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Trivedi, Usha, Toma S. Omofoye, Cindy Marquez, Callie R. Sullivan, Diane M. Benson, and Gary J. Whitman. "Mobile Mammography Services and Underserved Women." Diagnostics 12, no. 4 (April 5, 2022): 902. http://dx.doi.org/10.3390/diagnostics12040902.
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Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.
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Hine, D. "Establishing and Managing Breast Screening Services." Journal of Management in Medicine 4, no. 1 (January 1989): 67–73. http://dx.doi.org/10.1108/eb060529.
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Newman, Gina. "Social media is changing breast screening services." Cancer Nursing Practice 19, no. 1 (January 7, 2020): 14. http://dx.doi.org/10.7748/cnp.19.1.14.s12.
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Buttimer, Andreas. "Customer focus in breast cancer screening services." International Journal of Health Care Quality Assurance 22, no. 5 (July 17, 2009): 514–24. http://dx.doi.org/10.1108/09526860910975625.
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Pollack, Erica B., Daniel R. Mollura, Alice Chong, Susan C. Harvey, and John R. Scheel. "A Global Perspective on Screening." Journal of Breast Imaging 2, no. 4 (July 2020): 296–303. http://dx.doi.org/10.1093/jbi/wbaa047.
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Abstract Breast cancer is emerging as a major global public health problem. Incidence and mortality continues to rise in low- and middle-income countries (LMICs). A significant and growing disparity exists between high-income countries and LMICs in the availability of screening services and associated preventable mortality. However, population imaging-based screening programs are not appropriate for all settings. Planners should perform a thorough assessment of the target setting prior to implementing any breast cancer detection program, as appropriate guidelines vary according to the resources available. Financial, social, and cultural barriers to breast cancer care need to be addressed to sustainably improve the morbidity and mortality of the populations and make efficient use of available services. Creative approaches, such as mobile and portable imaging and bundling of services, can facilitate the installation of early breast cancer detection programs in LMICs. While image-based screening programs are not initially resource-appropriate in many LMICs, planners can work towards this goal as part of their comprehensive breast cancer detection strategy.
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Kolo, H. T. "Increasing Breast and Cervical Cancer Screening Uptake in Women of Child-Bearing Age in Niger State, Nigeria." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 213s. http://dx.doi.org/10.1200/jgo.18.85900.
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Background: Prevalence of breast and cervical cancer are on the increase in the developing countries despite the knowledge of how these diseases can be prevented through screening. Reproductive rights, Advocacy, Safe space and Empowerment Foundation (RAISE) initiated breast and cervical cancer screening program in Niger State as part of its reproductive health services. The program is hereby evaluated with the aim of improving its performance toward reducing burden of these diseases in Niger State. Aim: To evaluate the breast and cervical cancer screening program, to report the experience from the program, and to recommend necessary changes and scaling up of best practices. Methods: Audit of the breast and cervical cancer screening program was conducted. The basic components of cervical cancer screening programs; screening uptake, screening services, treatment of screen positives, follow-up and referrals were audited against previously set standards for the program. The difference in screening uptake for breast and cervical cancer was evaluated for better understanding of factors determining screening uptake in Niger state. Results: Between 18 July 2016 and 30 April 2018, 2035 women between the age of 15-75 years were screened for breast cancer and 1258 women between the age of 20-55 years were screened for cervical cancer, representing about 38% higher uptake of breast cancer screening compared with cervical cancer. The parity range of these women is 0-20. The mean age and parity for women screened during the audit period were; 35 years and 8 for breast cancer, while 29 years and 7 for cervical cancer. Fifty-two (2.56%) of the 2035 women screened for breast cancer had a palpable lump in either 1 or both breasts, while 4 (0.3%) of the 1258 women screened for cervical cancer had a positive result (aceto-white lesions) treated with cryotherapy. The women have low socioeconomic status with predominantly farmers, petty traders and housewives earning less than $2 per day. Most of the women are illiterate with little or no form of education. Other possible barriers for low uptake of breast and cervical cancer screening is lack of transportation, religious and cultural beliefs, shyness and lack of sensitization. Conclusion: Screening uptake is still very poor despite massive awareness campaign. The current awareness creation strategy has not been able to create needed demand for the available screening services. A total overhaul of awareness creation strategies is therefore advocated.
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Jenkins, C., T. T. Ngan, N. B. Ngoc, T. B. Phuong, L. Lohfeld, M. Donnelly, H. V. Minh, and L. Murray. "Strengthening Screening and Detection Services for Breast Cancer in Vietnam." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 52s. http://dx.doi.org/10.1200/jgo.18.39100.
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Background: The incidence of breast cancer has increased consistently in Vietnam over the past two decades. Data from 2012 indicates an increase from an age-standardized rate of 16.2 per 100,000 in 2002, to 23.0 per 100,000 in 2012. Despite this, and consistent studies indicating late diagnosis, there has been a lack of empirical studies on what breast cancer services exist and how they function across different levels of the Vietnamese health system. Aim: Our project sought to examine the accessibility, affordability, and appropriateness of breast cancer services in Vietnam with the objective of making recommendations to strengthen service delivery. Methods: The project used a mixed-methods approach, collecting data through self-administered questionnaires (n=69) and in-depth interviews (n=23) with health professionals working at facilities across all four levels of the Vietnamese health system (national, provincial, district, & commune). We completed in-depth interviews with women (n=12) diagnosed with breast cancer, focusing on their experiences of accessing and using services. Our study was located across three provinces, representing the northern, central, and southern regions of the country. Results: Our results show that screening activities for breast cancer in the community are not systematically organized or provided. There are no stand-alone screening campaigns for breast cancer and facility-based opportunistic screening is limited. There is scope for strengthening the primary and secondary levels of the Vietnamese health system to detect, diagnose and treat breast cancer. Increased autonomy and support for commune-level health stations to conduct screening activities, the systematic incorporation of opportunistic screening, and the extension of breast cancer-specific training for commune and district level health care staff are potential areas for strengthening. Conclusion: Our study suggests that there should be concerted efforts to implement the Ministry of Health's strategic objectives to decentralise and strengthen commune and district levels of the health system in relation to detection, diagnosis and treatment of breast cancer. No studies have been conducted that pilot interventions to provide systematic and comprehensive breast cancer services at the lower levels of the health system. Specific attention should be given to increasing autonomy and support for commune level health stations to conduct screening activities; for the systematic incorporation of opportunistic screening; and the extension of breast cancer-specific training for commune and district level health care staff.
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Paajanen, Hannu, Lea Pulliainen, Niilo Hendolin, Heikki Hermunen, Markku Helle, and Peter B. Dean. "The Demands of Screening Mammography on Surgical Inpatient Services of Breast Cancer." American Surgeon 67, no. 7 (July 2001): 648–53. http://dx.doi.org/10.1177/000313480106700712.
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A nationwide mammographic screening of women ages 50 to 59 years commenced in Finland in January 1987. We studied the demands of screening on surgical inpatient services by comparing the treatment strategy, volume of breast biopsies, and hospital stay before and after implementation of mass screening of women age 50 to 59. Approximately 20 patients per 100,000 inhabitants were referred annually from mass screening for surgical biopsies, in half of which cancer was detected. In 1985 through 1986 (before screening) we operated on 134 patients suspected of having breast cancer. After the first (in 1990) and the second (in 1995) round of mammographic screening we operated on 161 patients in 2 years suspected of having breast cancer. Concurrently 25 of 92 cancers (27%) were found only because of the screening. Before the screening period clinical symptoms and palpable tumors were cause for referral to surgery in 84 per cent of the cases and abnormal mammography in only 16 per cent. During screening these ratios were 34 and 61 per cent, respectively. The number of Tis-1 cancers (<2 cm) increased from 44 per cent before screening to 70 per cent during screening. In contrast the number of T2 cancers (2–4 cm) decreased from 40 to 20 per cent. The mammographic screening did not increase the hospital stay of patients. We conclude that the mammographic screening program of all women age 50 to 59 years increased the number of surgical biopsies in our hospital by only 30 per cent. Breast cancer was found at an earlier stage during screening. More than one-fourth of breast cancers are currently found through the mass screening program in Finland.
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Kennedy, Linda S., Suyapa A. Bejarano, Tracy L. Onega, Derek S. Stenquist, and Mary D. Chamberlin. "Opportunistic Breast Cancer Education and Screening in Rural Honduras." Journal of Global Oncology 2, no. 4 (August 2016): 174–80. http://dx.doi.org/10.1200/jgo.2015.001107.
