis, MO USA
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Yang Y. Trends in U.S. adult chronic disease mortality, 1960-1999: age, period, and cohort variations. Demography 2008; 45:387-416. [PMID: 18613487 PMCID: PMC2831365 DOI: 10.1353/dem.0.0000] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this paper, I examine temporal changes in U.S. adult mortality by chronic disease cause of death and by sex over a 40-year period in the second half of the twentieth century. I apply age-period-cohort (APC) analyses that combine conventional approaches and a new method of model estimation to simultaneously account for age, period, and cohort variations in mortality rates for four leading causes of deaths, including heart disease, stroke, lung cancer, and breast cancer. The results show that large reductions in mortality since the late 1960s continued well into the late 1990s and that these reductions were predominately contributed by cohort effects. Cohort effects are found to differ by specific causes of death examined, but they generally show substantial survival improvements. Implications of these results are discussed with regard to demographic theories of mortality reductions, differential cohort accumulation of health capital and lifetime exposures to socioeconomic and behavioral risk factors, and period changes in diagnostic techniques and medical treatment.
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Affiliation(s)
- Yang Yang
- Department of Sociology and Population Research Center and Center on Aging at NORC, The University of Chicago. IL, USA.
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39
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Cohort fertility patterns and breast cancer mortality among U.S. women, 1948-2003. DEMOGRAPHIC RESEARCH 2008. [DOI: 10.4054/demres.2008.18.9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
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40
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Guilfoyle S, Franco R, Gorin SS. Exploring older women's approaches to cervical cancer screening. Health Care Women Int 2008; 28:930-50. [PMID: 17987461 DOI: 10.1080/07399330701615358] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The purpose of this qualitative study (N = 98, 11 focus groups) is to investigate how low-income, African American and Hispanic older women make decisions about cervical cancer screening. Using the health belief model to guide content analysis of transcripts, we found that primary barriers to screening were; embarrassment with, fear of, and pain from the test, difficulty in accessing screening, stigma associated with Medicaid coverage, and prior negative experiences with cancer detection. Women experienced cues to screening from their own bodies, in symptoms, and relied on spiritual beliefs to support them in coping with their health problems. Enhanced understanding of these factors could increase uptake of cervical cancer screening among the unscreened and underscreened.
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Affiliation(s)
- Sharon Guilfoyle
- Department of Health Policy and Management, Columbia University, New York, New York 10027, USA
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41
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Paul C, Mason WM, McCaffrey D, Fox SA. A cautionary case study of approaches to the treatment of missing data. STAT METHOD APPL-GER 2008. [DOI: 10.1007/s10260-007-0090-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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42
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Tosteson ANA, Stout NK, Fryback DG, Acharyya S, Herman BA, Hannah LG, Pisano ED. Cost-effectiveness of digital mammography breast cancer screening. Ann Intern Med 2008; 148:1-10. [PMID: 18166758 PMCID: PMC2662630 DOI: 10.7326/0003-4819-148-1-200801010-00002] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The DMIST (Digital Mammography Imaging Screening Trial) reported improved breast cancer detection with digital mammography compared with film mammography in selected population subgroups, but it did not assess the economic value of digital relative to film mammography screening. OBJECTIVE To evaluate the cost-effectiveness of digital mammography screening for breast cancer. DESIGN Validated, discrete-event simulation model. DATA SOURCES Data from DMIST and publicly available U.S. data. TARGET POPULATION