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PubMed1992

Mammography usage and the health belief model.

Regular screening mammograms for asymptomatic women are the most effective method for early detection of breast cancer. This study assessed the relative influence of Health Belief Model (HBM) constructs on prior mammography usage and the intention to obtain mammograms with data from a sample of 1,057 women over the age of 35 years residing in an urban community in the United States. Covariance structure analysis with latent variables was used initially to perform a confirmatory factor analysis of indicators of Socioeconomic Status (SES), Perceived Susceptibility, Perceived Barriers, Perceived Benefits, Cues to Action, Prior Mammography, and Future Intentions. Once a plausible factor structure was confirmed, a predictive path model was tested with Future Intentions and Prior Mammography as the outcome variables. Cues to Action, operationalized as a physician influence variable, particularly impacted Prior Mammography, and Perceived Susceptibility was the most powerful predictor of Future Intentions. SES only related significantly to Perceived Barriers, and Cues to Action, and did not directly influence Prior Mammography and Future Intentions. HBM predictor variables alone accounted for the relationship between previous mammography experience and intentions to obtain mammograms in the future. Health education implications and an applied outreach program are discussed.

Adult↗
PubMedDate not supplied

An intervention to increase mammography use by Korean American women.

PURPOSE/OBJECTIVES: To test the effectiveness of a community-based intervention to increase mammography screening for Korean American women. DESIGN: Quasi-experimental, pre-/post-test, three-group design. SETTING: Urban Korean American communities in Southern California. SAMPLE: 141 Korean American women, aged 40-75, who had not had a mammogram in the previous 12 months. METHOD: Two Korean churches were selected randomly to be study sites that would provide health screening programs. The study included an experimental group that would have access to a peer-group educational program and low-cost mammography, a group that would have access to low-cost mammography alone, and a control group. Participant-focused strategies were used to involve Korean American women from the community. MAIN RESEARCH VARIABLES: Mammography use, breast cancer screening attitudes, and knowledge. FINDINGS: Women in the experimental program had significantly improved attitudes and knowledge about breast cancer screening. Mammography use in the experimental group (87%) was not significantly different from that in the mammography-access-only group (72%). Both interventions proved to be more effective than no intervention at all (control group = 47%). CONCLUSIONS: An educational program that includes participant-focused research strategies and access to low-cost mammograms resulted in higher levels of screening. IMPLICATIONS FOR NURSING: Community-focused interventions can increase rates of cancer screening among Korean American women.

Aged↗
PubMed2006

Sociocultural context of mammography screening use.

PURPOSE/OBJECTIVES: To examine variations in cultural and health beliefs about mammography screening among a socioeconomically diverse sample of African American and Caucasian women and to identify which set of beliefs predicted mammography screening adherence. DESIGN: Descriptive, retrospective, cross-sectional study. SETTING: Community-based organizations and public housing. SAMPLE: 111 African American women and 64 Caucasian women, aged 40 years or older, with no history of breast cancer. METHODS: Telephone and in-person structured interviews were conducted. Items used previously validated scales based on the Cultural Assessment Model for Health and the Health Belief Model. MAIN RESEARCH VARIABLES: Race or ethnicity, education, income, personal space, health temporal orientation, personal control, fatalism, susceptibility, benefits, barriers, self-efficacy, and mammography screening adherence. FINDINGS: African American women were more fatalistic about breast cancer and perceived fewer benefits to screening. Mammography screening-adherent women were more future oriented, believed that they had less control over finding health problems early, had fewer barriers to screening, and experienced more physical spatial discomfort during the screening procedure than nonadherent women. CONCLUSIONS: Several of the cultural beliefs were not significantly different by race or ethnicity. However, cultural and health beliefs were significant predictors of mammography screening. IMPLICATIONS FOR NURSING: Theoretically based cultural beliefs are important to consider for behavioral interventions to increase mammography screening in African American and Caucasian women.

Adult↗
PubMed2001

Comparison of breast magnetic resonance imaging, mammography, and ultrasound for surveillance of women at high risk for hereditary breast cancer.