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Purpose In Honduras, the breast cancer burden is high, and access to women’s health services is low. This project tested the connection of community-based breast cancer detection with clinical diagnosis and treatment in a tightly linked and quickly facilitated format. Methods The Norris Cotton Cancer Center at Dartmouth College partnered with the Honduran cancer hospital La Liga Contra el Cancer to expand a cervical cancer screening program, which included self-breast exam (SBE) education and clinical breast exams (CBEs), to assess patient attitudes about and uptake of breast cancer education and screening services. The cervical cancer screening event was held in Honduras in 2013; 476 women from 31 villages attended. Results Half of the women attending elected to receive a CBE; most had concerns about lactation. Clinicians referred 12 women with abnormal CBEs to La Liga Contra el Cancer for additional evaluation at no cost. All referred patients were compliant with the recommendation and received follow-up care. One abnormal follow-up mammogram/ultrasound result was negative on biopsy. One woman with an aggressive phyllodes tumor had a mastectomy within 60 days. Multimodal education about breast cancer screening maximized delivery of women’s health services in a low-tech rural setting. Conclusion The addition of opportunistic breast cancer education and screening to a cervical cancer screening event resulted in high uptake of services at low additional cost to program sponsors. Such novel strategies to maximize delivery of women’s health services in low-resource settings, where there is no access to mammography, may result in earlier detection of breast cancer. Close follow-up of positive results with referral to appropriate treatment is essential.
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Al-Hanawi, Mohammed Khaled, Rubayyat Hashmi, Sarh Almubark, Ameerah M. N. Qattan, and Mohammad Habibullah Pulok. "Socioeconomic Inequalities in Uptake of Breast Cancer Screening among Saudi Women: A Cross-Sectional Analysis of a National Survey." International Journal of Environmental Research and Public Health 17, no. 6 (March 20, 2020): 2056. http://dx.doi.org/10.3390/ijerph17062056.
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Timely and adequate screening for breast cancer could improve health outcomes and reduce health costs. However, the utilization of free breast cancer screening services among Saudi women is very low. This study aims to investigate socioeconomic inequalities in breast cancer screening among Saudi women. The data of this study were extracted from the nationally representative Saudi Health Interview Survey, conducted in 2013; the study included 2786 Saudi women. Multivariate logistic regression, the concentration curve, and the concentration index were used to examine, illustrate, and quantify income- and education-related inequalities in three outcomes: Knowledge about self-breast examination (SBE), clinical breast examination (CBE) received in the last year, and mammography, that has ever been previously carried out. Results showed a marked socioeconomic gradient in breast cancer screening services. The concentration index by income was 0.229 (SBE), 0.171 (CBE), and 0.163 (mammography). The concentration index by education was 0.292 (SBE), 0.149 (CBE), and 0.138 (mammography). Therefore, knowledge about breast cancer screening, and the utilization of screening services, were more concentrated among richer and better-educated women. Poorer and less educated women had less knowledge about self-breast examination, and had considerably less adherence to clinical breast examination and mammography. The findings are helpful for policy makers to devise and implement strategies to promote equity in breast cancer screening among Saudi women.
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Gaans, Deborah Van, Neil Coffee, Mark Daniel, and David Roder. "Breast Screen Service Characteristics as a Measure of Accessibility." Research in Health Science 3, no. 4 (November 29, 2018): 103. http://dx.doi.org/10.22158/rhs.v3n4p103.
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<p><em>Breast Screen Australia is a national breast cancer screening program which aims to reduce illness and death from breast cancer through early detection using mammography. Through this program women aged 40 and over in Australia are eligible for a free mammogram every two years. Around 55% of the target population participate in the program. Understanding the accessibility of breast screen services has the potential to improve the uptake of screening services. Spatial analysis of individual breast screen services: opening hours, disability and accessibility infrastructure, parking and transport data can be used to describe the accessibility of breast screen services. Through highlighting regional accessibility to breast screen services it is possible to identify regions where accessibility to services could be increased to improved equity in health service provision.</em></p>
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Majeed, Ayesha Isani, Assad Hafeez, and Shahzad Ali Khan. "Strengthening Breast Cancer Screening Mammography Services in Pakistan Using Islamabad Capital Territory as a Pilot Public Health Intervention." Healthcare 10, no. 6 (June 14, 2022): 1106. http://dx.doi.org/10.3390/healthcare10061106.
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Late diagnosis of treatable breast cancer is the reason for higher breast cancer mortality. Until now, no public breast cancer facility has been established in the Islamabad Capital Territory. First, a Federal Breast Screening Center (FBSC) was established. Afterward, awareness campaigns about breast cancer were organized among the public. Subsequently, women above 40 years of age were provided with mammography screenings. Data were analyzed in SPSS version 22.0. An intervention was performed using a six tier approach to strengthening the health system. Utilizing the offices of the FBSC and the national breast cancer screening campaign, breast cancer awareness has become a national cause and is being advocated by the highest offices of the country. The number of females undergoing mammography has increased each year, starting from 39 in 2015 to 1403 in 2019. Most of the cases were BI-RAD I (n = 2201, 50.74%) followed by BI-RAD II (n = 864, 19.92%), BI-RAD III (n = 516, 11.89%), BI-RAD IV (n = 384, 8.85%), BI-RAD V (n = 161, 3.71%), and BI-RVAD VI (n = 60, 1.38%). The current study has theoretical and practical implications for the contemplation of policymakers. The FBSC can serve as a model center for the establishment of centers in other parts of the country, thereby promoting nationwide screening coverage.
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Hedges, S., M. Davidson, S. Forrester, A. Casey, V. Pridmore, A. Cooper, A. Beauchamp, and N. McGrath. "A Breast Screening Shawl to Help Aboriginal Women Feel More Comfortable and Culturally Safe." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 40s. http://dx.doi.org/10.1200/jgo.18.11200.
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Background: It is recommended that Australian women aged 50-74 have a breast screen every two years. Aboriginal women have lower breast screening participation than the general population, and face barriers at a system, service and individual level including: • Cultural: lack of cultural awareness/safety at screening services • Fear: historical apprehension about health services due to the after effects of colonization and intergenerational trauma • Shame: feeling embarrassment/shame at being undressed in front of a stranger • Past experience: having a past unpleasant breast screen, or hearing about someone else' • Knowledge: lack of knowledge about screening • Logistics: not knowing service provider locations or limited access to transport During a 2016 project between BreastScreen Victoria (BSV) and Women's Health West, Aboriginal women discussed the need for a shawl to cover them during screening. This idea is based on a successful New Zealand model. Based on this, the Victorian Aboriginal Health Service (VAHS), Victorian Aboriginal Community Controlled Health Organization (VACCHO) and BSV formed a partnership to trial a breast screening shawl with Aboriginal women. A key principle underpinning the project is that success will reflect the degree to which this is an Aboriginal-led initiative, driven by the needs of Aboriginal women, and steered by community-based Aboriginal health organizations. Project aims: • Assess whether a cultural, strength based screening process increases engagement of Aboriginal women • Determine whether a screening shawl enhances comfort and culturally safety • Encourage breast screening services to develop culturally safe screening practices • Develop a flexible model that can be easily adapted by other Aboriginal health services to reproduce the shawl, in recognition of the diversity of Aboriginal communities Methods: This project adopted the following strategies: • A project steering group was established • The shawl will be trialled via a group booking at one BSV clinic • Before the group booking, BSV clinic staff will attend culturally safety training • On the trial day, women will attend an information session at VAHS about breast screening and receive their shawl, travel to the BSV clinic together for screening, and return to VAHS to discuss their experiences Results: The trial will be fully evaluated in 2018 to determine whether project aims were achieved. Conclusion: Key learnings to date are: • Breast screening interventions for Aboriginal women must be community-led to ensure they are culturally appropriate, safe and acceptable • Aboriginal women face a number of barriers to breast screening at a system, service and individual level • Health services play a critical role in adopting culturally safe screening practices • Developing a flexible model that can be easily adapted by other Aboriginal health services is critical in ensuring the sustainability and acceptability of the shawl.
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O'Brien, T. E., A. Peacock, and J. T. Stevenson. "Improving breast cancer screening for indigent minorities: A county hospital cancer center's experience." Journal of Clinical Oncology 25, no. 18_suppl (June 20, 2007): 17020. http://dx.doi.org/10.1200/jco.2007.25.18_suppl.17020.
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17020 Background: Indigent, minority women with breast cancer present with later stage disease, often because of lack of access to affordable screening tests. Breast exam and mammography are effective at early detection. A screening program targeting minority women is important, especially in an area with a high poverty rate. The most effective way to reach this population, though, has not been well established. Methods: From 11/03–7/05, 4 breast cancer screenings were performed at our cancer center which targeted poor, minority populations in the Cleveland area. Despite culturally appropriate advertisements and free exams by physicians, only 42 women were screened. To improve upon this, a bilingual community breast liaison was hired. An advisory council of community representatives was established which led to collaborations with over 100 neighborhood agencies. The venue for the screenings was changed to easily accessible locations (churches, shelters) and transportation was provided. Free clinical breast exams (CBE) were performed by experienced physicians and on-site mammograms (mam) were done. From 10/05–10/06, 7 community breast screenings were held. 403 women were screened and over 2000 were educated. Results: 98% were impoverished; 94% had an annual income of <$25,000. 78% had no health insurance. Median age=46 (range 35–89). 31% Latino; 46% AA; 16% Caucasian. Many pts had not had a mam (91%) or CBE (84%) within the past year; many never had either screening test before (31% never had a mam and 17% never had a CBE). The most common reason for this was lack of insurance (60%). “Too young” was the second most common reason (7%). Most common reason for coming to screenings: free services (49%). Of 403 pts screened, 27/371 had abnormalities on CBE and 26/293 mam were abnormal. Thus far, 2 cases of breast cancer have been diagnosed (stages I and II). Conclusion: Indigent minority women do not receive adequate breast cancer screening due to many barriers, including cost. To reduce this disparity, our center targeted this population. After adjusting our approach, screening attendance markedly improved, increasing from 42 to 403 pts screened. This improvement was due to cancer center services being brought out to the community and an active engagement of community organizations. No significant financial relationships to disclose.
