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PubMedDate not supplied

Access to breast cancer screening services for women with disabilities.

OBJECTIVE: To identify barriers to breast cancer screening services encountered by women with physical disabilities. DESIGN: Phenomenologic design using a semi-structured interview guide to explore the experiences of women with disabilities seeking breast cancer screening services. SETTING: Face-to face interviews conducted in the homes of women from the urban and rural mid-south. PATIENTS/PARTICIPANTS: A purposive sample of women with motor or sensory disabilities, age 21 to 65, was recruited for this study based on community type and type and severity of disability. Community collaborators working with people with disabilities identified eligible participants. RESULTS: Although the study focused on breast cancer screening services, women also described financial, architectural, environmental, and attitudinal barriers that affected all of their health care services. Women described poor transportation, heavy doors, and inaccessible exam tables and bathrooms. They felt devalued by their providers and believed that their symptoms were often overlooked. Women with disabilities want to be partners in their own health care. CONCLUSIONS: Women with physical disabilities face both financial and nonfinancial barriers to access that may result in delayed detection and increased risk of poorer outcomes from breast cancer. Providers require education about working with women with disabilities.

Adult↗

PubMed1998

Case-control studies of cancer screening: theory and practice.

This review summarizes methodologic theories for the design of cancer screening case-control studies and examines the methods applied in studies published in English from 1980 through 1996. In addition to summarizing state-of-the-art methodologic approaches, we identify areas where obvious gaps exist between theory and practice, and we recommend potential areas where theory and methodology may need further development. In particular, we focus on three major areas: 1) the selection of case and control subjects, 2) the definition of exposure (i.e., exposure to the screening test), and 3) bias. Each area is considered carefully by summarizing current theory, reviewing cancer screening applications, and linking recommended methodologic approaches to those used in practice to identify areas where inconsistencies exist. In general, we found methodologic theory and practice in this field of research to be consistent. However, discrepancies were identified in the area of exposure definition, including the use of screening frequency and the use of a detectable, curable preclinical phase for case subjects as the exposure measures. Even when recommended methods were followed, a number of difficulties arose in practice. Specific concerns included the ability to carry out the following: identifying all case subjects within a source population, defining eligibility criteria to ensure that case and control subjects had equal access to screening during the exposure period, distinguishing between symptomatic and diagnostic tests, and controlling for self-selection bias. Careful scrutiny is warranted in all aspects of the design of cancer screening case-control studies, and caution is advised in the interpretation of study results.

Case-Control Studies↗

PubMed2006

Knowledge, barriers, and predictors of colorectal cancer screening in an Appalachian church population.

INTRODUCTION: This study examined knowledge about and barriers to colorectal cancer screening and predictors of screening adherence among members from 16 Appalachian churches as part of a larger study on the prevention and early detection of colorectal cancer. METHODS: Baseline data were collected on 839 respondents aged 50 years and older through a self-administered survey, and 23 focus groups were conducted with 205 church members RESULTS: Survey results showed that older age, male sex, being current for other cancer screening, being physically active, having perceived support from others for screening, better provider communication, knowledge about screening guidelines, greater perceived susceptibility to colorectal cancer, and a family history of the disease were predictors of screening adherence. Major barriers to screening in both surveys and focus groups were failure of providers to recommend screening, lack of knowledge about the need for screening, and the belief that screening was not necessary without symptoms. Fear of cancer, lack of knowledge about screening methods other than colonoscopy, reliance on physicians for screening information, and the need for people to feel at risk for screening to occur were other findings from the focus groups. Focus groups supported survey findings and provided further insights. CONCLUSION: Several factors predictive of colorectal cancer screening in this study can be modified through educational interventions. Recognizing and changing risk factors for colorectal cancer, raising awareness of screening guidelines, and encouraging adults aged 50 years and older to discuss screening with their health care provider could increase colorectal cancer screening.

Aged↗

PubMedDate not supplied

Patient education regarding cancer screening guidelines.

A diverse group of agencies and organizations issues various cancer screening recommendations, which can confuse patients and healthcare providers. After risk for a particular cancer is understood, screening recommendations can be made. Healthcare providers should scrutinize carefully why particular recommendations are made and disclose the rationale to patients. Patients need to understand the strengths, limitations, risks, costs, and expected outcomes associated with recommendations for screening. Well-informed healthcare providers can encourage and facilitate dialogue with patients about cancer screening and help them make informed health promotion decisions. At the end of this article, an evidence-based pull-out reference sheet reviews the American Cancer Society's cancer screening recommendations.

