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PubMed2004

Breast cancer screening practices among women in the United States, 2000.

Results from recent studies indicate that many women in the US undergo routine screening for breast cancer, but some groups of women are under-screened. In this study, we examined the breast cancer screening practices of white and black women in the United States, according to Hispanic ethnicity and other factors, using data from the 2000 National Health Interview Survey. Among women aged > or =40 years, 71.2% (95% confidence interval, CI: 70.0-72.4%) of the 8201 white women and 67.6% (95% CI: 64.5-70.6%) of the 1474 black women in this sample reported having a mammogram in the past two years. About 60.3% (95% CI: 56.7-70.3%) of 970 Hispanic women (including those who reported they were white or black) and 71.5% (95% CI: 70.3-72.7%) of 8705 non-Hispanic women reported having a mammogram in the past two years. About 74.8% (95% CI: 73.8-76.8%) of 8176 white women and 73.8% (95% CI: 71.1-76.6%) of 1471 black women aged > or =40 years had received a clinical breast examination in the past two years. About 60.1% (95% CI: 56.1-64.0%) of 969 Hispanic women (including those who reported they were white or black) and 75.6% (95% CI: 74.6-76.6%) of 8678 non-Hispanic women had received a clinical breast examination in the past two years. Women with lower incomes, those with less education, and recent immigrants were less likely to be screened. Women who had a usual source of health care and those with health insurance coverage were more likely to have been screened. These results underscore the need for continued efforts to ensure that uninsured women and those who are medically underserved have access to cancer screening services.

Adult↗

PubMed2006

Self-reported prostate cancer screening in Austria.

OBJECTIVES: The prevalence of self-reported participation and frequency of prostate cancer screening (digital rectal examination (DRE), prostate-specific antigen (PSA)) in Austrian men aged 40-79 years in the year 2005 is reported. METHODS: In a population-based cross-sectional study, a representative sample of 500 men was asked whether they ever had heard of early detection of prostate cancer by DRE or PSA test and, if so, whether they had ever had a prostate cancer screening test during their life, and if so the number of tests and the type of physician. RESULTS: Overall, the prevalence of self-reported prostate cancer screening was 55.8% (23.7% DRE only). The highest prevalence was observed in the age group of 60-69 years with 68.8% (28.1% DRE only). The highest prevalence of PSA tests was observed in the age group 70-79 years (40.9%). About 75% of the screening tests were performed by urologists. CONCLUSIONS: More than half of the target population (men aged 40-79 years) have had at least one prostate cancer screening test. Nearly one-third of men have already had one or more PSA tests. One-fifth of the PSA tests were requested by general practitioners or internists.

Adult↗

PubMed1990

Three strategies to promote cancer screening. How feasible is wide-scale implementation?

Many studies have tested the efficacy of intervention strategies for improving physicians' performance of cancer screening tests. Less attention has been paid to the feasibility of strategy implementation. Three important dimensions of feasibility are acceptability to the targeted audience, logistical difficulties, and cost and cost-effectiveness. We assessed the relative feasibility along these dimensions of three intervention strategies shown previously to be efficacious among 62 internal medicine resident physicians. Two strategies, medical record audit with feedback and computerized cancer screening reminders were aimed at physicians directly, and one, patient education, indirectly through their patients. While all three interventions were acceptable to the physicians, implementation of the audit with feedback intervention was logistically more difficult and more costly than either the cancer screening reminders or patient education interventions. The average cost per additional screening test (beyond the number that would have been performed without intervention) was $50.40 for audit with feedback, $18.19 for cancer screening reminders, and $51.20 for patient education. Overall, the cancer screening reminder intervention was the most feasible of the three strategies.

Attitude of Health Personnel↗

PubMed1995

Knowledge, beliefs, and prior screening behavior among blacks and whites reporting for prostate cancer screening.