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Olasehinde, Olalekan, Olusegun I. Alatise, Olukayode A. Arowolo, Victoria L. Mango, Olalere S. Olajide, Adeleye D. Omisore, Carla Boutin-Foster, and Thoms P. Kingham. "Barriers to Mammography Screening in Nigeria: A Survey of Two Communities With Different Access to Screening Facilities." Journal of Global Oncology 4, Supplement 3 (October 2018): 31s. http://dx.doi.org/10.1200/jgo.18.10350.
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Purpose Breast cancer outcomes are poor in most low- and middle-income countries. This is a result, in part, of delayed presentation. Critical to improving this gloomy picture is the promotion of breast cancer screening programs; however, designing a formidable screening program requires obtaining necessary background data. This survey evaluates breast cancer screening practices and barriers in two Nigerian communities with different geographic access to screening facilities. Methods We administered a 35-item questionnaire to women age 40 years and older—1,169 participants (52.6%) in the Ife Central Local Government, where mammography services are offered, and 1,053 (47.4%) in the Iwo Local Government, where there are no mammography units. Information on breast cancer screening practices and barriers to mammography screening were compared between the two communities. Results Most women had heard of breast cancer (Ife, 94%; Iwo, 97%), but few have had any form of breast cancer screening recommended to them—37.7% of Ife respondents and 36.6% of Iwo respondents. Few women were aware of mammography (Ife, 11.8%; Iwo, 11.4%), whereas mammography uptake was 2.8% Ife respondents and 1.8% in Iwo respondents, despite the latter offering mammography services. Awareness and practice of mammography were not statistically different between the two communities ( P = .74 and P = .1 for Ife and Iwo, respectively). Lack of awareness was the most common reason cited for not undergoing mammography in both communities. Cost was also identified as a barrier, as only 20% of respondents could afford mammography. Despite being offered at little or no cost, uptake of clinical breast examination (CBE) was poor in both communities—27.4% in Iwo and 19.7% in Ife; however, the majority were willing to participate in a routine CBE-based breast cancer screening program. Conclusion Access without awareness and community mobilization does not guarantee use of breast cancer screening services. Given the above findings, a comprehensive breast health program that incorporates awareness creation, routine CBE-based screening, and selective mammography is currently underway in a selected Nigerian community. AUTHORS' DISCLOSURES OF POTENTIAL CONFLICTS OF INTEREST No COIs from the author
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K, Dr Latha. "Opportunities for medical college hospital to promote utilization of can-cer cervix screening services among rural women." JOURNAL OF CLINICAL AND BIOMEDICAL SCIENCES 06, no. 2 (June 15, 2016): 71–72. http://dx.doi.org/10.58739/jcbs/v06i2.9.
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The estimated global burden for new cases of uterine cervical cancer is 7.9% of all new cancer cases and 7.5% of all female cancer deaths. Globally cervical cancer is the fourth most common cancer in women after breast, colorectal and lung cancer and in the WHO south east Asian region (SEAR) it is the second most common cancer after breast cancer
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DeAngelis, Catherine D. "US Preventive Services Task Force and Breast Cancer Screening." JAMA 303, no. 2 (January 13, 2010): 172. http://dx.doi.org/10.1001/jama.2009.1990.
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Kosar, Sumreen. "Harms and Benefits of Mammography Screening." YMER Digital 21, no. 05 (May 2, 2022): 7–16. http://dx.doi.org/10.37896/ymer21.05/02.
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Mammography is one of the most technically challenging areas of radiography, required high spatial resolution, excellent soft tissue contrast and low radiation dose. Mammography screening for breast cancer is worldwide available. Early detection of breast cancer through screening can lower breast cancer mortality rate and reduce the burden of this disease in the population, the benefits and harms of mammography screening have been debated in the past years. This review discuss the benefits and harms of mammography screening in light of findings from randomized trials and more recent observational studies performed in the era of modern diagnosis. The main benefit for mammography screening is reduces the risk of dying from breast cancer. Reduction vary from 15 to 20% in randomized trials to more recent estimates of 13 to 17% in analyses of observational studies. UK data of 2007 shows that for 1,000 women invited to biennial mammography screening for 20years to 50years age, 2-3 women’s are prevented from breast cancer. Main harm of mammography screening is the over diagnosis of breast cancer. 15 women’s over diagnosis for every 1000 women invited to biennial screening for 20 years from 50 years age. In an era of limiting health care services, screening services need to scrutinized and compared with each other regard to effectiveness, cost effectiveness and harms.
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Rockson, Lois, Margaret Swarbrick, and Carlos Pratt. "Cancer Screening in Behavioral Health Care Programs." Journal of the American Psychiatric Nurses Association 26, no. 2 (October 3, 2019): 212–15. http://dx.doi.org/10.1177/1078390319877227.
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OBJECTIVE: Adults with serious mental illnesses have a lower life expectancy attributable to many factors including metabolic disorders and cancer. Access to cancer screening has been shown to decrease morbidity and increase chances of survival. This study examined access to cancer screening services among individuals with serious mental illnesses served by a community behavioral health care agency partial hospitalization program at four locations. METHOD: A self-administered paper-and-pencil survey was provided to adults attending partial hospitalization programs. The survey consisted of open- and closed-ended questions about utilization, access to, and barriers to cervical, breast, and colorectal cancer screenings. RESULTS: Surveys were completed by 136 individuals. Participant screening rates were above national rates for cervical and breast cancer but lower for colorectal cancer. The main cited barrier to receiving the screening tests was lack of physician recommendations. CONCLUSIONS: Psychiatric nurses are ideally suited to communicate with this population and other behavioral health care professions about the importance of these screenings. Communication should also advocate for improved education and increased support for cancer screenings to address this health care disparity.
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Pandya, Tanvi, Zixuan Liu, Hankiz Dolan, Jolyn Hersch, Meagan Brennan, Nehmat Houssami, and Brooke Nickel. "Australian Women’s Responses to Breast Density Information: A Content Analysis." International Journal of Environmental Research and Public Health 20, no. 2 (January 16, 2023): 1596. http://dx.doi.org/10.3390/ijerph20021596.
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Breast density (BD) is an independent risk factor for breast cancer and reduces mammographic sensitivity. This study explored women’s responses and intentions if notified that they had dense breasts. Methods: Content analysis was used to assess responses from a written questionnaire undertaken in conjunction with focus groups on BD involving 78 Australian women aged 40–74. Results: Half the women reported that they would feel a little anxious if notified they had dense breasts, while 29.5% would not feel anxious. The most common theme (29.5%) related to anxiety was the psychosocial impact of the possibility of developing cancer, and women believed that being better informed could help with anxiety (26.9%). When asked what they would do if notified of having dense breasts, the most common response was to consult their doctor for information/advice (38.5%), followed by considering supplemental screening (23%). Consequently, when asked directly, 65.4% were interested in undergoing supplemental screening, while others (10.3%) said they “wouldn’t worry about it too much”. Discussion: These findings have important implications for health systems with population-based breast screening programs that are currently considering widespread BD notification in terms of the impact on women, health services and primary care.
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Bowen, Michael E., Deepa Bhat, Jason Fish, Brett Moran, Temple Howell-Stampley, Lynne Kirk, Stephen D. Persell, and Ethan A. Halm. "Improving Performance on Preventive Health Quality Measures Using Clinical Decision Support to Capture Care Done Elsewhere and Patient Exceptions." American Journal of Medical Quality 33, no. 3 (October 14, 2017): 237–45. http://dx.doi.org/10.1177/1062860617732830.
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Preventive services required for performance measurement often are completed in outside health systems and not captured in electronic medical records (EMRs). A before–after study was conducted to examine the ability of clinical decision support (CDS) to improve performance on preventive quality measures, capture clinician-reported services completed elsewhere, and patient/medical exceptions and to describe their impact on quality measurement. CDS improved performance on colorectal cancer screening, osteoporosis screening, and pneumococcal vaccination measures ( P < .05) but not breast or cervical cancer screening. CDS captured clinician-reported services completed elsewhere (2% to 10%) and patient/medical exceptions (<3%). Compared to measures using only within-system data, including services completed elsewhere in the numerator improved performance: pneumococcal vaccine (73% vs 82%); breast (69% vs 75%), colorectal (58% vs 70%), and cervical cancer (53% vs 62%); and osteoporosis (72% vs 75%) screening ( P < .05). Visit-based CDS can capture clinician-reported preventive services, and accounting for services completed elsewhere improves performance on quality measures.
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Klinger, Kimberly, Brian Dontchos, Sarah Mercaldo, Janeiro Achibiri, Gary Wang, Randy Miles, Leslie Lamb, and Constance Dobbins Lehman. "Time to biopsy of screening mammography-detected abnormalities: Evaluating the impact of same-day services implemented during the COVID-19 pandemic." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): 1511. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.1511.