U.S. women age 40 years or older. TIME HORIZON Lifetime. PERSPECTIVE Societal and Medicare. INTERVENTION All-film mammography screening; all-digital mammography screening; and targeted digital mammography screening, which is age-targeted digital mammography (for women <50 years of age) and age- and density-targeted digital mammography (for women <50 years of age or women > or =50 years of age with dense breasts). OUTCOME MEASURES Cost per quality-adjusted life-year (QALY) gained. RESULTS OF BASE-CASE ANALYSIS All-digital mammography screening cost $331,000 (95% CI, $268,000 to $403,000) per QALY gained relative to all-film mammography screening but was more costly and less effective than targeted digital mammography screening. Targeted digital mammography screening resulted in more screen-detected cases of cancer and fewer deaths from cancer than either all-film or all-digital mammography screening, with cost-effectiveness estimates ranging from $26,500 (CI, $21,000 to $33,000) per QALY gained for age-targeted digital mammography to $84,500 (CI, $75,000 to $93,000) per QALY gained for age- and density-targeted digital mammography. In the Medicare population, the cost-effectiveness of density-targeted digital mammography screening varied from a base-case estimate of $97,000 (CI, $77,000 to $131,000) to $257,000 per QALY gained (CI, $91,000 to $536,000) in the alternative-case analyses, in which the sensitivity of film mammography was increased and the sensitivity of digital mammography in women with nondense breasts was decreased. RESULTS OF SENSITIVITY ANALYSIS Results were sensitive to the cost of digital mammography and to the prevalence of dense breasts. LIMITATIONS Results were dependent on model assumptions and DMIST findings. CONCLUSION Relative to film mammography, screening for breast cancer by using all-digital mammography is not cost-effective. Age-targeted screening with digital mammography seems cost-effective, whereas density-targeted screening strategies are more costly and of uncertain value, particularly among women age 65 years or older.
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Affiliation(s)
- Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Lebanon, New Hampshire 03756, USA.
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Cabeza E, Esteva M, Pujol A, Thomas V, Sánchez-Contador C. Social disparities in breast and cervical cancer preventive practices. Eur J Cancer Prev 2007; 16:372-9. [PMID: 17554211 DOI: 10.1097/01.cej.0000236243.55866.b0] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Knowledge of factors related to the use of preventive practices is essential in order to build strategies to decrease cancer incidence and mortality. The aim of this study is to describe the characteristics of women who periodically use cervical smear and mammography. This is a cross-sectional study based on the 2001 Balearic Health Survey, using a stratified sample of non-institutionalized population resident in the Balearic Islands. The study included 560 women, aged 20 years or over. The variables studied were age, marital status, social class, education, place of residence and birth, self-perceived health status, satisfaction with health services, job status and type of medical coverage. A multivariate analysis was performed using logistic regression models. Thirty-five per cent had regular mammography (72% between 50 and 64 years) and 54% had cervical smears. The probability of having undergone mammography is higher in women between the ages of 50 and 64 years [odds ratio (OR)=11.74; interval confidence (IC): 5.89-23.39] and in those with additional medical coverage (OR=1.97; IC: 1.19-3.27) and much lower in single women (OR=0.22; IC: 0.10-0.49). The probability of having undergone a Pap test increases according to educational level (OR=2.25; IC: 0.98-5.18 for women in the higher level) and social class (OR=1.98; IC: 0.91-4.28 for social class I) and decreases in women older than 65 years (OR=0.15; IC: 0.07-0.35) and in single women (OR=0.29; IC: 0.16-0.50). Age and marital status are factors related to both practices. Socio-economic status remains associated with cervical smear use, while having an additional medical coverage increases the probability of regular mammography.
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Affiliation(s)
- Elena Cabeza
- Department of Public Health, Balearic Department of Health and Consumer Affairs, Palma de Mallorca, Spain.
