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PubMed2006

Breast cancer screening behaviors among African American women with a strong family history of breast cancer.

BACKGROUND: Despite the importance of breast cancer screening to reduce morbidity and mortality, limited information is available on screening practices among African American women with a family history that is suggestive of hereditary breast cancer. OBJECTIVES: To describe adherence to breast cancer screening recommendations among African American women with a family history that is suggestive of hereditary disease. METHODS: Participants were unaffected African American women (n=65) who had a family history of cancer that was suggestive of hereditary breast cancer. Breast cancer screening practices were evaluated by self-report. The study was conducted at the University of Pennsylvania in Philadelphia, PA. Women were recruited to participate in the study from February 2003-December 2005. RESULTS: Most women were adherent to recommendations for mammography (75%) and CBE (93%). A sizeable minority of women (41%) also performed excessive BSE. Being older than age 50 was associated significantly with mammography adherence (FET<0.05). Employment had a significant independent association with BSE; unemployed women were most likely to perform excessive BSE (OR=3.28, 95% CI: 1.05, 10.21, p<0.05). CONCLUSIONS: The results of this study suggest a complex pattern of breast cancer screening practices among African American women at increased risk for hereditary breast cancer.

Black or African American↗

PubMed2004

The 'hows', 'whos', and 'whens' of screening: gynaecologists' perspectives on cervical cancer screening in urban Sweden.

Population-based screening has contributed to decreased mortality in cervical cancer. However, the 'hows', 'whos' and 'whens' of screening still concern health professionals and policy makers. As part of a research project aimed at examining a population-based cervical cancer screening program (PCCSP) from different stakeholders' perspectives, the aim of this qualitative interview study was to elucidate the views of gynaecologists, working in both public and private settings, as stakeholders in the PCCSP in the county of Stockholm, Sweden. Results from semi structured interviews with 17 physicians indicate ambiguity in their descriptions of the purpose of both the PCCSP and smear testing in general, leading to different views about appropriate time intervals for Pap-smear testing. The gynaecologists also described experiencing a number of dilemmas related to information content and provision-both prior to screening and in relation to test results. In addition, the gynaecologists tended to differentiate morally through choice of language between women who participate in some form of screening and non-attendees of the PCCSP. There also appeared to be distinctions in how these gynaecologists conceptualised and discussed women receiving Pap-smears, dependent on whether they were regarded as within the category of 'my patients' (seen by the gynaecologist in a private or public setting) or 'the population' (women unknown to the gynaecologist). This study indicates the importance of comprehensively analysing the context of professionals' work when attempting to understand professional attitudes. Seeming disparities in attitudes as well as varying practices may be explained by the simultaneous existence of multiple value systems, applied to different patient populations, as found in this study.

Adult↗

PubMed1994

Medicine residents' practices in cancer screening in a Hispanic population.

Cancer screening is a valuable intervention to reduce breast cancer mortality and the incidence of invasive cervical carcinoma. We conducted a retrospective survey to determine the residents' compliance with use of mammography and Pap smear in Hispanic women. A total of 280 charts that met the inclusion criteria were reviewed. According to the guidelines, 784 mammograms and 714 Pap smears were indicated. The residents' compliance with mammography was 10.6% (+/- 9.16) and with Pap smear, 6.6% (+/- 7.68). The study demonstrates an unacceptable level of cancer screening practice by the medicine residents caring for this Hispanic population.

Adult↗

PubMed2001

Factors related to cancer screening in Hispanics: a comparison of the perceptions of Hispanic community members, health care providers, and representatives of organizations that serve Hispanics.

Hispanics have lower rates of screening for cervical, breast, and colon cancer than non-Hispanics. Activities to increase cancer screening in this population may not be informed by Hispanics, which may have implications for success rates of interventions. In this study, the perceptions about cancer screening behaviors in Hispanics are compared among three groups: a random sample of respondents (75% Hispanic) to a population-based survey, health care providers (primarily non-Hispanic), and representatives of organizations that serve Hispanics (36% Hispanic). While there was agreement that socioeconomic factors were important for cancer screening, differing views were expressed regarding the importance of cultural factors for cancer screening among Hispanics. Interventions developed by those who serve the Hispanic population may be based on inaccurate perceptions about the beliefs and practices of the population served. For effective interventions, it will be necessary to understand the factors important to Hispanics for cancer screening.

Adult↗

PubMed2006

Rates and predictors of colorectal cancer screening.