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1511 Background: Screening mammography programs often require patients undergo multiple visits (screening exam, diagnostic exam, and biopsy) before tissue diagnoisis of screen-detected abnormalities. During the COVID-19 pandemic, same-day breast imaging services were leveraged to decrease the number of visits following abnormal screening exams. Specifically, in May 2020, we implemented an immediate-read screening mammography program to synergize with our pre-existing same-day breast biopsy program, such that every effort was made to perform diagnostic imaging during the same visit after an abnormal screening mammogram. This study aims to evaluate the impact of these same-day breast imaging services on time and number of patient visits to undergo breast biopsy after an abnormal screening mammogram. Methods: Consecutive screening mammograms performed during normal business hours pre- (6/1/16 to 5/30/17) and post-implementation (6/1/20 to 5/30/21) of same-day services were identified. Patient demographics, imaging and biopsy results, and visit dates were extracted from the medical record. Multivariable logistic, linear, and ordinal regression models estimated with generalized estimating equations were fit to assess the association of period (pre- versus post-implementation), patient age, and race and ethnicity (White versus races other than White) with having a same-day biopsy (biopsy on the same day as the abnormal screening exam), number of days to biopsy, and number of visits. Adjusted odds ratios (aOR) and beta estimates (aBeta) of each covariate and corresponding 95% confidence intervals (CI) were estimated. Results: A total of 409/25,922 (1.6%) of patients (median age 61, IQR 50-70) pre-implementation and 221/20,452 (1.1%) patients (median age 62, IQR 49-71) post-implementation had screen-detected abnormalities leading to diagnostic breast imaging and biopsy. Median number of days from screening to biopsy decreased from 16 days pre-implementation to 5 days post-implementation (p < 0.001). Pre-implementation, 86.8% of patients required 3 visits between screening and biopsy, while post-implementation only 23.1% required 3 visits (p < 0.001). Compared to pre-implementation, the post-implementation period was associated with increased odds of undergoing same-day biopsy (aOR 20.7, 95% CI 8.3-51.7), p < 0.001), fewer days from abnormal screening mammogram to biopsy (aBeta -13.3, 95% CI -15.7 to -10.9, p < 0.001), and fewer visits (aOR 0.05, 95% CI 0.02-0.09), p < 0.001), controlling for age and race and ethnicity. Conclusions: Same-day breast imaging services decreased time and patient visits between abnormal screening mammogram and breast biopsy. Same-day services implemented out of necessity during the COVID-19 pandemic should be continued after the pandemic has subsided to improve timeliness of care.
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Skop, Michelle, Justin Lorentz, Mobin Jassi, Danny Vesprini, and Gillian Einstein. "“Guys Don’t Have Breasts”: The Lived Experience of Men Who Have BRCA Gene Mutations and Are at Risk for Male Breast Cancer." American Journal of Men's Health 12, no. 4 (February 5, 2018): 961–72. http://dx.doi.org/10.1177/1557988317753241.
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Men with BRCA1 or BRCA2 gene mutations are at increased risk of developing breast cancer and may have an indication for breast cancer screening using mammography. Since breast cancer is often viewed as a woman’s disease, visibilizing and understanding men’s experience of having a BRCA mutation and specifically, of screening for breast cancer through mammography, were the objectives of this research study. The theoretical framework of interpretive phenomenology guided the process of data collection, coding, and analysis. Phenomenology is both a philosophy and research method which focuses on understanding the nature of experience from the perspectives of people experiencing a phenomenon, the essence of and commonalities among people’s experiences, and the ways in which people experience the world through their bodies. Data were collected via in-depth interviews with a purposive sample of 15 male participants recruited from the Male Oncology Research and Education (MORE) Program. This article reports findings about participants’ use of gender-specific language to describe their breasts, awareness of the ways in which their bodies changed overtime, and experiences of undergoing mammograms. This study is the first to describe men with BRCA’s perceptions of their breasts and experiences of mammography in a high-risk cancer screening clinic. This study sheds light on an under-researched area—breasts and masculinities—and could potentially lead to improved clinical understanding of men’s embodied experiences of BRCA, as well as suggestions for improving the delivery of male breast cancer screening services.
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Zhang, Wei, Sally Rose, Alison Foster, Sue Pullon, and Beverley Lawton. "Breast cancer and breast screening: perceptions of Chinese migrant women living in New Zealand." Journal of Primary Health Care 6, no. 2 (2014): 135. http://dx.doi.org/10.1071/hc14135.
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INTRODUCTION: Migrant Chinese constitute a significant and increasing proportion of New Zealand women. They have lower rates of participation in breast cancer screening than other New Zealanders, but reasons for this are unknown. The aim of this study was to investigate factors affecting Chinese womens understanding of, and access to, breast health services, to better understand reasons for low participation in screening and their experiences of breast cancer clinic care. METHODS: The participants were 26 Chinese migrant women 19 recruited in the community and seven recruited from 17 eligible women attending a breast clinic between 2008 and 2010 in Wellington, New Zealand. The design was that of a qualitative study, using semi-structured interviews and thematic content analysis. FINDINGS: There were low levels of awareness about the national breast screening programme and limited engagement with preventive primary care services. Concerns about privacy and a range of communication difficulties were identified that related to oral language, lack of written information in Chinese, and limited understanding about Chinese perceptions of ill health and traditional Chinese medicine by New Zealand health professionals. CONCLUSION: Addressing communication barriers for Chinese migrant women has the potential to raise awareness about breast cancer and breast health, and to increase successful participation in breast cancer screening. Greater efforts are needed to ensure this group has an understanding of, and is engaged with a primary care provider. Such efforts are key to improving health for this growing sector of the New Zealand population. KEYWORDS: Breast cancer; Chinese; mammography; mass screening; New Zealand
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DeGennaro, V., M. Gibbs, C. Wilson, N. Louis, D. Kanyandekwe, and C. Petterson. "Women's Cancer Screening in Haiti: Increasing Access by Bringing Services to the Workplace." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 209s. http://dx.doi.org/10.1200/jgo.18.84300.
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Background: Cervical cancer is the leading cause of cancer-related death in Haiti yet the country does not provide sufficient screening. Working class women in Haiti are less likely to receive cancer screening or education than the poorest quartile of women. This is an untouched demographic not necessarily because of financial burdens but because most women work 6 days weekly and lack the time to seek healthcare and appropriate screening. Innovating Health International (IHI) and Share Hope recently implemented a cancer screening program using vaginal HPV self-swabs and clinical breast exams for working class women in Port-au-Prince. Aim: To not only bring much needed cervical cancer education, screening and treatment to an unreached demographic but also to assess the plausibility and acceptance by female factory workers to receive routine screening and treatment in clinics that reside within the workplace. Methods: The project began in September 2017 and will run for 12 months with plans to screen 4000 women with vaginal HPV swabs (QIAGEN careHPV) and clinical breast exams. Nurses perform clinical breast exam, teach self-breast exam, and instruct patients how to perform vaginal self-swab in the factory infirmary. Inclusion criteria for women include age 30 to 50 years. Women who screen positive for HPV will then be followed with visual inspection of the cervix with acetic acid (VIA) and thermocoagulation. Those who have suspicious masses in their breast have a breast ultrasound performed at the factory clinic. A smaller percentage of women with advanced disease will be referred to outside gynecology clinics. Results: Data collection is half-way completed and we´ll present full data in October. Over 3122 women have participated and received education on women's health issues during their lunch hour at the factories. Of all those sensitized, 2691 or 86.1% chose to have clinical breast exam. Of those who are eligible for HPV screening, 1948 or 93.8% of those eligible accepted testing. Of those tested, 344 or 16% were HPV-positive and all but a 5 completed VIA. For women who are HPV-positive, 69 or 20% were also VIA positive. All HPV-positive women received thermocoagulation except for 2, who were referred for colposcopy and loop electrocautery excisional procedure. There were 141 women who had a positive clinical breast exam and underwent breast ultrasound with only 2 requiring a biopsy. Conclusion: We seek to expand access to cervical cancer screening for the rural and working poor through using mobile health technologies coupled with community-based education and screening. HPV-positive women can undergo treatment by a traveling nurse with portable thermocoagulation therapy where they live or work, without the need to travel or leave work. With no doctor, no electricity, no pelvic exam for most women, and no stable infrastructure, we can screen women in rural areas and the working poor at their place of employment.
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MacDonald, Madeline, Abu-Sayeef Mirza, Rahul Mhaskar, Aldenise Ewing, Liwei Chen, Katherine Robinson, Yuanyuan Lu, et al. "Preventative Cancer Screening Rates Among Uninsured Patients in Free Clinics: A Retrospective Cohort Study of Cancer Survivors and Non-cancer Survivors." Cancer Control 29 (January 2022): 107327482110729. http://dx.doi.org/10.1177/10732748211072983.