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44
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Fenton JJ, Cai Y, Weiss NS, Elmore JG, Pardee RE, Reid RJ, Baldwin LM. Delivery of cancer screening: how important is the preventive health examination? ARCHIVES OF INTERNAL MEDICINE 2007; 167:580-5. [PMID: 17389289 PMCID: PMC3443471 DOI: 10.1001/archinte.167.6.580] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Patients and physicians strongly endorse the importance of preventive or periodic health examinations (PHEs). However, the extent to which PHEs contribute to the delivery of cancer screening is uncertain. METHODS In a retrospective cohort study, we determined the association between receipt of a PHE and cancer testing in a population-based sample of enrollees in a Washington State health plan who were aged 52 to 78 years and eligible for colorectal, breast, or prostate cancer screening in 2002-2003 (N = 64 288). Outcomes included completion of any colorectal cancer testing (fecal occult blood testing, sigmoidoscopy, colonoscopy, or barium enema), screening mammography, and prostate-specific antigen testing. RESULTS More than half (52.4%) of the enrollees received a PHE during the study period. After adjusting for demographics, comorbidity, number of outpatient visits, and historical preventive service use before January 1, 2002, receipt of a PHE was significantly associated with completion of colorectal cancer testing (incidence difference, 40.4% [95% confidence interval (CI), 39.4%-41.3%]; relative incidence, 3.47 [95% CI, 3.34-3.59]), screening mammography [incidence difference, 14.2% [95% CI, 12.7%-15.7%]; relative incidence, 1.23 [95% CI, 1.20-1.25]), and prostate-specific antigen testing (incidence difference, 39.4% [95% CI, 38.3%-40.5%]; relative incidence, 3.06 [95% CI, 2.95-3.18]). CONCLUSIONS Among managed care enrollees eligible for cancer screening, PHE receipt is associated with completion of colorectal, breast, and prostate cancer testing. In similar populations, the PHE may serve as a clinically important forum for the promotion of evidence-based colorectal cancer and breast cancer screening and of screening with relatively less empirical support, such as prostate cancer screening.
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Affiliation(s)
- Joshua J Fenton
- Department of Family and Community Medicine, University of California, Davis, Sacramento, CA 95817, USA.
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45
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Meissner HI, Breen N, Taubman ML, Vernon SW, Graubard BI. Which women aren’t getting mammograms and why? (United States). Cancer Causes Control 2007; 18:61-70. [PMID: 17186422 DOI: 10.1007/s10552-006-0078-7] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2006] [Accepted: 08/27/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE This study investigates why women who reported no recent mammogram did not get the test. METHODS Using data from the 2000 National Health Interview Survey (NHIS), we examine correlates of mammography use among women 40 years and older (n = 10,212), with particular focus on the 30% (n = 3,188) who reported no recent mammogram. Non-screening is examined in the context of two important correlates of mammography use-access to health care and a physician's recommendation to get a mammogram. RESULTS In total, 80% of non-screeners who reported having access to healthcare did not receive a recommendation for a mammogram. Women age 65 years and older were more likely than younger women to report not receiving a recommendation (OR 1.77, 95% CI 1.25-2.50). For women who reported having access, non-screening was significantly more likely among younger women (40-49), those with less education, incomes less than 20,000 dollars, residence outside Metropolitan Statistical Areas (MSAs) and no family history of breast cancer. Among women with access problems, those who had not visited a primary care provider in the past year were much more likely to be non-screeners (80%) compared with those who had seen a provider (46%). Among women with access, those who reported put it off as the main reason for non-screening were significantly more likely to be younger and to be born in the U.S. than women who said that they didn't know they needed a mammogram. CONCLUSIONS Most non-screeners report not receiving a physician recommendation for mammography. Although a minority reported access problems, the effect of lacking access on utilization was strong and is accentuated when women without access do not see a doctor. These findings confirm the importance of a mammography recommendation and raise questions concerning whether this information is being conveyed by physicians or heard by patients.
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Affiliation(s)
- Helen I Meissner
- Applied Cancer Screening Research Branch, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd., EPN 4102 MSC 7331, Bethesda, MD 20892-7331, USA.
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46
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Liang W, Kasman D, Wang JH, Yuan EH, Mandelblatt JS. Communication between older women and physicians: preliminary implications for satisfaction and intention to have mammography. PATIENT EDUCATION AND COUNSELING 2006; 64:387-92. [PMID: 16872797 DOI: 10.1016/j.pec.2006.04.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2005] [Revised: 03/08/2006] [Accepted: 04/10/2006] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To explore the associations between physician communication styles and their older patients' intentions to get mammography and satisfaction with physician communication. METHODS This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n=7) and their female patients aged 65 years and older (n=56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor-elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit. RESULTS The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as "deep", "trusting" and "bonding" were more satisfied with communication than women who rated physician communication as less trusting (p=0.03, 0.02 and 0.02, respectively). CONCLUSION Physicians' communication styles affect their older female patients' satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography. PRACTICE IMPLICATIONS Improving physicians' communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.