INTRODUCTION: Despite widespread recommendations for colorectal cancer screening, the U.S. screening rate is low. The objectives of this study were to describe the rates and predictors of colorectal cancer screening use by examining groups in two categories--1) those who have ever been screened and 2) those with up-to-date screening--and to assess whether trends and predictors change over time. METHODS: We analyzed data from the 2000 and 2003 National Health Interview Surveys about the use of fecal occult blood tests, sigmoidoscopies, and colonoscopies for adults aged 50 years and older and without a history of colorectal cancer (N = 11,574 in 2000 and N = 11,779 in 2003). RESULTS: Rates in the 2000 study population of those who have ever been screened for colorectal cancer (53%) had increased in the 2003 study population (55%) as had the rates in the 2003 study population of those with up-to-date colorectal screening (53%) compared with the rates in the 2000 study population (38%). Among those who were ever screened, 76% were up-to-date with screening in 2003, compared with 68% in 2000. There was increased use of colonoscopies but decreased use of fecal occult blood tests and sigmoidoscopies. Individuals were more likely to be up-to-date with screening if they had higher income, higher education, insurance coverage, a usual source of care, and a dental visit in the last year than if these predictors were not evident. Since 2000, these predictors of colorectal cancer screening use have remained stable. CONCLUSION: Although there has been relatively limited success in increasing overall screening, it is encouraging that most people in the group of those who have ever been screened are up-to-date with colorectal cancer screening. Predictors for colorectal screening were stable over time despite changes in screening policies and rates. Further research is needed to uncover barriers to colorectal cancer screening.

Adult↗

PubMedDate not supplied

Barriers to prostate cancer screening in African American men.

Prostate cancer is one of the most significant health problems facing men today, especially African American men. Decreased participation in prostate cancer screening by African American men is a serious problem, as decreased survival rates occur when the diagnosis of prostate cancer is delayed. This descriptive correlational study focuses on identifying the relationship between perceived barriers and participation in a free prostate cancer screening program. A purposive sample of African American men (n = 1,395) was drawn from multiple community sites in the southeast United States. All significant variables (age, income group, marital status, and educational intervention were used as covariants for the multiple logistic regression. With the addition of the covariants, the barrier suggesting "would be embarrassed" remained significant (p = 0.03). Two other barriers, "no way to get there" and "refuse to go" approached significance (p = 0.08 and p = 0.09, respectively). Nurses can use knowledge about barriers identified in this study to develop interventions aimed at increasing participation in prostate cancer screening among African American men.

Adult↗

PubMed1994

Predictors of cancer prevention attitudes and participation in cancer screening examinations.

BACKGROUND: Few current data are available regarding factors associated with participation in cancer screening examinations in the general population. METHODS: To identify factors associated with participation in cancer screening examinations, random population samples of 25- to 74-year-old men and women in six various-sized communities in three upper-Midwestern states (n = 4,915) were surveyed in 1987-1989. Multivariate-adjusted means were calculated and compared using analysis of covariance. RESULTS: Statistically significant (P < 0.05) strong predictors (other than age and sex) of ever having had a specific cancer screening test were as follows (the numbers in parentheses following each listed association are the absolute maximum differences in mean proportions among the levels of the predictors): (1) rectal examination: higher education (14%); (2) fecal occult blood testing: higher education (6%) and never smoker (5%); (3) sigmoidoscopy: higher income (7%) and higher education (6%); and (5) mammography: higher income (25%), higher education (8%), and a positive family history of breast cancer (7%). There were no strong predictors (out of nine) of ever having had a Papanicolaou smear or a breast self-examination. CONCLUSIONS: The largest differences among the population for participation in cancer screening examinations involves income and the two most expensive cancer screening tests: higher income is a strong predictor of having a mammogram and, to a lesser extent, of having a sigmoidoscopy. The most consistent predictor of participation in cancer screening examinations across all cancer screening tests is education: higher education is a predictor of having each kind of cancer screening test.

Adult↗

PubMed2003

Racial differences in breast cancer screening, knowledge and compliance.

BACKGROUND: Breast cancer is the second leading cause of cancer death among women in the United States. Although the incidence of breast cancer is 13% higher in white women, mortality in black women is 28% higher, due to histological and socioeconomic factors. Existing research regarding racial differences in compliance with breast cancer screening recommendations has found conflicting results. METHODS: Data on more than 4,500 women were taken from the 1992 National Health Interview Survey, a nationally representative, population-based sample survey. Logistic regression was used to estimate the relative odds of knowledge of breast self-exam (BSE) and mammograms, and compliance with BSE, clinical breast exams (CBE), and mammograms. RESULTS: Black women were less likely than white women to be aware of and use breast cancer screening tests. However, among women who were aware of screening tests, compliance was higher among black women. Women with low educational attainment, low cancer knowledge, and no usual source of care were less likely to be CBE or mammogram compliant. Socioeconomic differences were larger for the two clinical tests than for BSE. CONCLUSIONS: Programs should inform women about cancer screening tests and remove barriers that hinder women from receiving clinical screening exams.