OBJECTIVES: A survey to determine prostate cancer-related knowledge, beliefs, and prior screening behavior was administered to men participating in prostate cancer screening events at nine major sites in the southeast. Since prostate cancer disproportionately affects blacks, a primary focus of the analysis was to determine if differences in responses exist between racial groups. METHODS: A 20-question, multiple-choice survey to ascertain prostate cancer knowledge and beliefs, demographics, and health care access information was administered at nine major southeastern sites participating in Prostate Cancer Awareness screening events. Potential differences between the responses of blacks and whites were tested using the Cochran-Mantel-Haenszel test (P < 0.05), adjusting for differences among sites. RESULTS: Major findings of this study on 286 black and 1218 white men are as follows: (1) only 28% of black or white men report that their doctor ever discussed a test for prostate cancer with them; (2) blacks were less likely to have a regular doctor (P = 0.03) or ever to have had a digital rectal examination (P < 0.001) or prostate-specific antigen testing (P = 0.005); (3) blacks were less likely to report knowing someone with prostate cancer (P < 0.001) and were more apt to report their acquaintances experiencing post-treatment impotence than whites (P = 0.03); they were less likely to report that "a man with prostate cancer can lead a normal life" (P < 0.001) or that "men can have prostate cancer without symptoms" (P < 0.001); (4) a substantial number of all men did not know that race and/or heredity are risk factors; and (5) "peace of mind" was the leading reason why men (63% of whites and 50% of blacks) attended prostate cancer screening events. CONCLUSIONS: There are a number of similarities among black and white men regarding knowledge and beliefs related to prostate cancer. Important differences, however, in access to screening, perception of the disease and its treatment, and knowledge of risk factors exist between racial groups and represent significant barriers to early detection among African Americans.

Black or African American↗

PubMed1994

The effect of risk on changes in breast cancer screening rates in Los Angeles, 1988-1990.

BACKGROUND: Although there have been clear secular trends of increased use of some breast cancer screening modalities, such as mammography, it is less certain that similar trends have occurred among high risk women. METHODS: Population-based surveys were conducted in three socioeconomically diverse Los Angeles communities in 1988 and 1990. Trends in breast cancer screening behavior and key determinants of screening were compared separately for women with a family history of breast cancer, a personal history of benign breast disease, and for women without these risks. RESULTS: In two independent samples drawn in 1988 and 1990, women at a higher risk of breast cancer (positive family history) showed smaller increases in the prevalence of self-reported breast cancer screening than a comparison group of women without a family history of breast cancer or a history of benign breast disease. This was especially true for family-history-positive minority women and women aged 65 years and older, for whom screening actually decreased. In 1990, mammograms for the prior year were reported by only 39% of women with a positive family history, 54% of women with benign breast disease, and 35% of women without these risks. Trends in physicians' office visit discussions of breast cancer screening paralleled trends observed in screening behavior. CONCLUSIONS: Although breast cancer screening increased substantially among lower risk women, rates were unchanged for women at increased risk because of a family history of breast cancer. By identifying and counseling higher risk women, physicians can play an important role in promoting appropriate screening to this group.

Adult↗

PubMed1996

Factors associated with intention to undergo annual prostate cancer screening among African American men in Philadelphia.

BACKGROUND: This study assesses whether African American men in Philadelphia are receptive to annual prostate cancer screening. Factors associated with intention to undergo prostate cancer screening are also identified. METHODS: The authors randomly selected 218 African American men from the patient population of a large primary care practice in Philadelphia. The men were 40 to 70 years of age and were available for a telephone survey. Responses to survey items defined by the Preventive Health Model were collected from 154 respondents (71%). Univariate and multivariate analyses of screening intention were performed using survey data on sociodemographic background and medical history; knowledge, attitudes, and beliefs about prostate cancer and screening; social support and influence; and, intention to undergo a screening examination. RESULTS: Overall, 69% of subjects reported that they intended to have annual prostate cancer screening. Logistic regression analyses showed that subject belief in screening efficacy (P=0.0002) were positively and significantly associated with intention to screen. CONCLUSIONS: Findings reported here show that African American men in an urban primary care practice setting are receptive to annual prostate cancer screening and that psychologic and social influence factors are associated with screening intention. The data highlight the need for health care professionals to provide education and advice regarding prostate cancer care to men in this population.

Adult↗

PubMed1991

Risk perception, family history, and use of breast cancer screening tests.