American Cancer Society↗

PubMed2005

Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice.

BACKGROUND: Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening. METHODS: We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50-75 years old recruited from an academic internal medicine practice. RESULTS: Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask) before viewing the decision aid to 3.2 afterwards (difference, 0.4; p < 0.0001, paired t-test). Most found the aid useful and reported that it improved their knowledge about screening. Sixty percent said they were ready to be tested, 18% needed more information, and 22% were not ready to be screened. Within 6 months of viewing, 43% of patients had completed screening tests. CONCLUSION: We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening. PRACTICE IMPLICATIONS: This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels.

Academic Medical Centers↗

PubMed2002

Interventions that increase use of adult immunization and cancer screening services: a meta-analysis.

PURPOSE: The relative effectiveness of the diverse approaches used to promote preventive care activities, such as cancer screening and adult immunization, is unknown. Despite many high-quality published studies, practices and policymakers attempting to improve preventive care have little definitive information on which to base decisions. Thus, we quantitatively assessed the relative effectiveness of previously studied approaches for improving adherence to adult immunization and cancer screening guidelines. DATA SOURCES: MEDLINE, the Cochrane Effective Practice and Organization of Care Review Group register, previous systematic reviews, and the Medicare Health Care Quality Improvement Project database. STUDY SELECTION: Controlled clinical trials that assessed interventions to increase use of immunizations for influenza and pneumococcal pneumonia and screening for colon, breast, and cervical cancer in adults. DATA EXTRACTION: Two reviewers independently extracted data on characteristics and outcomes from unmasked articles. Intervention components to increase use of services were classified as reminder, feedback, education, financial incentive, legislative action, organizational change, or mass media campaign. DATA SYNTHESIS: Of 552 abstracts and articles, 108 met the inclusion criteria. To assess the effect of intervention components, meta-regression models were developed for immunizations and each cancer screening service by using 81 studies with a usual care or control group. The most potent intervention types involved organizational change (the adjusted odds ratios for increased use of services from organizational change ranged from 2.47 to 17.6). Organizational change interventions included the use of separate clinics devoted to prevention, use of a planned care visit for prevention, or designation of nonphysician staff to do specific prevention activities. The next most effective intervention components were patient financial incentives (adjusted odds ratios, 1.82 to 3.42) and patient reminders (adjusted odds ratios, 1.74 to 2.75); the adjusted odds ratios ranged from 1.29 to 1.53 for patient education and from 1.10 to 1.76 for feedback. CONCLUSIONS: Rates of adult immunization and cancer screening are most likely to improve when a health care organization supports performance of these activities through organizational changes in staffing and clinical procedures. Involving patients in self-management through patient financial incentives and reminders is also likely to positively affect performance.

Adult↗

PubMedDate not supplied

A nurse-delivered intervention to reduce barriers to breast and cervical cancer screening in Chicago inner city clinics.

An 18-month intervention was implemented to increase breast and cervical cancer screening among poor African-American women in Chicago. Breast and cervical cancer screening programs were set up in two public clinics, one community-based and the other hospital-based. Nurse clinicians and public health workers were used in these programs to recruit women in the clinics and in targeted community institutions to receive free breast and cervical cancer screening. The following barriers were specifically addressed by the intervention: accessibility of screening, knowledge about breast and cervical cancers, access to followup screening examinations, and access to treatment. A computerized followup system was specifically designed to track patients. During the 18 months of the intervention, 10,829 visits were made by 7,654 low-income women. A total of 84 cases of breast cancer and 9 cases of cervical cancer were detected. Awareness of the program, as measured by a survey after the completion of the intervention, increased in both clinics compared with baseline results. Knowledge about breast and cervical cancers also increased, as measured by scores on tests given before and after a class on breast and cervical cancers. Followup rates were 86 percent for women attending the programs. More than 90 percent of the women referred for evaluation of breast abnormalities kept an appointment. In summary, the intervention was successful in reducing barriers to breast and cervical cancer detection and in attracting a high-risk group of women.

Adult↗

PubMed2006

Knowledge of colon cancer screening in a national probability sample in the United States.