PURPOSE: Recommended surveillance for BRCA1 and BRCA2 mutation carriers includes regular mammography and clinical breast examination, although the effectiveness of these screening techniques in mutation carriers has not been established. The purpose of the present study was to compare breast magnetic resonance imaging (MRI) with ultrasound, mammography, and physical examination in women at high risk for hereditary breast cancer. PATIENTS AND METHODS: A total of 196 women, aged 26 to 59 years, with proven BRCA1 or BRCA2 mutations or strong family histories of breast or ovarian cancer underwent mammography, ultrasound, MRI, and clinical breast examination on a single day. A biopsy was performed when any of the four investigations was judged to be suspicious for malignancy. RESULTS: Six invasive breast cancers and one noninvasive breast cancer were detected among the 196 high-risk women. Five of the invasive cancers occurred in mutation carriers, and the sixth occurred in a woman with a previous history of breast cancer. The prevalence of invasive or noninvasive breast cancer in the 96 mutation carriers was 6.2%. All six invasive cancers were detected by MRI, all were 1.0 cm or less in diameter, and all were node-negative. In contrast, only three invasive cancers were detected by ultrasound, two by mammography, and two by physical examination. The addition of MRI to the more commonly available triad of mammography, ultrasound, and breast examination identified two additional invasive breast cancers that would otherwise have been missed. CONCLUSION: Breast MRI may be superior to mammography and ultrasound for the screening of women at high risk for hereditary breast cancer.

Adult↗
PubMed2005

Mammography, breast ultrasound, and magnetic resonance imaging for surveillance of women at high familial risk for breast cancer.

PURPOSE: To compare the effectiveness of mammography, breast ultrasound, and magnetic resonance imaging (MRI) for surveillance of women at increased familial risk for breast cancer (lifetime risk of 20% or more). PATIENTS AND METHODS: We conducted a surveillance cohort study of 529 asymptomatic women who, based on their family history and/or mutational analysis, were suspected or proven to carry a breast cancer susceptibility gene (BRCA). A total of 1,542 annual surveillance rounds were completed with a mean follow-up of 5.3 years. Diagnostic accuracies of the three imaging modalities used alone or in different combinations were compared. RESULTS: Forty-three breast cancers were identified in the total cohort (34 invasive, nine ductal carcinoma-in-situ). Overall sensitivity of diagnostic imaging was 93% (40 of 43 breast cancers); overall node-positive rate was 16%, and one interval cancer occurred (one of 43 cancers, or 2%). In the analysis by modality, sensitivity was low for mammography (33%) and ultrasound (40%) or the combination of both (49%). MRI offered a significantly higher sensitivity (91%). The sensitivity of mammography in the higher risk groups was 25%, compared with 100% for MRI. Specificity of MRI (97.2%) was equivalent to that of mammography (96.8%). CONCLUSION: Mammography alone, and also mammography combined with breast ultrasound, seems insufficient for early diagnosis of breast cancer in women who are at increased familial risk with or without documented BRCA mutation. If MRI is used for surveillance, diagnosis of intraductal and invasive familial or hereditary cancer is achieved with a significantly higher sensitivity and at a more favorable stage.

Adult↗
PubMed2001

Young Jordanian women's health beliefs about mammography.

This descriptive study assesses the beliefs held by a group of young Jordanian women toward mammography utilization as a screening procedure for breast cancer. The Health Belief Model (HBM) is the theoretical framework of this study. Champion's (1993) translated HBM tool was utilized as the self-administered questionnaire that was filled in by all participants in this study. The sample consisted of young (< or = 45 years) Jordanian women chosen out of convenience from among those visiting one of the largest maternal and child health centers in Amman. The overall results indicated favorable beliefs toward the use of mammography, coupled with the majority of women (76%) voicing their agreement with the overall benefits of mammography, and 24% were either not in agreement with or unsure about these benefits. Although about half of the sample (49%) perceived barriers to utilizing mammography, the vast majority (85%), reported an overall agreement with the statements of the health motivation subscale. There were no significant differences in women's beliefs as a function of their subgroups of age, education, or insurance status. Nevertheless, when compared with a group of older women who had undergone mammography, significant differences (in favor of the older group) were reported between the two samples, especially in terms of the responses given to selected preventive statements such as "wanting to discover health problems early" (t = 2.27, p = .024) and "eating a well-balanced meal" (t = 1.92, p = .05). Implications for nursing practice, such as recognizing culturally specific barriers and enhancing health education programs to trigger mammography utilization, were addressed.