A family history of breast cancer is an established risk factor for the disease, but there are few published studies on the use of breast cancer screening tests among family-history-positive women. Among 1015 respondents to telephone surveys of random samples of women 50 to 75 years old residing on Long Island (New York), the frequency of ever having had a mammogram or having a mammogram during the past year was significantly higher in respondents with a self-reported family history of breast cancer than in other women 50 to 64 (but not 65 to 75) years old. The association between family history and mammography during the past year held only among 50 to 64-year-old women with a lower perceived risk of breast cancer. Among women 50 to 64 years old, strong agreement with the ability of mammography to detect nonpalpable lumps was positively associated with mammography during the past year, especially among women with lower perceived risk of breast cancer. Implications are discussed with regard to breast cancer screening programs.

Adult↗

PubMed2004

Factors associated with colon cancer screening: the role of patient factors and physician counseling.

BACKGROUND: The prevalence of colon cancer screening is nationally low. The relative contribution of patient factors and physician counseling patterns to the low prevalence of screening is unclear. METHODS: We used multivariable analysis to examine the prevalence of colon cancer screening nationally and the reasons for this low prevalence using data from the 2000 National Health Interview Survey, a nationally generalizable survey of US households. RESULTS: Among 11,427 respondents to the Cancer Control Supplement, 16% reported annual fecal occult blood testing (FOBT) and 29% reported having undergone a sigmoidoscopy in the last 5 years or a colonoscopy in the last 10 years. After adjusting for age, sex, body mass index (BMI), healthcare access, and region of the country, Hispanics were less likely to undergo FOBT [OR 0.7 (95% CI 0.6-0.9)] and sigmoidoscopy or colonoscopy [OR 0.8 (95% CI 0.7-0.9)] compared to Whites. Respondents with lower education levels were also less likely to undergo screening. These factors were not associated with being less adherent to physician recommendations for screening. Nevertheless, non-Whites and those less educated were less likely to receive counseling from their health provider about colon cancer screening. Among respondents who did not undergo FOBT, 64% were unaware they needed the test; only 2% cited pain and discomfort as a deterrent, but 94% were not counseled by their physician about the test. Among those who did not undergo sigmoidoscopy or colonoscopy, 72% were unaware that they needed the test and only 1% was deterred by pain and discomfort; 92% were not counseled by their physician. CONCLUSION: The low prevalence of screening for colorectal cancer appears to be due to lack of awareness and inadequate provider counseling rather than poor patient acceptance for screening. Systematic counseling about colorectal cancer screening will likely improve screening rates and reduce disparities by race/ethnicity and education.

Age Distribution↗

PubMed1994

[Effects of aging on urinary secretion of 3-hydroxyproline and its importance for cancer screening in the elderly with ROC analysis].

OBJECTIVE: to observe the influence of aging on urinary secretion of 3-hydroxyproline (3-Hyp) in normal subjects and in cancer patients and study the effects of aging on the accuracy of urinary 3-Hyp as a general-purpose cancer screening test. DESIGN: We reanalyzed, from the aspect of gerontology, the amounts of 3-Hyp in the urine samples of the 211 healthy persons and 94 patients with cancer reported earlier. The two groups were divided in 3 age subgroups: adult, 30 to 44 years, middle-aged, 45 to 64 years, and aged, 65 years and older. The cancer stage was separated into 3 categories: stage 1, the early stage without any invasion, stage 2, locally invasive with no distant metastasis, and stage 3, advanced cancer. The correlation of age and urinary 3-Hyp was analyzed in normal subjects and cancer patients. Sensitivity and specificity were calculated for different cutoff points in the diverse groups to construct the receiver operating characteristic (ROC) curves. MAIN RESULTS: We observed that aging decreases the urinary secretion of 3-Hyp in normal subjects, with a correlation coefficient of -0.250 (p < 0.001). The mean levels of urinary 3-Hyp in patients with cancer were significantly higher than in the normal subjects, p = 0.005. The correlation coefficient of urinary 3-Hyp and age was not significant (0.100) in cancer patients. The cutoff points of 0.800 mg/g creatinine of urinary 3-Hyp for persons under 65 years of age and 0.600 mg/g creatinine for persons 65 years or older were the best thresholds for cancer screening. In the ROC analyses, we observed that 3-Hyp has higher accuracy for cancer screening in the aged group for all stages together and in the aged and middle-aged for early stages of cancer. CONCLUSIONS: The urinary 3-Hyp test was more effective for cancer screening in old persons (65 years or older), where cancer is more frequent and more difficult to discover. The authors stress the necessity and importance of verifying the effectiveness of urinary 3-Hyp for general cancer screening in a larger population and in a community set.