Adult↗

PubMed2006

Prevalence and correlates of cervical cancer screening among injection drug users.

OBJECTIVE: Access to cervical cancer screening may be lower among lower income and socially disadvantaged populations. However, few studies have specifically examined factors associated with cervical cancer screening among socially marginalized populations, especially in settings with free health care systems. METHODS: The present study was conducted to examine the prevalence and correlates of cervical cancer screening among injection drug users. We examined rates of Papanicolaou (Pap) smear testing among female participants in the Vancouver Injection Drug Users Study (VIDUS). Univariate and logistic regression analyses were used to evaluate factors associated with cervical cancer screening. RESULTS: During the period from December 2004 to May 2005, 297 female injection drug users were seen. In logistic regression analyses, age (adjusted odds ratio [AOR]=0.70; 95% confidence intervals [CI] 0.53, 0.92, P=0.010), HIV infection (AOR=2.46; 95% CI 1.41,4.26, P=0.001), hepatitis C infection (AOR=0.25; 95% CI 0.09,0.71, P=0.010), and having visited a family physician in the prior six months (OR=3.10; 95% CI 1.58, 6.07, P=0.001) were independently associated with recent cervical cancer screening. CONCLUSIONS: After adjustment for regular physician visits, HIV infection was associated with elevated rates of cervical screening. This is reassuring, given the elevated risk of cervical cancer among this population. Interventions may be required to improve uptake of screening among older injection drug users and drug users infected with hepatitis C.

Adult↗

PubMed1999

Incidental findings in a federally-sponsored cancer screening program.

The volume of non-cancer related clinical services and referrals for medical care of women as a consequence of their enrollment in a federally-sponsored breast and cervical cancer screening program was examined. We randomly sampled 100 medical records from among 389 individuals who received cancer screening services through the Connecticut Breast and Cervical Cancer Early Detection Program. Medical record audits tabulated occasions when women were offered or received diagnostic or therapeutic procedures as a by product of their program participation. Breast screening was provided to 100 women and 49 individuals received cervical cancer screening. In addition, 87 percent of the sample were offered or received one or more non-cancer related health services. Physical exams were provided to 86 women, laboratory tests were ordered for 11 individuals and 55 referrals were made to address a myriad of specific medical needs that were uncovered incidental to breast and cervical cancer screening. Among 26 women who did not heed recommendations for follow-up care, cost, inconvenience and beliefs that medical problems were not immediate concerns were cited. Local screening program sponsors should be cognizant that the health care needs and limited resources of some target populations may be substantial. Mechanisms to assure that needed health care is available to individuals should be built and into all categorical health service programs.

Attitude to Health↗

PubMed1996

American Indian women's talking circle. A cervical cancer screening and prevention project.

BACKGROUND: Cervical cancer is important to American Indian women due to high mortality and low survival rates compared with other ethnic groups. This article describes the development and implementation of a culturally acceptable cervical cancer screening program in urban and rural American Indian health clinics in California. METHODS: A team of researchers used social learning theory, research data, and focus groups to design a cervical cancer screening program. The major component of the program was the adaptation of a culturally acceptable mode of communication called Talking Circles. The American Indian Talking Circle project used the Talking Circle format, coupled with traditional Indian stories, as a vehicle to provide cancer education and to improve adherence to cancer screening. Eight American Indian clinics were randomly assigned into intervention and control sites (n = 400 women). The intervention was administered to 200 Indian women 18 years and older in four American Indian clinics; four additional American Indian clinics (n = 200 women) served as control sites. RESULTS: Preliminary results from the research show that American Indian women responded favorably to a culturally framed education project. Initial reports indicate that health-related information is accepted and acted on when it is coupled with cultural information that is presented in a sensitive manner. Final evaluation of the project is forthcoming. CONCLUSIONS: Utilizing a culturally acceptable intervention has the potential to improve the health status of American Indian Women.

Attitude to Health↗

PubMed1997

The costs and effects of cervical and breast cancer screening in a public hospital emergency room. The Cancer Control Center of Harlem.