This study examined colon cancer screening knowledge and potential covariates (demographic, health, health care, and cancer information seeking) among adults of at least 45 years of age. Data were analyzed from the 2003 National Cancer Institute's (NCI's) Health Information National Trends Survey (HINTS 2003), a U.S. random-digit dial study. Our sample consisted of 3,131 adults (53.6% female, 77.9% White). The colon cancer screening knowledge questions assessed whether participants had heard of the fecal occult blood test (FOBT; 73.7%), knew the recommended start age (26.1%), knew the frequency of FOBT (39.5%), had heard of flexible sigmoidoscopy or colonoscopy (84.3%), knew the start age (39.6%), and knew the frequency with which to test (12.8%). Factors associated with lower knowledge (all equal to p < .05 in a multivariate analysis) included being younger (45 to 49 years old) or older (70 years old or more), African American or non-Hispanic other, unmarried; had lower educational attainment; had not visited a health care provider in the past year; had not previously undergone FOBT; and had never looked for cancer information. This study documents low rates of colon cancer screening knowledge in the general population, and identifies subgroups where health communication interventions are most warranted.

Adult↗

PubMed2001

Interim assessment of a community intervention to improve breast and cervical cancer screening among Korean American women.

Breast and cervical cancer screening practices are suboptimal among Korean American women. A community intervention program was launched in 1996 to improve breast and cervical cancer screening among Korean American women in Alameda County, California. After 18 months, interim program assessment revealed that mammograms improved, but Pap smears, breast self-examinations, and clinical breast examinations did not change significantly. However, results were similar for the control county probably because the program was not implemented fully. Several strategies for improving program implementation are discussed including recommendations for researchers planning community intervention projects.

Adult↗

PubMed2006

Colorectal cancer screening in young patients with poor health and severe comorbidity.

BACKGROUND: Young patients with poor health and a high risk of mortality from comorbid diseases have less chance of deriving a survival benefit from colorectal cancer screening. The aim of this study was to examine the relationship between colorectal cancer screening, self-reported health status, and comorbidity in a cohort of young patients, defined as patients between the ages of 50 and 64 years. METHODS: This was a single-center study conducted at a Veterans Affairs Medical Center from October 1, 1996, to March 30, 2004. Colorectal cancer screening information was obtained from 861 outpatients who completed the 36-Item Short-Form Health Survey (measure of health status) and the Kaplan-Feinstein Index (comorbidity score). Rates of screening were examined by age, physical component summary score, and severity of comorbid illnesses. RESULTS: Of the veterans, 45.9% had undergone screening within 5 years of their index visit. Screening rates were high among patients with moderate (44.9%) and severe (45.8%) comorbidities. When stratified by age group and physical component summary quartile, there was a trend toward increasing screening rates with better health status in the 50- to 54- and 55- to 59-year age groups. In the 60- to 64-year age group, high screening rates for patients with poorer health were observed: physical component summary quartiles 1 and 2, 55.7% and 54.2%, respectively. Fifty-two patients died during the 5-year follow-up; 37 (71.2%) had undergone screening for colorectal cancer. CONCLUSIONS: Young patients with potentially reduced life expectancy are being screened for colorectal cancer at relatively high rates. Comprehensive assessment of health status and comorbidity should guide cancer screening decisions, especially in individuals with reduced life expectancy who may obtain the least benefit from screening.

Barium Sulfate↗

PubMed2003

Lung cancer screening with low-dose CT.

Screening for lung cancer is hoped to reduce mortality from this common tumour, which is characterised by a dismal overall survival, relatively well defined risk groups (mainly heavy cigarette smokers and workers exposed to asbestos) and a lack of early symptoms. In the past studies using sputum cytology and chest radiography have failed to demonstrate any reduction in lung cancer mortality through screening. One of the reasons is probably the relatively poor sensitivity of both these tests in early tumours. Low radiation dose computed tomography (CT) has been shown to have a much higher sensitivity for small pulmonary nodules, which are believed to be the most common presentation of early lung cancer. As, however, small pulmonary nodules are common and most are not malignant, non-invasive diagnostic algorithms are required to correctly classify the detected lesions and avoid invasive procedures in benign nodules. Nodule density, size and the demonstration of growth at follow-up have been shown to be useful in this respect and may in the future be supplemented by contrast-enhanced CT and positron emission tomography. Based on these diagnostic algorithms preliminary studies of low-dose CT in heavy smokers have demonstrated a high proportion of asymptomatic, early, resectable cancers with good survival. As, however, several biases could explain these findings in the absence of the ultimate goal of cancer screening, i.e. mortality reduction, most researchers believe that randomised controlled trials including several 10000 subjects are required to demonstrate a possible mortality reduction. Only then general recommendations to screen individuals at risk of lung cancer with low-dose CT should be made. It can be hoped that international cooperation will succeed in providing results as early as possible.

