Biomedical subjects

C Lerman

Publications and source records attributed to C Lerman.

118 records · Page 7Linked to original sources

PubMedDate not supplied

Factors influencing acceptance of mammography: implications for enhancing worksite cancer control.

PURPOSE: The purposes of this article are to review what is known about participation in mammography programs and to propose several elements that warrant consideration in planning mammography screening programs in occupational settings. Breast cancer is the most common female cancer. Regular screening programs including mammography, clinical breast examination, and monthly breast self-examination can reduce breast cancer deaths by as much as 35%. However, mammography is underutilized. This review examines factors affecting acceptance of mammography and possible worksite-based strategies to increase its appropriate use. SEARCH METHODS: We identified the sources cited in this review through a combination of literature searches of computerized data bases, backward searches of reference lists, and contacts with active investigators. The article includes a selected subset of the most recent and relevant references. SUMMARY OF IMPORTANT FINDINGS: A variety of individual factors, environmental influences, health care system factors, and employer factors influence the acceptance of mammography. Workplace mammography programs can be especially important in reducing access barriers. MAJOR CONCLUSIONS: Six program elements which are central to planning successful worksite mammography programs are discussed: location and facilities; health professional involvement; the range of services; education and referral; employer policies, and plans for follow-up and repeat screening.

Adult↗

PubMedDate not supplied

Feasibility of a telephone survey to recruit health maintenance organization members into a tamoxifen chemoprevention trial.

A large-scale, nationwide tamoxifen chemoprevention trial is currently being planned as a primary preventive strategy against breast cancer. The recruitment of health asymptomatic women into a long-term clinical trial will pose unique recruitment problems. This study examines the feasibility of telephone recruitment from a health maintenance organization population into such a trial. A random sample of 203 women aged 50 and older with a personal family history of breast cancer were contacted by telephone. A structured interview was administered to assess self-perceived risk of breast cancer, willingness to participate in a trial, and anticipated barriers to participation. Of the 203 names generated from the health maintenance organization membership roster 128 (63%) met eligibility criteria and participated in the interview. Forty-five % of the eligible women expressed interest in the tamoxifen trial. Women who felt that their family would support their participation expressed significantly more interest, while concern about possible side effects emerged as potential barriers. We conclude that contact by telephone among health maintenance organization members can identify a significant proportion of women who are interested in primary chemoprevention for breast cancer. Participation rates may be improved by bolstering family support and by addressing concerns about drug toxicity.

Aged↗

PubMedDate not supplied

Multistrategy health education program to increase mammography use among women ages 65 and older.

Mammography use decreases with age although the risk of breast cancer increases with age. Medicare now provides biennial coverage for screening mammography. This study was designed to simulate the Medicare condition by subsidizing mammography among women in eight retirement communities in the metropolitan Philadelphia area. The study also measured the impact of health education interventions and the presence of a mobile mammography van on increased use of mammography. Retirement communities were assigned randomly to the control (cost subsidy alone) or experimental group (cost subsidy, mammography van, and tailored health education interventions). A total of 412 women ages 65 and older who had not had mammograms in the previous year were surveyed at baseline and 3 months later. Analytic techniques reflected the cluster nature of the randomization. Women in the experimental group were significantly more likely than the control group women to have obtained mammograms. Forty-five percent of the experimental group women compared with 12 percent of the control group women subsequently had mammograms in the 3 months after the baseline interview (P less than .001). Logistic regression analysis for mammography use indicated an odds ratio of 6.1 associated with being in the experimental group. For women in the experimental group, a separate logistic regression for mammography use showed an odds ratio of 7.8 associated with attendance at the educational presentation. The results suggest that Medicare coverage alone will not increase mammography use sufficiently to achieve year 2000 objectives. However, the addition of access enhancing and health education interventions boosts utilization dramatically.

Aged↗

PubMedDate not supplied

Why do some women get regular mammograms?

One in nine American women will be diagnosed with breast cancer at some time in their lives. Although mammography is a proven technology for diagnosing early, curable breast cancer, most women do not obtain regular mammograms. The purpose of this study was to identify the characteristics of women who received more than one mammogram. Such information is needed to develop health education programs aimed at fostering adherence to routine mammographic screening. The data were obtained from a 1989 random telephone survey of 910 women 50-74 years of age. The survey is part of the evaluation strategy for a five-year breast screening study. Two-thirds of the respondents reported having had mammograms. Most of these women had one or two mammograms. We report two logistic regression models which describe women who had mammograms in the past year and those who had one versus two or more mammograms. The most important variable in the models was physician support. Other consistently significant variables included being willing to pay $75-$100 (although most women did not pay this amount), visiting the doctor at least annually when healthy, being a nonsmoker, and recognizing that women older than 50 are at greater risk for breast cancer. The results indicate that two-pronged educational strategies aimed at both women and their physicians are needed to increase the percentage of women who obtain regular mammograms.

Aged↗

PubMedDate not supplied

Breast screening practices among primary physicians: reality and potential.

Increased use of regular screening mammograms and clinical breast examinations (CBE) among women aged 40 years and more could have a dramatic impact on mortality from breast cancer, but patient and physician barriers to mammography impede its acceptance. We conducted a survey of 300 primary care physicians to assess their knowledge, attitudes, beliefs, and breast screening practices. Our results show that only 71 percent of the respondents ordered mammograms for all women aged 50 to 75 years, which is the recommendation by the National Cancer Institute and American Cancer Society. Approximately 46 percent of respondents performed CBE on all women patients aged 50 to 75 years. Inadequate patient insurance coverage, equivocal radiology reports, patient reluctance or worry, and patient embarrassment all appear to be barriers to physicians' utilization of breast screening.