OBJECTIVES: This study assessed the cost-effectiveness of cervix and breast cancer screening in a public hospital emergency room. METHODS: Age-eligible women with nonurgent conditions and without recent screening were offered screening by a nurse. A decision analysis compared the costs and outcomes of emergency room screening and standard hospital screening efforts. RESULTS: The undiscounted cost-effectiveness results for establishing new programs were $4050 (cervical cancer), $403,203 (breast cancer), and $4375 (joint cervix and breast cancer) per year of life saved. If screening is added to an existing program, results are more favorable ($429, $21,324, and $479 per year of life saved for cervix, breast, and joint screening, respectively). Results were most sensitive to volume and probability of receiving treatment after an abnormal screen. CONCLUSIONS: Emergency room screening was cost-effective for cervical cancer; breast cancer screening was relatively expensive given the low number of women reached. More intensive recruitment and follow-up strategies are needed to maximize the cost-effectiveness of such programs.

Breast Neoplasms↗

PubMed2003

Cultural sensitivity and informed decision making about prostate cancer screening.

Because informed consent for prostate cancer screening with prostate specific antigen (PSA) is recommended, we determined how African Americans, Hispanics, and Caucasians want information about screening with PSA and the digital rectal exam (DRE) presented in culturally sensitive brochures specific for each group. We analyzed focus group discussions using content analysis and compared themes across groups in a university outpatient internal medicine practice setting. The participants were twenty couples with men age 50 and older who participated in four focus groups. Main outcome measures were participants' views on the content and graphic design of culturally sensitive brochures promoting informed decision making about prostate cancer screening. There were content and graphic design differences in the way ethnic groups wanted information presented about the prostate, prostate cancer, risk, and screening. Caucasians likened the size of the prostate to a walnut; Hispanics, to a small lime. Hispanics emphasized how advanced prostate cancer can be symptomatic; Caucasians, how early prostate cancer can be asymptomatic. African Americans wanted risk information specific for them and the advantages and disadvantages of a PSA and DRE; Hispanics, did not. Caucasians and African Americans sought a more active role for men in informed decision making than Hispanics. Differences in the way African Americans, Hispanics, and Caucasians want information presented about prostate cancer screening suggest there may be cultural differences in the reasonable person standard of informed consent, in attitudes toward the physician-patient relationship, screening, and informed decision making. Physicians promoting informed decision making about controversial screening tests should take cultural sensitivity into account when designing educational interventions and using them.

Aged↗

PubMed2001

Time costs associated with cervical cancer screening.

OBJECTIVES: Time costs borne by women when undergoing cervical cancer screening have rarely been elucidated, although such costs may pose substantial barriers to care. The purpose of this project was to quantify the opportunity costs associated with cervical cancer screening in young women attending Planned Parenthood Clinics. METHODS: We conducted a self-report survey of 105 women from six clinics to measure travel, waiting, and exam times associated with cervical cancer screening. Respondents recorded their time of arrival and departure, length of time in the waiting room, age, income level, and hours per week they worked outside of the home. Time costs were valued three ways: through self-reported hourly wage, age- and gender-adjusted minimum earnings, and national age- and gender-adjusted hourly wages. RESULTS: Respondents were on average 24 years old, worked 29 hours per week outside the home, and earned less than $20,000 per year. Mean time for one-way travel was 18.7 minutes; waiting room time was 16.9 minutes; and exam time was 50.8 minutes. Time costs were estimated to be $14.08 per visit based upon the self-reported hourly wage; $16.46 per visit based upon age- and gender-adjusted minimum earnings; and $19.63 per visit based upon age- and gender-adjusted national wage rates. CONCLUSIONS: Time costs associated with cervical cancer screening represent an important opportunity cost and should be considered in studies attempting to identify barriers to screening adherence. Our results indicate that time costs accounted for up to 25% of cervical cancer screening costs. Time costs should be identified, measured, valued, and included in cost-effectiveness analyses of cervical cancer screening.

Adult↗

PubMed1989

[Evaluation of cancer screening from the epidemiologic point of view].

In Japan four kinds of cancer screening programs, namely screening programs for stomach cancer, uterine cancer, breast cancer and lung cancer, have been conducted under the Health and Medical Law for the Aged People. Now, however, it is demonstrated that cancer screening is not always effective in reducing cancer mortality. Therefore, new cancer screening programs, including colo-rectal cancer screening, should be evaluated by a well-designed study, like randomized controlled trial, before implementation as a public health policy.

Breast Neoplasms↗

PubMed2005

Differential effects of messages for breast and cervical cancer screening.