Adult↗

PubMedDate not supplied

Breast and cervical cancer screening: impact of health insurance status, ethnicity, and nativity of Latinas.

PURPOSE: Although rates of cancer screening for Latinas are lower than for non-Latina whites, little is known about how insurance status, ethnicity, and nativity interact to influence these disparities. Using a large statewide database, our study examined the relationship between breast and cervical cancer screening rates and socioeconomic and health insurance status among foreign-born Latinas, US-born Latinas, and non-Latina whites in California. METHODS: Data from the1998 California Women's Health Survey (CWHS) were analyzed (n = 3,340) using multiple logistic regression models. Utilization rates of mammography, clinical breast examinations, and Papanicolaou (Pap) smear screening among foreign-born Latinas, US-born Latinas, and non-Latina whites were the outcome measures. RESULTS: Foreign-born Latinas had the highest rates of never receiving mammography, clinical breast examinations, and Pap smears (21%, 24%, 9%, respectively) compared with US-born Latinas (12%, 11%, 7%, respectively) and non-Latina whites (9%, 5%, 2%, respectively). After controlling for socioeconomic factors, foreign-born Latinas were more likely to report mammography use in the previous 2 years and Pap smear in the previous 3 years than non-Latina whites. Lack of health insurance coverage was the strongest independent predictor of low utilization rates for mammography (odds ratio [OR] = 2.05; 95% confidence interval [CI], 1.53-2.76), clinical breast examinations (OR = 2.29; 95% CI, 1.80-2.90) and Pap smears (OR = 2.89; 95% CI, 2.17-3.85.) CONCLUSIONS: Breast and cervical cancer screening rates vary by ethnicity and nativity, with foreign-born Latinas experiencing the highest rates of never being screened. After accounting for socioeconomic factors, differences by ethnicity and nativity are reversed or eliminated. Lack of health insurance coverage remains the strongest predictor of cancer screening underutilization.

Adolescent↗

PubMed2006

Organization of cervical cancer screening in Campinas and surrounding region, São Paulo State, Brazil.

Cervical cancer screening remains a challenge in developing countries due to a complex array of problems. This paper aimed to describe the experience with organization of cervical cancer screening in three districts of Campinas and the surrounding region in São Paulo State, Brazil, and to report the resulting data. The program was organized in a pyramid format, and the health care hierarchy was defined according to the complexity and total number of medical procedures. Screening has been extended currently to 88 municipalities, of which 51 are equipped with colposcopy and eight have facilities for treating advanced cervical cancer. The standardized incidence rate for cervical cancer in Campinas was 14.2/100,000 women per year in 1993-1995, and the standardized mortality rate per district ranged from 2.7 to 3.0 per 100,000 women in 1997-1998. This project has clearly shown that hierarchical and decentralized organization of health procedures is a necessary condition for achieving the goals of an effective cervical cancer screening program.

Brazil↗

PubMed2004

Preferences of husbands and wives for outcomes of prostate cancer screening and treatment.

OBJECTIVE: To explore the preferences of male primary care patients and their spouses for the outcomes of prostate cancer screening and treatment, and quality of life with metastatic prostate cancer. DESIGN: Cross-sectional design. SETTING: Primary care clinics in Galveston County, Texas. PATIENTS: One hundred sixty-eight couples in which the husband was a primary care patient and a candidate for prostate cancer screening. MEASUREMENTS AND MAIN RESULTS: Preferences were measured as utilities for treatment outcomes and quality of life with metastatic disease by the time trade-off method for the husband and the wife individually and then conjointly for the couple. For each health state considered, husbands associated lower utilities for the health states than did their wives. Couples' utilities fell between those of husbands and wives (all comparisons were significant at P <.01). For partial and complete impotence and mild-to-moderate incontinence, the median utility value for the wives was 1.0, indicating that most wives did not associate disutility with their husbands having to experience these treatment complications. CONCLUSIONS: Male primary care patients who are candidates for prostate cancer screening evaluate the outcomes of prostate cancer treatment and life with advanced prostate cancer as being far worse than do their wives. Because the choice between quantity and quality of life is a highly individualistic one, both the patient and his partner should be involved in making decisions about prostate cancer screening. J