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Affiliation(s)
- Wenchi Liang
- Department of Oncology, Division of Health Behaviors and Outcomes, Georgetown University Medical Center and Cancer Control Program, Lombardi Comprehensive Cancer Center, Washington, DC, USA.
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Silvestri GA, Nietert PJ, Zoller J, Carter C, Bradford D. Attitudes towards screening for lung cancer among smokers and their non-smoking counterparts. Thorax 2006; 62:126-30. [PMID: 17101739 PMCID: PMC2111262 DOI: 10.1136/thx.2005.056036] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND There has been resurgence of interest in lung cancer screening using low-dose computed tomography. The implications of directing a screening programme at smokers has been little explored. METHODS A nationwide telephone survey was conducted. Demographics, certain clinical characteristics and attitudes about screening for lung cancer were ascertained. Responses of current, former and never smokers were compared. RESULTS 2001 people from the US were interviewed. Smokers were significantly (p < 0.05) more likely than never smokers to be male, non-white, less educated, and to report poor health status or having had cancer, and less likely to be able to identify a usual source of healthcare. Compared with never smokers, current smokers were less likely to believe that early detection would result in a good chance of survival (p < 0.05). Smokers were less likely to be willing to consider computed tomography screening for lung cancer (71.2% (current smokers) v 87.6% (never smokers) odds ratio (OR) 0.48; 95% confidence interval (CI) 0.32 to 0.71). More never smokers as opposed to current smokers believed that the risk of disease (88% v 56%) and the accuracy of the test (92% v 71%) were important determinants in deciding whether to be screened (p < 0.05). Only half of the current smokers would opt for surgery for a screen-diagnosed cancer. CONCLUSION The findings suggest that there may be substantial obstacles to the successful implementation of a mass-screening programme for lung cancer that will target cigarette smokers.
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Affiliation(s)
- Gerard A Silvestri
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical University of South Carolina, 96 Jonathan Lucas St, PO Box 250630, Charleston, SC, USA.
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Schootman M, Jeffe DB, Baker EA, Walker MS. Effect of area poverty rate on cancer screening across US communities. J Epidemiol Community Health 2006; 60:202-7. [PMID: 16476748 PMCID: PMC2465556 DOI: 10.1136/jech.2005.041020] [Citation(s) in RCA: 85] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
STUDY OBJECTIVE To analyse the contextual effect of area poverty rate on never having been screened for breast, cervical, and colorectal cancer by (1) describing the extent of the variation in screening behaviours among 98 US metropolitan areas; (2) determining if the variation in lack of screening can be explained by differences in the characteristics of the persons who resided in these areas; and (3) determining if living in a metropolitan area with a higher poverty rate increased the likelihood of never having been screened for cancer over and above individual characteristics. DESIGN Cross sectional survey using data from the 2002 Behavioral Risk Factor Surveillance System. Multilevel logistic regression included both individual level factors as well as area poverty rate. SETTING Ninety eight areas across the USA. PARTICIPANTS Over 118 000 persons residing in 98 areas; a sample aimed at estimating 48.3% of the US population age 18 or older. MAIN RESULTS After adjustment for individual level factors, increasing area level poverty rate (per 5%) remained associated with never having had a mammogram (odds ratio (OR) = 1.28, 95% confidence interval (CI): 1.03 to 1.37); clinical breast examination (OR = 1.28, 95% CI: 1.11 to 1.48), colonoscopy/sigmoidoscopy (OR = 1.10, 95% CI: 1.01 to 1.19), and a faecal occult blood test (OR = 1.19, 95% CI: 1.12 to 1.27). Poverty rate was not independently associated with never having had a Pap smear (OR = 1.12; 95% CI: 0.90 to 1.41). The size of the variance among metropolitan or micropolitan statistical areas (MMSAs) varied by type of screening test, with intraclass correlation coefficients ranging from 4.9% (never having had a Pap smear) to 1.2% (never having had a colonoscopy/sigmoidoscopy). CONCLUSIONS Area poverty rate was independently associated with never having been screened for breast and colorectal cancer, but not cervical cancer. The size of the variance among MMSAs was modest at best.