The aim of this study was to compare responses to two interventions (personalized-form [PF] letter messages versus personalized-tailored [PT] letter messages) using medical record data for promoting appointment scheduling and screening for breast and cervical cancer among urban low-income women from three ethnic groups: African-American, Mexican-American, and non-Hispanic white women. The 1,574 women participating in the randomized controlled trial were assigned to one of three groups: (1) PF letter, (2) PT letter, (3) control (no letter). Logistic regression analyses show that (1) personalized-tailored letters containing individualized references to recipients' cancer risk factors failed to increase rates of recommended cancer screening behaviors, especially among non-Hispanic white women; and that (2) in contrast, a personalized-form letter with general breast and cervical cancer screening messages increased cancer screening rates in this population, especially among non-Hispanic white and Mexican-American women.

Breast Neoplasms↗

PubMedDate not supplied

Recruitment of African Americans into prostate cancer screening.

PURPOSE: Both incidence and mortality rates for prostate cancer are significantly higher in African American men than in white men. This report identifies community sites for the optimal recruitment of African American men into prostate cancer screening. DESCRIPTION OF STUDY: A descriptive study was conducted, providing an educational program to 1369 African American men, 1264 of whom completed a survey on demographic data, prostate cancer knowledge, and prostate cancer screening history. The programs were offered at six different types of community sites, including various work sites, churches, housing projects, National Association for Advancement of Colored Persons (NAACP) sites, barber shops, and a state fairground. Free prostate cancer screening was offered to all participants. RESULTS: The advertised mass screening site (state fairground), the most common method used nationally to recruit African American men for cancer screening, was the least effective site, with only 16 men completing the survey. Of the 1264 men completing the survey at all community sites, 597 men (47%) did so at work sites and 438 (35%) did so at churches. Per site, the largest percentage of men who had never been screened was at work sites (n = 276, 46%) and NAACP sites (n = 22, 33.8%). The highest percentage of men who obtained free screening were at the state fairground (14 of 16), churches (256 of 438), and work sites (336 of 597). The most prostate cancers were detected at the housing projects, where 3 of 38 (7.9%) men who were screened received diagnoses of prostate cancer. CLINICAL IMPLICATIONS: To reduce prostate mortality rates in African American men, healthcare providers need to make a concerted effort to increase prostate cancer education and screening in this population. To be effective, recruitment of African American men must move from a provider/health site orientation to a consumer/community orientation. These findings indicate that recruitment strategies are more successful if efforts are based in the community or where a large number of African American men live and/or work. Because a history of screening has been shown to be a predictor for current participation, programs need to target men who have not had previous screening ever or within the last year. In addition, the large percentage of men recruited at work sites who had not been screened previously indicates an opportunity for collaboration with healthcare professionals in employee health programs. Efforts to increase participation in prostate cancer screening will be enhanced significantly by eliciting the active involvement of community leaders.

Adult↗

PubMed1994

Value of prostate cancer screening in a comprehensive community cancer center.

Early detection of prostate cancer may help decrease cancer deaths from this disease despite the increased incidence of prostate cancer. In 1990 and 1991 we conducted one-day "screens" for prostate cancer. This analysis was undertaken to determine the value of the screening procedures for detecting prostate cancer in the community. A total of 579 men, aged 39-84 years (mean 58 years), were evaluated by digital rectal examination (DRE) by a urologist, serum prostate specific antigen (PSA) determination by monoclonal antibody assay, and completion of a detailed questionnaire. Forty-eight percent had not seen a physician in over 2 years; 17% had a 1st- or 2nd-degree relative with prostate cancer. There was a 25% "suspicious" rate including 76 (13%) men with abnormal DRE only, 48 (8%) with abnormal PSA only, and 21 (4%) with abnormal DRE and PSA. Patients with findings suspicious for cancer were recontacted by telephone at 2-month intervals for 6 months to determine outcome because subsequent diagnostic management was at the discretion of practicing physicians. By 6 months, 84% of patients with abnormal findings had seen a physician as recommended. Of the 76 with abnormal DRE only, 11 were biopsied and only one cancer was found (9%). Of 48 with an elevated PSA only, 19 were biopsied; 11 (58%) had cancer (9/9 positive transrectal ultrasound) and 8 had no cancer at biopsy (5/5 negative transrectal ultrasound). Of 21 with both tests suspicious, 11 were biopsied and 9 had cancer (82%). Thus, by 6 months after each screen there was a 3.5% overall cancer detection rate for the whole population screened, a 67% positive biopsy rate among those with an elevated PSA, a 45% positive biopsy detection rate among those with an abnormal DRE, and a 51% positive biopsy rate among all those biopsied. Eighty percent of the PSA elevations were between 4.1 and 10.0 ng/ml. This screening experience yielded several new diagnoses of prostate cancer, and the use of serum PSA levels and ultrasound-guided biopsy was associated with a high positive biopsy rate for cancer.

Adult↗