Aged↗

PubMed1996

The influence of risk factors on breast carcinoma screening of Medicare-insured older women. National Cancer Institute Breast Cancer Screening Consortium.

BACKGROUND: It is not certain whether older women with additional breast carcinoma risk factors are adequately screened or whether they are more likely to undergo screening than other older women. This study was conducted to determine whether selected risk factors influence the breast carcinoma screening rates of Medicare-insured older women (i.e., age 65 years or older). METHODS: Self-reported rates of screening mammography and clinical breast examination in the previous year were compared for women with benign breast disease, women with a family history of breast carcinoma, and women lacking these risks, using samples of non-Hispanic white, Medicare-insured women surveyed at the 5 National Cancer Institute Breast Cancer Screening Consortium sites in 1991 (n = 5376, mean age = 69.7 years) and 1994 (n = 5086, mean age = 69.7 years). RESULTS: In 1993, rates of screening mammography reported in the previous year at the 5 Consortium sites had a range of 46-61% for women with a family history of breast carcinoma, 49-66% for women with benign breast disease, and 31-43% for women lacking these risks. Women with a positive family history or a personal history of benign breast disease were also more likely to report having had a clinical breast examination in the previous year and having received a physician's mammography recommendation. A substantial proportion of older women with a positive family history remain inadequately screened, however. Between 25% and 35% of women in this group had not had a screening mammogram in the previous 2 years, while at some Consortium sites more than 20% reported never having had a mammogram in their lives. CONCLUSIONS: Older women with additional risk factors are more likely to undergo screening mammography. This is due partly to more frequent physician recommendations for screening and partly to more frequent provision of clinical breast examinations. However, a substantial proportion of high risk older women remain inadequately screened, despite widespread clinical consensus that these women should be regularly screened. Interventions that target older women with risk factors and their physicians appear warranted. Understanding the mechanisms by which risk factors influence screening is an important area for future research.

Aged↗

PubMedDate not supplied

Self-reported reasons men decide not to participate in free prostate cancer screening.

PURPOSE: To determine the reasons why men fail to participate in a free prostate cancer screening. DESIGN: Survey and secondary analyses using correlational design. SETTING: Community sites in the Southeastern United States. SAMPLE: The sample (N = 241) ranged in age from 40-68 years. Mean age was 50 years (SD = 7.4). Most of the men were African American (79%) and married (70%). Almost half of the subjects (44%) earned between $9,601 and $25,020 per year. METHOD: Telephone survey of men who did not participate in initial prostate cancer screening after educational program. MAIN RESEARCH VARIABLES: Demographics, self-reported reasons men decided not to participate in a free screening following a prostate cancer educational program, and predictors for subsequent participation in screening. FINDINGS: The main self-reported reason for not participating in a free prostate cancer screening opportunity was time problems. A significant relationship between income and physician problems existed among the men who did not participate. Twenty-one percent of the 241 men participated in a second opportunity for free prostate cancer screening. Men who cited "lost packet" as their reason for not participating in the first free screening were more than twice as likely to go for the second opportunity for free screening when offered another packet or voucher for a free screening with their physician of choice. CONCLUSIONS: "Time problems" was the most frequent self-reported reason men gave for failure to participate. Providing a follow-up phone call and vouchers a second time for reimbursement of the cost associated with a screening increased participation. Men often need assistance with locating physicians and nurse practitioners who will file for financial reimbursement. Appointment reminders are critical. IMPLICATIONS FOR NURSING: The findings of this study of the significant relationship between income and "physician problems" for not participating has implications for healthcare providers. Future programs could provide telephone follow-up with men and remail vouchers, as needed. In addition, men could be encouraged to designate one place in their households for health-related papers (for safekeeping).