Humans↗

PubMed1992

Comparative study of mammography and mammary serum antigen estimation for breast cancer screening.

OBJECTIVE: To compare mammary serum antigen (MSA) levels with mammography as a screening test for breast cancer. To determine the value of MSA testing to decrease the need for women to undergo mammography. DESIGN: A blind prospective comparison of MSA levels and mammography to detect breast cancer. SETTING: Royal Women's Hospital Breast Cancer Screening Clinic. Women were mainly self-referred. RESULTS: MSA levels had a wide range in normal women and women with mammography-detected breast cancer. Mean MSA levels in women with breast cancer reflected tumour volume, but a wide range was again seen. At 60% specificity, the sensitivity of an elevated MSA level for breast cancer was 63% for invasive cancer and zero for in-situ disease. MSA levels were modestly but significantly elevated in smokers over non-smokers. CONCLUSION: The MSA level is an insufficiently sensitive or specific marker to have a role in screening for breast cancer.

Antigens, Neoplasm↗

PubMed1994

Self-reported use of cancer screening tests among Latinos and Anglos in a prepaid health plan.

OBJECTIVE: To evaluate self-reported use of cancer screening tests by Latino and Anglo prepaid health plan members, we conducted telephone interviews about the knowledge of, use of, and reason for Papanicolaou (Pap) smear, clinical breast examination, mammogram, rectal examination, fecal occult blood test, and sigmoidoscopy. METHODS: Cross-sectional telephone survey of randomly selected Kaiser Permanente Medical Care Program members in San Francisco and Alameda Counties, California. A total of 844 Latinos (432 men and 412 women) and 510 Anglos (208 men and 302 women), between 35 and 74 years of age, completed the interview. RESULTS: Overall, 97.4% of Latinas reported having had at least one Pap smear compared with 99.7% of Anglo women; 90% in each group reported a Pap smear within 3 years. A clinical breast examination within 2 years was reported by 87% of Latina and 90% of Anglo women. Seventy-six percent of Latina and 85% of Anglo women aged 35 years or more reported having had at least one mammogram; and 65% of Latina and 75% of Anglo women reported a mammogram within 2 years. Among members 40 to 74 years of age, a lower proportion of Latinos compared with Anglos reported having had at least one digital rectal examination (67% vs 80%) and one fecal occult blood test (46% vs 54%); among those 50 to 74 years of age, fewer Latinos reported at least one sigmoidoscopy (29% vs 41%). After adjusting for age, education, employment, perceived health status, marital status, and county of residence, Latinos were significantly less likely to report having had at least one digital rectal examination (odds ratio; 0.60, 95% confidence interval, 0.45, 0.79), fecal occult blood test (odds ratio, 0.77; 95% confidence interval, 0.59-1.01), and sigmoidoscopy (odds ratio, 0.70; 95% confidence interval, 0.52, 0.95). After adjusting for the same variables, Latinos were more likely than Anglos to claim forgetfulness/carelessness (75% vs 60%; odds ratio, 1.84; 95% confidence interval, 1.41-2.40) as a reason for not obtaining cancer screening tests. CONCLUSION: These data suggest that, within this prepaid health plan without direct financial barriers to cancer screening services, Latinos are less likely than Anglos to obtain selected recommended cancer screening tests.

Adult↗

PubMedDate not supplied

Veiled yet vulnerable. Breast cancer screening and the Muslim way of life.