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Background There is limited research on screening rates among uninsured cancer survivors. Uninsured cancer survivors are at higher risk of poorer health outcomes than the insured due to limited access to preventative screening for secondary cancers. This study examines the rates of surveillance and screening of uninsured cancer survivors and compares to uninsured patients without a cancer history seen in free clinics. Methods Data were collected retrospectively from electronic medical records and paper charts of patients from 10 free clinics between January 2016 and December 2018 in the Tampa Bay area. The prevalence of socioeconomic characteristics, cancer diagnoses, and screening practices were compared for cancer survivors and free clinic patients without a history of cancer. Study participants were determined to be eligible for cancer screenings based on the United States Preventive Services Task Force guidelines. Results Out of 13 982 uninsured patients frequenting free clinics between 2016 and 2018, 402 (2.9%) had a documented history of cancer. Out of the 285 eligible cancer survivors, 44 (15.4%) had completed age-appropriate colon cancer screening. Among the 170 female cancer survivors, 75 (44.1%) had completed breast cancer screenings, and only 5.9% (59/246) had completed cervical cancer screenings. After adjusting for age, gender, race, salary, employment status, and household size, cancer survivors were more likely to undergo colorectal cancer screening (OR: 3.59, 95% CI: 2.10–6.15) and breast cancer screening (OR: 2.13, 95% CI: 1.30–3.84) than patients without a cancer history. This difference was not seen for cervical cancer screening (OR: 0.99, 95% CI: .62–1.58). Conclusions Uninsured cancer survivors frequenting free clinics represent a unique population that is underrepresented in the medical literature. Our results suggest that uninsured survivors use screening services at higher rates when compared to uninsured patients without a reported cancer diagnosis. However, these rates are suboptimal when compared to national screening rates of insured cancer survivors.
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DiGiulio, Sarah. "3 QUESTIONS ON... Care Disparities in Breast Cancer Screening Services." Oncology Times 43, no. 17 (September 5, 2021): 42. http://dx.doi.org/10.1097/01.cot.0000791868.13372.eb.
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Mele, Nancy, Jeanne Archer, and Burton D. Pusch. "Access to Breast Cancer Screening Services for Women With Disabilities." Journal of Obstetric, Gynecologic & Neonatal Nursing 34, no. 4 (July 2005): 453–64. http://dx.doi.org/10.1177/0884217505276158.
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Vaile, M. S. B., M. Calnan, D. R. Rutter, and Barbara Wall. "Breast cancer screening services in three areas: uptake and satisfaction." Journal of Public Health 15, no. 1 (March 1993): 37–45. http://dx.doi.org/10.1093/oxfordjournals.pubmed.a042818.
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Bitencourt, Almir GV, Carolina Rossi Saccarelli, Christiane Kuhl, and Elizabeth A. Morris. "Breast cancer screening in average-risk women: towards personalized screening." British Journal of Radiology 92, no. 1103 (November 2019): 20190660. http://dx.doi.org/10.1259/bjr.20190660.
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Breast cancer screening is widely recognized for reducing breast cancer mortality. The objective in screening is to diagnose asymptomatic early stage disease, thereby improving treatment efficacy. Screening recommendations have been widely debated over the past years and controversies remain regarding the optimal screening frequency, age to start screening, and age to end screening. While there are no new trials, follow-up information of randomized controlled trials has become available. The American College of Physicians recently issued a new guidance statement on screening for breast cancer in average-risk women, with similar recommendations to the U.S. Preventive Services Task Force and to European guidelines. However, these guidelines differ from those ofother American specialty societies. The variations reflect differences in the organizations’ values, the metrics used to evaluate screening results, and the differences in healthcare organization (individualized or state-organized healthcare). False-positive rates and overdiagnosis of biologically insignificant cancer are perceived as the most important potential harms associated with mammographic screening; however, there is limited evidence on their actual consequences. Most specialty societies agree that physicians should offer mammographic screening at age 40 years for average-risk women and discuss its benefits and potential harms to achieve a personalized screening strategy through a shared decision-making process.
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Earle, Craig C., Harold J. Burstein, Eric P. Winer, and Jane C. Weeks. "Quality of Non–Breast Cancer Health Maintenance Among Elderly Breast Cancer Survivors." Journal of Clinical Oncology 21, no. 8 (April 15, 2003): 1447–51. http://dx.doi.org/10.1200/jco.2003.03.060.
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Purpose: To assess the quality of preventive health care, the role of health care participation, and the patient and provider characteristics associated with high-quality care for breast cancer survivors. Methods: We analyzed the 1997 to 1998 Medicare data of elderly women who were diagnosed with nonmetastatic breast cancer in 1991 or 1992 while living in a Survival, Epidemiology, and End Results (SEER) tumor registry area and who survived to the end of 1998 without evidence of cancer recurrence. Controls were matched for age, race, and geographic location. Results: The 5,965 breast cancer survivors received more preventive services (influenza vaccination, lipid testing, cervical and colon screening, and bone densitometry) than matched controls. Among both groups, those who were younger, non–African-American, of higher socioeconomic status, living in urban areas, and receiving care in a teaching center were most likely to receive high-quality health maintenance. Those survivors who continued to see oncology specialists were more likely to receive appropriate follow-up mammography for their cancer, but those who were monitored by primary care physicians were more likely to receive all other non–cancer-related preventive services. Those who saw both types of practitioners received more of both types of services. When the control group was restricted only to women actively undergoing mammographic screening before the study period, receipt of preventive services was similar. Conclusion: Breast cancer survivors receive high-quality preventive services, but disparities on the basis of nonmedical factors still exist. Cancer follow-up may provide regular contact with the health system, maximizing the likelihood of receiving appropriate general medical care.
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Bouhmam, Houda, Natasha L. Romanoski, and Alison L. Chetlen. "Reducing Barriers to Breast Imaging in Patients with Mobility Limitations." Journal of Breast Imaging 2, no. 1 (January 2020): 56–60. http://dx.doi.org/10.1093/jbi/wbz079.
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Abstract Over 1 billion people worldwide live with a disability. Patients living with disability are often challenged by many barriers to healthcare access, especially preventive and screening services. The Americans with Disabilities Act of 1990 mandated that access to public accommodations related to medical care in the United States be available to all; however, many healthcare facilities fall short of meeting this requirement. Research studies suggest that women with chronic disabilities are less likely to undergo breast cancer screening due to financial, environmental, and physical limitations, as well as psychological barriers. There is scarcity of research on the needs of individuals with mobility impairments and the features of the barriers they face when accessing healthcare services, especially breast imaging services. The objective of this article is to illustrate the existing barriers to breast imaging services that individuals with mobility impairments face and to provide a list of guidelines to be used in clinical practice for breast care practices and medical staff working with patients who have mobility impairments.
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Mohd Said, Zakiah, and Rosnah Sutan. "ARE WE DOING ENOUGH IN PROMOTING BREAST CANCER SCREENING: AN EVALUATION OF MALAYSIA BREAST CANCER SCREENING PROGRAM." Malaysian Journal of Public Health Medicine 21, no. 3 (December 28, 2021): 230–39. http://dx.doi.org/10.37268/mjphm/vol.21/no.3/art.1430.
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Breast cancer is the most common cancer affecting women globally. Several ways of breast cancer screening tools are available. This study aims to evaluate Malaysia's breast cancer screening program using the national database based on participation and performance indicators for the past five years. A retrospective cumulative analysis of clinical breast examination and mammogram screening services were performed using the national dataset of 2016-2020 obtained from the Health Informatics Centres, Ministry of Health Malaysia. The performance indicator represents the percentage of breast abnormality detected during clinical breast examination and the proportion of confirmed cancer through mammogram screening. A reduction in the participation rate for clinical breast examination was noted from 2016 (25.8%) to 2020(25.1%). However, a high participation rate in 2019 (29.1%) was noted following active health promotion intervention. The rate of high-risk women who underwent mammogram screening fluctuated by years according to active breast awareness campaign. The average rate of confirmed breast cancer annually was 0.7% and was noted highest in 2020 (1.17%). Improving early diagnosis is an eminent strategy for cancer control in all settings, including strengthening health systems and providing universal health coverage. Successful breast cancer prevention and control programs require intersectoral planning and active community participation. Ensuring sustainability and accessibility of breast cancer screening programs is highly needed. Fostering good collaborative multiagency partnership and community participation for the cancer control program urges an innovative approach through a policy formulation.
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Procopio, Pietro, Sabine Deij, Louiza S. Velentzis, Amanda Tattam, Lara Petelin, and Carolyn Nickson. "Abstract P2-10-05: The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery." Cancer Research 82, no. 4_Supplement (February 15, 2022): P2–10–05—P2–10–05. http://dx.doi.org/10.1158/1538-7445.sabcs21-p2-10-05.