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Affiliation(s)
- Mario Schootman
- Division of Health Behavior Research, Washington University, Saint Louis, MO 63108, USA.
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Wu H, Zhu K, Jatoi I, Shah M, Shriver CD, Potter J. Factors associated with the incompliance with mammogram screening among individuals with a family history of breast cancer or ovarian cancer. Breast Cancer Res Treat 2006; 101:317-24. [PMID: 16821080 DOI: 10.1007/s10549-006-9298-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2006] [Accepted: 05/31/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The national guidelines recommend more intensive screening for breast cancer for women with a family history of breast or ovarian cancer. Using the data from the 2000 National Health Interview Survey (NHIS), we examined factors related to the underuse of mammogram in this population. METHOD The study subjects were 1,215 women aged 30-79 who had a family history of breast or ovarian cancer in their first-degree relatives. According to the American Cancer Society's guidelines for breast cancer screening, having no mammogram in last year was used as an outcome for this study. Socio-demographic characteristics, health-related conditions, lifestyle factors, health behaviors, menstrual/reproductive information and health care access and utilization were analyzed to assess their relations to mammogram underuse using unconditional logistic regression method. RESULTS The results showed that younger age, having no place to go when sick (OR = 2.2, 95% CI, 1.2-4.0), having no visits to a general doctor (OR = 1.7, 95% CI, 1.2-2.4) or medical specialist (OR = 2.2, 95% CI, 1.6-3.1) and having no influenza shot in last year (OR = 1.7, 95% CI, 1.2-2.3) increased the risk of underusing mammography screening among women who had a family history of breast or ovarian cancer. Women who had no home care from health professionals in the last year were less likely to underuse mammogram with an OR of 0.3 (95% CI, 0.1-0.6), compared with women who had. CONCLUSION Medical care-related factors may affect the use of mammography screening in women with a family history of breast or ovarian cancer.
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Affiliation(s)
- Hongyu Wu
- United States Military Cancer Institute, Walter Reed Army Medical Center, 6900 Georgia Ave., NW Building 1, Suite E-111, Washington, DC 20307-5001, USA
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Blackman DJ, Masi CM. Racial and ethnic disparities in breast cancer mortality: are we doing enough to address the root causes? J Clin Oncol 2006; 24:2170-8. [PMID: 16682736 DOI: 10.1200/jco.2005.05.4734] [Citation(s) in RCA: 114] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. Mortality from breast cancer has declined since the late 1980s, but this decline has been steeper among white women compared with black women. As a result, the black:white mortality rate ratio has increased over the last two decades. Other ethnic minorities also suffer from disproportionately high breast cancer mortality rates. This review discusses the causes of racial and ethnic disparities in breast cancer mortality and describes the most common approaches to reducing these disparities. The literature suggests that outcome disparities are related to patient-, provider-, and health system-level factors. Lack of insurance, fear of testing, delay in seeking care, and unfavorable tumor characteristics all contribute to disparities at the patient level. At the provider level, insufficient screening, poor follow-up of abnormal screening tests, and nonadherence to guideline-based treatments add to outcome disparities. High copayment requirements, lack of a usual source of care, fragmentation of care, and uneven distribution of screening and treatment resources exacerbate disparities at the health system level. Although pilot programs have increased breast cancer screening among select populations, persistent disparities in mortality suggest that changes are needed at the policy level to address the root causes of these disparities.
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Affiliation(s)
- Dionne J Blackman
- Section of General Internal Medicine and the Center for Interdisciplinary Health Disparities Research, The University of Chicago, Chicago, IL 60637, USA.
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