Adult↗

PubMedDate not supplied

Factors associated with inadequate cervical cancer screening among lower income primary care patients.

This study identified factors associated with cervical cancer screening patterns among lower income primary care patients. One hundred forty-one women completed a self-administered questionnaire before their medical visit. The results indicated that 71 percent had a Papanicolaou (Pap) test in the past year, 14 percent had one between 1 and 3 years ago, and 15 percent had not had a Pap test for 3 or more years. Advanced age was associated with a reduced likelihood of adequate screening; 21 percent of women aged 50-64 years and 39 percent of those aged 65 years and older had not had a Pap test in the past 3 years. Factors positively associated with screening included perceived susceptibility to cervical cancer and the belief in the efficacy of Pap tests and benefits of screening. Fear of finding cancer was a significant barrier to cervical screening in this population. Of those women who had not been screened adequately, 58 percent were interested in obtaining Pap tests in the primary care setting. The implications for promoting cervical cancer screening in primary care practices are discussed.

Adult↗

PubMedDate not supplied

The correlation between family planning program inputs and contraceptive use in Indonesia.

Using 1980 Census and 1986 service statistics program inputs, this paper evaluates the net correlation of socioeconomic, region, and program variables with 1987 contraceptive prevalence and method-specific use rates for Indonesian regencies and municipalities. The region variables--primarily, though not exclusively, reflecting program design and maturity--correlate most strongly with the contraceptive prevalence rates. Field-worker activities, field-worker supervisor activities, and community-based distributors also have a correlation with these rates. Pill use is highest in the areas that are predominantly Islamic and least developed, whereas the pattern is reversed for use of the IUD, condom, and other modern methods (mainly female sterilization). The findings are assessed in terms of their implications for policymaking.

Community Health Services↗

PubMedDate not supplied

Awareness of heightened breast cancer risk among first-degree relatives of recently diagnosed breast cancer patients. The High Risk Breast Cancer Consortium.

This investigation had two goals: (a) to determine the proportion of first-degree relatives of recently diagnosed breast cancer patients who are unaware of their elevated risk for breast cancer; and (b) to identify demographic medical, and lifestyle factors that characterize these women. The ultimate objective was to identify women at increased risk who could benefit from breast cancer risk education. Three hundred ninety-five female first-degree relatives, ages 30-75 years, completed a structured telephone interview. Twenty-five % of these women believed that their risk for breast cancer was the "same as or lower than" women who do not have a family history of breast cancer, despite the fact that they had an objectively increased risk. Bivariate analyses revealed that women who were unmarried (chi2 = 14.8; P = 0.001) and had less than or equal to a high school education (chi2 = 9.2; P = 0.002) were significantly less likely to perceive themselves as being at increased risk for breast cancer. In addition, almost one-half of African-American women were unaware of their increased risk compared to only 19% of white women (chi2 = 29.9; P < 0.001). More smokers were unaware of their elevated risk compared to nonsmokers (43 versus 21%; chi2 = 15.1; P < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMedDate not supplied

Utilization of ovarian cancer screening by women at increased risk.

Our objective was to identify demographic, medical, and psychological correlates of ovarian cancer screening utilization in a sample of women at increased risk. We designed a cross-sectional study that evaluated demographic factors, risk factors, psychological factors, and utilization of ovarian cancer screening in first-degree relatives of ovarian cancer patients. In multivariable analysis, use of CA-125 was associated with number of affected relatives [odds ratio (OR), 2.9; 95% confidence interval (95% CI), 1.3-6.5] and ovarian cancer worries (OR, 2.9; 95% CI, 1.1-8.1). For ultrasound (transvaginal or abdominal), the model included employment status (OR, 2.7; 95% CI, 1.1-6.8) and ovarian cancer worries (OR, 3.3; 95% CI, 1.2-9.1). Significant interaction terms in the ultrasound models indicated that employment was a significant predictor of ultrasound utilization in women with 2 or more affected relatives. Among women with only one affected relative, ultrasound use was strongly associated with the presence of ovarian cancer worries. Utilization of ovarian cancer screening among women at increased risk is influenced by psychological and sociodemographic factors, in addition to level of risk.

Adolescent↗

PubMedDate not supplied

Recruiting high risk women into a breast cancer health promotion trial.

This study sought to identify factors that facilitate or hinder participation in a breast cancer health promotion trial among high-risk women. The subjects were 271 women ages 35 years and older who had a family history of breast cancer in at least one first-degree relative. All subjects were eligible for participation in a randomized trial which compares breast cancer risk counseling with general health counseling. Structured telephone interviews evaluated demographic characteristics, risk factors, risk perceptions, breast cancer concerns, and past screening practices. The results showed that education level was a key determinant of the importance of these factors in participation. Logistic regression modeling indicated that women with a high school education or less were most likely to participate if: (a) their relatives' diagnoses had greatly increased their perceptions of their personal risks [OR (OR) = 4.1], particularly if they perceived that risk to be very high (OR for interaction = 6.4); and (b) if they were ages 40-49 years versus 35-39 or 50 + years (OR = 2.6). By contrast, among women with education beyond high school, participation was predicted by (a) marital status (OR = 2.6), (b) employment (OR = 0.03 for employed), (c) number of affected relatives (OR = 0.07 for 1 versus 2 first-degree relatives), and (d) previous biopsy (OR = 0.42). These findings suggest that recruitment strategies that tailor messages to women's educational levels might be most effective.

Adult↗