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Abstract OBJECTIVES AND RATIONALE Estimating the impact of COVID-19 on cancer screening programs and related outcomes can help health services prepare for potential delays in diagnoses and different demands on treatment services and plan for best approaches to recovery. Simulation modelling enables estimation of outcomes for a range of scenarios. In this study, we estimate the impact of various disruptions and recovery strategies for the Australian biennial mammographic breast screening program (BreastScreen). METHOD Policy1-Breast is a continuous-time, multiple-cohort micro-simulation model that simulates the whole Australian female population, incorporating breast cancer risk and natural history, breast density, menopause, hormone therapy use and breast cancer screening. Firstly, in the early stages of the COVID pandemic we used Policy1-Breast to evaluate how 3, 6, 9 and 12-month pauses to BreastScreen would impact on population-level breast cancer diagnoses, tumour staging, and breast cancer survival, compared to business-as-usual (BAU) outcomes. Secondly, to explore options for recovery after an actual one-month screening pause in April 2020, we evaluated a range of assumed throughput levels following screening resumption (50% or 80% up to December, then 100% to 120% from Jan 2021), comparing various protocols where specific sub-groups of clients were prioritised for screening during the recovery period. Outcomes are reported for the target age range for the BreastScreen program (50-74 years). RESULTS For 3- to 12-month pauses, we estimated a slight reduction in 5-year survival following diagnosis for women directly affected by a pause, but no discernible changes to population-level breast cancer mortality rates up to 2023. We estimated marked fluctuations in population rates of invasive breast cancer diagnoses with a 10% increase in cancer diagnoses between 2020-2021 and 2022-2023. For a 12-month pause to screening we estimate that population-level breast cancers would increase in size (with an additional 4% >15mm at diagnosis) and be more likely to involve the nodes (increasing from 26% to 30% of all cancers). We estimate that median screening intervals during 2020-2021 would increase from 104 weeks under BAU up to 130 weeks with a 12-month pause, and BreastScreen recall rates and false positive recall rates would fluctuate markedly over time. For the second evaluation of a one-month pause followed by various throughput and prioritisation scenarios, we estimated that screen-detected cancer rates would vary markedly with throughput but interval cancer rates would not, leading to fluctuations in program sensitivity of up to 6%. Reflecting the periodic nature of screening participation, we estimated the extent to which longer-term future screening participation rates are expected echo the peaks and troughs in participation due to the impacts of the COVID pandemic in 2020. We estimate that for a given throughput assumption, client prioritisation could lead to different rescreening rates, screening intervals, and time required for prioritisation protocols, with little change to cancer outcomes. CONCLUSION These modelled evaluations estimate short and longer-term effects of COVID-19 on the impact of population breast cancer screening in Australia. The estimated changes in breast cancer rates and characteristics would be expected to have a flow-on effect on the demand for treatment services in terms of throughput and case-mix. Preparing for such outcomes is critical given that treatment services are also directly impacted by the pandemic. The modelled outcomes are likely to be relevant to other high-income settings with established population breast cancer screening programs. Citation Format: Pietro Procopio, Sabine Deij, Louiza S Velentzis, Amanda Tattam, Lara Petelin, Carolyn Nickson. The estimated impact of COVID-19 on population breast cancer screening outcomes, and options for risk-based recovery [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-10-05.
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Ting, Frederic Ivan Leong, Louis Mervyn Banua Leones, Abigail Sy Chan, and Jorge Garcia Ignacio. "The pink vans: Bringing cancer screening closer to home." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): e14021-e14021. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.e14021.
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e14021 Background: A global survey reported that among 15 Asian countries, the Philippines has the highest breast cancer mortality rate and the lowest mortality-to-incidence ratio. This may be due to the fact that majority of breast cancers are diagnosed in locally advanced or metastatic stages among low- and middle-income countries. Studies show that in the Philippines more than half (53%) of patients with breast cancer were diagnosed at stages III and IV, while only 2-3% of cases were treated at Stage I. This translates to a dismal 58.6 % 5-year survival rate. Furthermore, socioeconomic factors were identified as one of the major causes for the lack of access to early detection and treatment. These include lower educational level, higher poverty rates, inadequate or no health insurance, lack of transportation, and/or the unavailability of health services in far-flung areas. These findings are currently of urgent national concern since the improvements in breast cancer survival rates brought by advances in treatments are mainly dependent on early detection, screening and timely treatment. Methods: In response to this gap in the delivery of services to promote early cancer detection, the University of the Philippines – Philippine General Hospital (UP-PGH) Cancer Institute established the Mobile Breast Cancer Diagnostic Clinic Program, a first in the country where two fully equipped “pink” vans are sent out to far flung areas and provide breast cancer screening and diagnostic services (eg. Mammogram, breast ultrasound, biopsies of suspicious masses, etc). These vans are manned by medical and surgical oncologists, and various paramedical professionals. Results: In the first 6 months of the program, the “pink” vans were able to visit 3 strategically identified areas in the country. These three tours have served a total of 189 women who all underwent screening mammography. 18 had their suspicious lesions biopsied, and two-thirds of which were found to be malignant. These patients were then referred to our institution for further work-up and management. Conclusions: As the Philippine health department continues to emphasize clinical and self-breast exam as part of its breast cancer control program, efforts like the UP-PGH “Pink Vans” may eventually help supplement the gap in the country’s breast cancer screening endeavors with the goal of improving survival by identifying the disease at its earliest stage.
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Walker-Smith, Tammy Lynn, and Sara Baldwin. "A Quality Improvement Initiative: Improving Mammogram Screening Rates Among Low-income Hispanic Women in Primary Care." Journal of Doctoral Nursing Practice 13, no. 1 (January 27, 2020): 71–78. http://dx.doi.org/10.1891/2380-9418.jdnp-d-19-00004.
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BackgroundLow-income women of predominantly Hispanic ethnicity between the ages of 50–74 who receive primary care services in a South Texas region experienced a 12% disparity gap for women completing a screening mammogram in the last 2 years when compared to Hispanic women nationally.ObjectiveThe purpose of this quality improvement (QI) initiative is to design and implement interdisciplinary evidence-based interventions to improve the screening mammogram completion rates in a primary care clinical setting.MethodsFollowing a systematic review and selection of two evidence-based breast cancer risk screening tools, a pre-post intervention was conducted. The Knowledge-to-Action (KTA) framework was used to train staff and providers to implement the screening tools. The Breast Cancer Risk Assessment Tool (BCRAT) and the National Health Interview Survey (NHIS) provided triggers for initiating a screening mammogram.ResultsEvidence-based screenings triggered mammogram initiation resulting in a 7.21% improvement in screening mammogram completion rates over a 3-month time period.Conclusion/Implications for NursingThe outcomes discussed in this report provide guidance for new policy considerations and clinical protocol initiatives along with processes to improve mammogram completion rates.
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Sabik, Lindsay M., Bassam Dahman, Anushree Vichare, and Cathy J. Bradley. "Breast and Cervical Cancer Screening Among Medicaid Beneficiaries: The Role of Physician Payment and Managed Care." Medical Care Research and Review 77, no. 1 (May 4, 2018): 34–45. http://dx.doi.org/10.1177/1077558718771123.
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Medicaid-insured women have low rates of cancer screening. There are multiple policy levers that may influence access to preventive services such as screening, including physician payment and managed care. We examine the relationship between each of these factors and breast and cervical cancer screening among nonelderly nondisabled adult Medicaid enrollees. We combine individual-level data on Medicaid enrollment, demographics, and use of screening services from the Medicaid Analytic eXtract files with data on states’ Medicaid-to-Medicare fee ratios and estimate their impact on screening services. Higher physician fees are associated with greater screening for comprehensive managed care enrollees; for enrollees in fee-for-service Medicaid, the findings are mixed. Patient participation in primary care case management is a significant moderator of the relationship between physician fees and the rate of screening, as interactions between enrollee primary care case management status and the Medicaid fee ratio are consistently positive across models of screening.
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Vaughan-Briggs, Celeste, Edith P. Mitchell, and Vincent Pepe. "An update to a retrospective comparison of results between the National Breast and Cervical Cancer Early Detection Program and NCI cancer center based early detection program with evidenced based patient navigation and social work support." Journal of Clinical Oncology 40, no. 16_suppl (June 1, 2022): e18572-e18572. http://dx.doi.org/10.1200/jco.2022.40.16_suppl.e18572.
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e18572 Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) through the CDC has provided uninsured women access to breast and cervical cancer screening/diagnostic services. The uninsured face obstacles which include fear, lack of access and trust in the system, financial and logistical barriers to accessing health care services (Natale-Pereira, et.al, 2011) Disparities in access to screening and diagnostic testing, cancer treatment and survivorship is well documented for medically vulnerable populations that impact stage of diagnosis and mortality (Guadagnolo, Dohan & Raich 2011). The Jefferson's program participates in the NBCCEDP program and uses other private resources which incorporate Social Work core competencies that provide assistance to address barriers. The program navigates along the continuum of cancer care (e.g, prevention, screening, treatment and survival). We have found in a comparative analysis that TJUH’s program has higher rates of diverse racial and ethnic participation of key medically underserved demographics than the National Program. Methods: TJUH's program employs a clinical model, Clinical Patient Navigation with a Licensed Clinical Social Worker operating from a strengths based framework to direct care with administrative support. The program utilizes best practices for working with the at risk population: translation services for the Limited English Proficient, appointment confirmation, transportation assistance and psychosocial support from initial point of contact through final diagnosis. Program staff coordinate internal and external referrals from multiple providers. Results: The study population includes 3144 participants who received breast and cervical cancer screening services through the program from 2012 through 2020. 13.9% were white, 41.7% were African-American, 24.5% were Asian and 19.1% Latinx participated in the program, Table. The age of the participants was slightly younger than the National program as well with 15% under 40, 46% between the ages of 40-49. Conclusions: TJUH’s program provides comprehensive psychosocial support to address barriers along the continuum of screening and diagnostic services leading with increased participation among at risk populations. This further reduces no show rates and participants being lost to follow up. TJUH’s program screens a larger proportion of African American and Asian and younger women compared to the NBCCED program. Additionally, we serviced a slightly younger population than the national program. TJUH’s program addresses health disparities and inequity in access to cancer screening services as shown by the data of the diversity of the participants.