OBJECTIVES: While multiple reports have been published in the literature that describe the effect of religion and spirituality on healthcare practices, few have been reported that attempt to describe the effect of the fundamental beliefs and customs of the followers of Islam. A qualitative study aimed toward gaining an understanding of the degree to which Islamic beliefs and customs influence followers' breast cancer screening practices was, therefore, undertaken. MATERIALS AND METHODS: The study was designed with semistructured focus groups as the primary means of gathering data. A purposefully selected sample of nine Muslim women were recruited to participate in the study. Throughout the focus group, attempts were made to engage the women in a manner that stimulated in-depth discussion of the beliefs and customs influencing breast cancer screening. RESULTS: Data revealed that the religious beliefs and customs of the Muslim women participating in the focus group significantly influenced their participation in breast cancer screening. Despite their knowledge of the benefits of regular breast cancer screening, the women indicated that they choose not to participate in available breast cancer screening programs, given that they were not structured in a manner that was consistent with the beliefs and customs of Islam. CONCLUSIONS: This study illustrates the manner and degree to which Islamic beliefs and customs can influence the breast cancer screening behavior of Muslim women and the importance of carefully designing breast health programs tailored to the needs of this population of women.

Adult↗

PubMed2005

Recollection of previous colon cancer screening in Minnesota adults.

Regularly scheduled screening of patients has been shown to be effective for decreasing morbidity and mortality from colorectal cancer. We used a questionnaire to assess patients' ability to accurately recall the date and type of their most recent colorectal cancer screening. The study included 200 consecutive patients whose records indicated they had undergone previous colorectal cancer screening (8 patients were later excluded because they had been screened more than 5 years earlier). Overall, 32.3% of patients could not recall the date of their last colorectal cancer screening, 34.3% recalled the date inaccurately, and 33.3% recalled the date accurately within 1 month. The results suggest that recall alone is not sufficient to determine the date and type of previous colorectal cancer screening, especially if the screening was performed more than a year earlier.

Aged↗

PubMed2000

Mandated coverage for cancer-screening services: whose guidelines do states follow?

OBJECTIVES: To determine the prevalence and nature of state coverage mandates for cancer screening. METHODS: We contacted insurance departments in 50 states, Washington, DC, and Puerto Rico for copies of state codes that mandate coverage of screening for breast, cervical, prostate, and colorectal cancer by private insurers. We further compared mandates, when identified, with American Cancer Society (ACS) and U.S. Preventive Services Task Force (USPSTF) guidelines for likely sources of screening recommendations. RESULTS: Forty-three states and the District of Columbia currently mandate coverage of cancer screening. Breast cancer-screening coverage was most frequently mandated (n =44), followed by cervical (n =22), prostate (n =18), and colorectal cancer screening (n =1). Twenty-three states used ACS guidelines only, 18 states used ACS and non-ACS/non-USPSTF guidelines, and 3 states used only non-ACS/non-USPSTF guidelines in development of coverage mandates. No state screening coverage mandate reflected USPSTF-screening guidelines. Of 85 mandates in place, 57 have been passed since 1990. CONCLUSIONS: Although state mandates for insurer coverage of cancer screening are common and increasing, we found noticeable inter- and intra-state variation in coverage, selection, and use of screening guidelines.

Adolescent↗

PubMed2006

Breaking down barriers to breast and cervical cancer screening: a university-based prevention program for Latinas.

INTRODUCTION: The lower rate of utilization of mammography and cervical cancer screening observed for Latinas in the United States has been attributed to cultural, economic, and linguistic barriers they may encounter. METHODS: A screening program was implemented offering cancer prevention education plus breast and cervical cancer screening to Latinas, as well as all necessary follow-up care, at no cost to the participant. RESULTS: In the first 6 years of this project, a total of 928 screening visits occurred; 53% were participants who had returned at least once for additional annual screening. Ninety-one percent of participants preferred speaking in Spanish to their health care providers; however, only 2% identified a primary care provider and 5% stated they had health care insurance. The participant characteristics and results of initial evaluation, as well as necessary follow-up studies, are presented. CONCLUSIONS: By removing economic concerns and by providing care and education through bilingual staff in a culturally sensitive environment, some of the barriers to cancer screening for Latinas were overcome. The success of the program is reflected by a high rate of return for additional annual screening by our participants.

Adult↗

PubMed1998

Behavioral science applied to cancer screening.

Behavioral science has played an important role in gaining an understanding of behavior related to use of cancer screening; however, thus far this role has been limited mainly to breast and cervical cancer screening. Progress has been made recently in identifying barriers to cancer screening in underserved populations, the role of provider behavior in promoting screening adherence, and in beginning to understand behavioral issues related to genetic susceptibility. Research based on behavioral science theory is increasing, and there is need for more of this type of theory-based research focused on screening for other types of cancer in addition to breast and cervical screening.

Genetic Counseling↗