Adult↗

PubMed2005

Cancer screening and risk factor rates among American Indians.

OBJECTIVES: We examined cancer screening and risk factor patterns in California using 4 different statistical tabulations of American Indian and Alaska Native (AIAN) populations. METHODS: We used the 2001 California Health Interview Survey to compare cancer screening and risk factor data across 4 different tabulation approaches. We calculated weighted prevalence estimates by gender and race/ethnicity for cancer screening and risk factors, sociodemographic characteristics, and access to care variables. We compared AIAN men and women with members of other racial groups and examined outcomes among AIAN men and women using the 4 tabulation methods. RESULTS: Although some differences were small, in general, screening and risk factor rates among American Indians/Alaska Natives were most similar to rates among Whites when the most inclusive multiracial tabulation approach was used and least similar when the more exclusive US census "single-race" approach was used. CONCLUSIONS: Racial misclassification and undercounting are among the most difficult obstacles to obtaining accurate and informative data on the AIAN population. Our analysis suggests some guidelines for overcoming these obstacles.

California↗

PubMed1998

Predictors of participation in prostate cancer screening at worksites.

Unfortunately, African American men have a higher incidence of and a higher mortality rate for prostate cancer than White men but are less likely to participate in prostate cancer screening. This correlational survey research identifies predictors for participation in a free prostate cancer screening in 179 men, 64% of whom are African American. Each man was invited to see his personal physician for a free prostate cancer screening following a prostate cancer educational program given at his worksite. Forty-seven percent of the African American men went to their personal physician following the educational program and received a digital rectal examination (DRE) and a prostate specific antigen (PSA) screening. In the original cohort of educational program attendees, only 16% of the African Americans had obtained a DRE in the previous 12 months. However, 44% subsequently did participate in free DRE screening. Similarly, only 6% of the African American men had received a PSA screening in the previous 12 months, yet 42% obtained a PSA screening after the educational program, a sevenfold increase. Implications for allocating limited resources for education and screening to the high-risk group of African American men are discussed. This study's model of a prostate cancer educational program at worksites followed by attendees visiting their personal physician for screening could be replicated throughout the United States to increase African American men's participation in prostate cancer screening.

Adult↗

PubMed1998

Urinary symptoms as a predictor for participation in prostate cancer screening among African American men.

BACKGROUND: There are minimal data on the influence of urinary symptoms and participation in prostate cancer screening in African American men. METHODS: This correlational study examined the influence of urinary symptoms on 1) participation in a free prostate cancer screening program and 2) abnormal screening results. The 1,402 African American men in the South Carolina Prostate Cancer Project (SCPCP), mean age of 50 years, completed a survey that included self-reported urinary symptoms, participated in a prostate cancer educational program, and received a free prostate cancer screening consisting of a digital rectal examination (DRE) and prostate-specific antigen (PSA) from their personal physician. RESULTS: One in 5 men reported the presence of urinary symptoms. Over 60% of the 1,402 men participated in the free CaP screening. Among the 852 men who participated in the free prostate cancer screening, 73 (8.6%) had abnormal screening results as classified by abnormal DRE and/or PSA >4.0 ng/ml. Urinary symptoms were significant predictors, both of participation in screening (OR = 1.30, CI = 1.00, 1.70) and of obtaining an abnormal screening result (OR = 1.78, CI = 1.17, 2.72). CONCLUSIONS: Prostate cancer health education needs to include the fact that prostate cancer, in its early stages, has no urinary symptoms.

Adult↗

PubMed1986

An analysis of the mortality effect in a breast cancer screening study.

In order to better understand the effect of breast cancer screening on mortality, we use the theory of competing risks to analyse deaths from the long-term follow-up of the HIP breast cancer screening trial. We conclude that some, but not all, of the breast cancer cases detected early as a result of screening realized a benefit in terms of elimination of the risk of breast cancer mortality. Breast cancer screening appears not to affect the rate of mortality from causes of death other than breast cancer. Methodologically, we demonstrate the importance of analysing mortality separately for the breast cancer cases as well as for the entire population in a trial.

Adult↗