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Sinclair, Julia, Mark McCann, Ellena Sheldon, Isabel Gordon, Lyn Brierley-Jones, and Ellen Copson. "The acceptability of addressing alcohol consumption as a modifiable risk factor for breast cancer: a mixed method study within breast screening services and symptomatic breast clinics." BMJ Open 9, no. 6 (May 2019): e027371. http://dx.doi.org/10.1136/bmjopen-2018-027371.
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ObjectivesPotentially modifiable risk factors account for approximately 23% of breast cancers, with obesity and alcohol being the two greatest. Breast screening and symptomatic clinical attendances provide opportunities (‘teachable moments’) to link health promotion and breast cancer-prevention advice within established clinical pathways. This study explored knowledge and attitudes towards alcohol as a risk factor for breast cancer, and potential challenges inherent in incorporating advice about alcohol health risks into breast clinics and screening appointments.DesignA mixed-method study including a survey on risk factors for breast cancer and understanding of alcohol content. Survey results were explored in a series of five focus groups with women and eight semi-structured interviews with health professionals.SettingWomen attending NHS Breast Screening Programme (NHSBSP) mammograms, symptomatic breast clinics and healthcare professionals in those settings.Participants205 women were recruited (102 NHSBSP attenders and 103 symptomatic breast clinic attenders) and 33 NHS Staff.ResultsAlcohol was identified as a breast cancer risk factor by 40/205 (19.5%) of attenders and 16/33 (48.5%) of staff. Overall 66.5% of attenders drank alcohol, and 56.6% could not estimate correctly the alcohol content of any of four commonly consumed alcoholic drinks. All women agreed that including a prevention-focussed intervention would not reduce the likelihood of their attendance at screening mammograms or breast clinics. Qualitative data highlighted concerns in both women and staff of how to talk about alcohol and risk factors for breast cancer in a non-stigmatising way, as well as ambivalence from specialist staff as to their role in health promotion.ConclusionsLevels of alcohol health literacy and numeracy were low. Adding prevention interventions to screening and/or symptomatic clinics appears acceptable to attendees, highlighting the potential for using these opportunities as ‘teachable moments’. However, there are substantial cultural and systemic challenges to overcome if this is to be implemented successfully.
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Omotoso, Olabode Ebenezer, Ghadier Matariek, Elizabeth F. Omotoso, Amira Matareek, Ghada M. Abdul-Rafee, Sucheta Malakar, and Nabanita Chutia. "Practice of Breast Self-Examination and Knowledge of Breast and Cervical Cancer Screening." SciMedicine Journal 3, no. 3 (September 1, 2021): 219–29. http://dx.doi.org/10.28991/scimedj-2021-0303-3.
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The burden of breast and cervical cancer is increasing exponentially, especially among women in low- and mid-income countries. Early detection, hinged on screening uptake is a key to higher survival rate and managing cancer outcome. The present study assessed Nigerians and Egyptians’ knowledge of breast self-examination (BSE) and breast and cervical cancer screening. A cross-sectional questionnaire was utilized to obtain 1,006 respondents via a convenient sampling method. The mean age of respondents was 30.43 ± 6.69. About one-third of participants had good knowledge (> 66%) of breast cancer screening (42%), cervical cancer screening (44%) and BSE practice (36%). Age range (26–40 years), educational level (tertiary), and marital status were demographic data that influenced knowledge level. The screening uptake among the studied population is very poor as only (11%) had ever been screened and only (2.2%) ever vaccinated. The major reasons for poor screening uptake were “no awareness of where to be screened” and “no symptoms”. Assessing the knowledge and uptake level of African women through studies like this is crucial in identifying the loopholes in the fight against cancer. More efforts are required for promoting the utilization of cancer screening services, HPV vaccination, and BSE practice among African women. Doi: 10.28991/SciMedJ-2021-0303-3 Full Text: PDF
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Majeed, F. Azeem, Derek G. Cook, Rosalind Given-Wilson, Pat Vecchi, and Jan Poloniecki. "Do General Practitioners Influence the Uptake of Breast Cancer Screening?" Journal of Medical Screening 2, no. 3 (September 1995): 119–24. http://dx.doi.org/10.1177/096914139500200301.
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Objectives — To investigate the relative importance of patient and general practice characteristics in explaining variations between practices in the uptake of breast cancer screening. Design — Ecological study examining variations in breast cancer screening rates among 131 general practices using routine data. Setting — Merton, Sutton, and Wandsworth Family Health Services Authority, which covers parts of inner and outer London. Main outcome measure — Percentage of eligible women aged 50–64 who attended for mammography during the first round of screening for breast cancer (1991–1994). Results — Of the 43 063 women eligible for breast cancer screening, 25 826 (60%) attended for a mammogram. Breast cancer screening rates in individual practices varied from 12·5% to 84·5%. The estimated percentage list inflation for the practices was the variable most highly correlated with screening rates ( r= −0·69). There were also strong negative correlations between screening rates and variables associated with social deprivation, such as the estimated percentage of the practice population living in households without a car ( r= −0·61), and with variables that measured the ethnic make-up of practice populations, such as the estimated percentage of people in non-white ethnic groups ( r= −0·60). Screening rates were significantly higher in practices with a computer than in those without (59·5% v 53·9%, difference 5·6%, 95% confidence interval 1·1 to 10·2%). There was no significant difference in screening rates between practices with and without a female partner; with and without a practice nurse; and with and without a practice manager. In a forward stepwise multiple regression model that explained 58% of the variation in breast cancer screening rates, four factors were significant independent predictors (at P = 0·05) of screening rates: list inflation and people living in households without a car were both negative predictors of screening rates, and chronic illness and the number of partners in a practice were both positive predictors of screening rates. The practice with the highest screening rate (84·5%) contacted all women invited for screening to encourage them to attend for their mammogram and achieved a rate 38% higher than predicted from the regression model. Breast cancer screening rates were on average lower than cervical cancer screening rates (mean difference 14·5%, standard deviation 12·0%) and were less strongly associated with practice characteristics. Conclusions — The strong negative correlation between breast cancer screening rates and list inflation shows the importance of accurate age-sex registers in achieving high breast cancer screening rates. Breast cancer screening units, family health services authorities, and general practitioners need to collaborate to improve the accuracy of the age-sex registers used to generate invitations for breast cancer screening. The success of the practice with the highest screening rate suggests that practices can influence the uptake of breast cancer screening among their patients. Giving general practitioners a greater role in breast cancer screening, either by offering them financial incentives or by giving them clerical support to check prior notification lists and contact non-attenders, may also help to increase breast cancer screening rates.
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Sobero, Raúl A., and Gloria P. Giraldo. "Using a Culturally Competent Framework to Increase Annual Breast Cancer Screening Rates Among Low-Income Latinas." Californian Journal of Health Promotion 1, no. 2 (June 1, 2003): 101–17. http://dx.doi.org/10.32398/cjhp.v1i2.1688.
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The Orange County, California, Cancer Detection Partnership is a successful example of a multitiered breast cancer detection program that reaches low-income, underserved women with remarkably high breast cancer screening rates for Latinas. Between July 1999 and June 2001, 65.3 percent of Latinas eligible for free breast cancer screening services were screened by the provider network affiliated with this partnership. This case study provides evidence that culturally competent services are effective. The key elements underlying the effectiveness of this program are a strong foundation of collaboration, commitment to integrate community participation into program decision-making, and innovative implementation strategies developed within a culturally competent framework. These elements have either reduced or eliminated barriers related to infrastructure, socio-cultural issues, and financial concerns that low-income women often face when accessing services. The California Department of Health Services, Cancer Detection Section, designed a model that enables ten regional cancer detection partnerships to prevent and reduce the devastating effects of breast cancer through early detection, diagnosis and treatment by incorporating these and other key elements into their programs. This case study includes discussion and recommendations for program enhancement and future research.
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Sobero, Raúl A., and Gloria P. Giraldo. "Using a Culturally Competent Framework to Increase Annual Breast Cancer Screening Rates Among Low-Income Latinas." Californian Journal of Health Promotion 1, no. 2 (June 1, 2003): 101–17. http://dx.doi.org/10.32398/cjhp.v1i2.433.
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The Orange County, California, Cancer Detection Partnership is a successful example of a multitiered breast cancer detection program that reaches low-income, underserved women with remarkably high breast cancer screening rates for Latinas. Between July 1999 and June 2001, 65.3 percent of Latinas eligible for free breast cancer screening services were screened by the provider network affiliated with this partnership. This case study provides evidence that culturally competent services are effective. The key elements underlying the effectiveness of this program are a strong foundation of collaboration, commitment to integrate community participation into program decision-making, and innovative implementation strategies developed within a culturally competent framework. These elements have either reduced or eliminated barriers related to infrastructure, socio-cultural issues, and financial concerns that low-income women often face when accessing services. The California Department of Health Services, Cancer Detection Section, designed a model that enables ten regional cancer detection partnerships to prevent and reduce the devastating effects of breast cancer through early detection, diagnosis and treatment by incorporating these and other key elements into their programs. This case study includes discussion and recommendations for program enhancement and future research.
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Salako, O., K. Okunade, P. Okediji, L. A. Agaga, and O. Olajiga. "Determinants of Uptake of Breast and Cervical Cancer Screening by Users in Lagos, Southwestern Nigeria." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 53s. http://dx.doi.org/10.1200/jgo.18.68100.
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Background: Breast and cervical cancer are the two most common cancers in Nigerian women with a huge morbidity and mortality burden in those affected. Previous Nigerian studies indicate a wide variation in the knowledge and perceptions of women, which significantly impacts on their willingness and motivations to make use of available cancer screening services. The result of this is late presentations and poor treatment outcomes. This study assessed the factors affecting the uptake of breast and cervical cancer screening services in Lagos, Nigeria. Methods: This cross-sectional study was conducted among female users of a breast and cervical cancer screening service in Lagos, Nigeria. Data were collected using a self-administered questionnaire and analyzed with the level of significance set at < 0.05. Results: A total of 491 women were screened between October and December 2017 for breast and cervical cancer. The mean age was 38.3 ± 12.7 years, with majority married (60.3%), educated up to tertiary level (47.7%), and were professionals (30.8%). Majority knew about cervical cancer screening (61.3%) ( Table 1 ), with 23.6% having a previous cervical cancer screening and 9.8% had vaccination for cervical cancer. Older (42.3 ± 10.8 years), married professionals with tertiary education who have heard about cervical cancer were more likely to have had a previous cervical cancer screening ( P < 0.05) ( Fig. 1 ). About 65.9% of the total sample population knew about breast cancer screening ( Table 2 ) and 62.0% of these do periodic breast self-examination. However, many of the women sampled had never had a clinical breast examination (64.2%) nor a screening mammogram (74.3%) ( Fig. 2 ). Determinants of breast self-examination were tertiary education and those in professional occupations ( P < 0.05). Conclusion: In line with the goal of ensuring that every eligible woman is screened for breast and cervical cancer, there is an urgent need to improve knowledge and awareness of breast and cervical cancer, as well as the need for screening, among Nigerian women with little or no education, who are involved in unskilled or semiskilled occupations.[Figure: see text][Figure: see text][Table: see text][Table: see text]
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Jensen, Brooke, Hafiz Khan, and Rakhshanda Layeequr Rahman. "Sociodemographic Determinants in Breast Cancer Screening among Uninsured Women of West Texas." Medicina 58, no. 8 (July 28, 2022): 1010. http://dx.doi.org/10.3390/medicina58081010.
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Background and Objectives: Early detection through appropriate screening is key to curing breast cancer. The Access to Breast Care for West Texas (ABC4WT) program offers no-cost mammography to underserved women in West Texas. The U.S. Preventative Task Force (USPSTF) guidelines are breast cancer screening guidelines which suggest screening for all women at the age of 50 years. The focus of this study was to identify sociodemographic barriers and determinants for breast cancer screenings, as well as screening outcomes, in low income, uninsured, or under-insured communities in West Texas. Materials and Methods: The ABC4WT program’s patient database was queried from 1 November, 2018, to 1 June, 2021, for sociodemographic variables, screening history, and results to identify high-risk groups for outreach. The American College of Radiology’s risk assessment and quality assurance tool, BI-RADS (Breast Imaging-Reporting and Data System), a widely accepted lexicon and reporting schema for breast imaging, was used for risk differentiation. Results: The cancer rate for ABC4WT’s program was significantly higher than the national mean (5.1), at 23.04 per 1000 mammograms. Of the 1519 mammograms performed, women between 40 and 49 years old represented the highest percentages of BI-RADS 4 and 5 (42.0% and 28.0%, respectively; p = 0.049). This age group also received 43.7% of biopsies performed and comprised 28.6% (n = 10) of cancers diagnosed (n = 35) (p = 0.031). Additionally, participants with a monthly household income of less than USD 800/month/person were more likely to result in a cancer diagnosis (70.6%) than higher incomes (29.4%) (p = 0.021). Conclusions: These determinants most starkly impacted women 40–49 years old who would not have been screened by U.S. Preventative Services Task Force (USPSTF) guidelines. This population with increased cancer risk should be encouraged to undergo screening for breast cancer via mammography.
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Changkun, Zhu, Ghose Bishwajit, Lu Ji, and Shangfeng Tang. "Sociodemographic correlates of cervix, breast and oral cancer screening among Indian women." PLOS ONE 17, no. 5 (May 11, 2022): e0265881. http://dx.doi.org/10.1371/journal.pone.0265881.
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Introduction Cervix, breast and oral cancers account for about one-third of all cancers in India which as a group is a major contributor to all non-communicable disease-related morbidity and mortality among women. Existing evidence suggests that early diagnosis plays a pivotal role in the prevention and intervention of these cancers, and many community-based early screening and awareness programs have been in place in developed countries. Currently, there is not enough research evidence regarding the sociodemographic correlates of cervix, breast and oral cancer screening among Indian women. In the present study, we aimed to assess the self-reported percentage and sociodemographic factors associated with the use of these three types of cancer screening services among Indian women aged 15–49 years. Methods Data were collected from National Family Health Survey conducted during 2015–16. Sample population was 699,686 women aged 15–49 years. Associations between self-reported cervical, breast and oral cancer screening status and the associated sociodemographic factors were analyzed using multivariable logistic regression methods. Results The percentage of screening for cervical (21%), breast (8.95%), and oral cancers (13.45%) varied significantly across the population sub-groups. Higher age, urban residence, higher education, having employment, health insurance, use of electronic media, higher household wealth quintile, having healthcare autonomy, showed a positive effect on taking screening services. Further analyses revealed that the strength of the associations varied considerably between urban and rural residents, denoting the need for region-specific intervention strategies. Sex of household head, age, watching TV, using radio, and having health insurance were the most significant contributors to the outcome effects. Conclusions The present study provides important insights regarding the current scenario of seeking cancer screening services among women in India. These findings could inform policy analysis and make an avenue for further in-depth analysis for future studies. Our findings conclude that cancer prevention policies should focus on leveraging the positive effects of better socioeconomic status, employment, health insurance ownership, exposure to electronic media, and better healthcare autonomy to improve the cancer screening service uptake among Indian women.
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Siu, Albert L. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Annals of Internal Medicine 164, no. 4 (January 12, 2016): 279. http://dx.doi.org/10.7326/m15-2886.
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Stephens, T. W. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Yearbook of Diagnostic Radiology 2011 (January 2011): 60–62. http://dx.doi.org/10.1016/s0098-1672(10)79235-3.
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Woolf, Steven H. "United States preventive services task force recommendations on breast cancer screening." Cancer 69, S7 (April 1, 1992): 1913–18. http://dx.doi.org/10.1002/1097-0142(19920401)69:7+<1913::aid-cncr2820691707>3.0.co;2-6.
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Muffih, T. P., C. Claudettea, F. Manjuha, G. DeGregoriob, S. Mangaa, K. Nulaha, E. Kiyanga, et al. "Implementing a Fee-for-Service Cervical Cancer Screening and Treatment Program in Cameroon: Challenges and Opportunities." Journal of Global Oncology 4, Supplement 2 (October 1, 2018): 73s. http://dx.doi.org/10.1200/jgo.18.67200.
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Background: Cervical cancer screening is one of the most effective cancer prevention strategies, but most women in Africa have never been screened. In 2007, the Cameroon Baptist Convention Health Services, a large faith-based health care system in Cameroon, initiated the Women's Health Program (WHP) to address this disparity. Trained nurses provide fee-for-service cervical cancer screening using visual inspection with acetic acid enhanced by digital cervicography (VIA-DC), prioritizing care for women living with HIV/AIDS. They also provide clinical breast examination, family planning (FP) services, and treatment of reproductive tract infections (RTI) and refer for further tests and treatment indicated. Methods: We retrospectively reviewed and analyzed WHP medical records from women who presented for cervical cancer screening from 2007-2014. Results: In 8 years, WHP nurses screened 44,979 women for cervical cancer. The number of women screened increased nearly every year. The WHP is sustained primarily on fees-for-service, with external funding totaling about $20,000 annually. In 2014, of 12,191 women screened for cervical cancer, 99% received clinical breast exams, 19% received FP services, and 4.7% received treatment of RTIs. We document successes, challenges, solutions implemented, and recommendations for optimizing this screening model. Conclusion: The WHP's experience using a cost-recovery model and offering multiple services in a single clinic rather than stand-alone cervical cancer screening may be a practical model to make cervical cancer screening services accessible, comprehensive and sustainable. Integrating other women's health services enabled women to address additional health care needs.