Adolescent↗
PubMed1997

Physician gender and screening: do patient differences account for differences in mammography use?

Women are more likely to receive mammography if they see a female, rather than a male, physician (Lurie et al., 1993). This difference in mammography use could arise from differences in the behavior of male and female physicians, or from differences in their patients. This paper examines the extent to which differences in mammography use are attributable to physician differences, controlling for patient differences, and expands on previous research by examining both demographic and attitudinal differences between the patients of male and female physicians. A population based sample of Washington State women (n = 852) between the ages of 50 and 80 years old were asked to complete an extensive telephone interview regarding their demographic and attitudinal characteristics, their mammography use, and the gender of their primary care physician. Women patients of male and female physicians were not found to differ significantly in their education, financial status, employment, assertiveness with their physician, or values regarding physician characteristics including preventive care and communication skills. Analyses conducted to examine the contribution of physician gender to mammography use revealed almost a two-fold reduction in screening associated with having a male physician (adjusted odds ratio 1.95; p < .05). Differences in mammography use associated with male and female physicians do not appear to arise from characteristic demographic or attitudinal differences between their patient populations.

Aged↗
PubMed1997

Attitudes about breast cancer and mammography: racial, income, and educational differences.

This study examined the effect of race, income, and education on perceived susceptibility to and control over breast cancer, perceived benefits of and barriers to mammography, and knowledge about breast cancer and mammography use, in addition to determining if predictors for mammography use differed between races. Self-reported mailed survey data were obtained from a convenience sample of 1083 church women (78% Caucasian, 22% African-American) > or = 50 years with no history of breast cancer. ANOVA identified higher susceptibility and lower knowledge scores for African-American women; higher knowledge scores for upper income women of both races; interactions between race and income for benefits and perceived control; and interactions between race and education for barriers. African-American women were more likely to regard fear of radiation as a barrier to mammography (OR = .34; CI = .20, .57) and were more likely to worry about getting breast cancer (OR = .50; CI = .30, .82). Caucasian women were more likely to regard cost as a barrier (OR = 2.36, CI = 1.27, 4.40). For both races, variables predictive of ever having a mammogram were perceived control (White: OR = .69, CI = .54, .88; Black: OR = .50, CI = .38, .92), perceived barriers (White: OR = .88, CI = .83, .95; Black: OR = .75, CI = .64, .88), and knowledge (White: OR = 1.18, CI = 1.04, 1.33; Black: OR = 1.28, CI = 1.02, 1.61). Perceived benefits was predictive only for Caucasians (OR = 1.71, CI = 1.42, 2.06). Racial differences in perceived barriers to mammography and findings about the knowledge differences related to race, income, and education provide direction for health education efforts. The significance of cost factors for Caucasian and low-income women suggest that access barriers remain despite increased use of mammography.

Black or African American↗
PubMed2005

A community-based intervention to increase screening mammography among disadvantaged women at an inner-city drop-in center.

PURPOSE: To determine the effectiveness of a community- based intervention to increase the use of screening mammography among disadvantaged women at an inner-city drop-in center. METHODS: This study involved women 50 to 70 years old who were clients of an inner-city drop-in center in Toronto, Canada, during the years 1995-2002 (N = 158 in 1995-2001 and N = 89 in 2002). In 2002, the drop-in center and a nearby hospital initiated a collaborative breast cancer screening project in which a staff member of the drop-in center accompanied small groups of women for mammography visits at a weekly pre-arranged time. Interrupted time series analysis was used to examine the effect of this intervention on the annual rate of screening mammography, as determined by review of medical records. RESULTS: More than half of the women 50 to 70 years old who used the drop-in center in 2002 had been diagnosed with a major mental illness, and one-third were either homeless or living in supportive housing. In the 7 years before the introduction of the intervention, annual mammography rates among women using the drop-in center averaged 4.7%. During the intervention year, 26 (29.2%) of 89 women underwent mammography (p = 0.0001 for the change from pre-to post-intervention). CONCLUSIONS: The introduction of accompanied small-group visits was associated with significantly increased use of mammography in a group of disadvantaged women who were clients of an inner-city drop-in center. This approach may be useful to promote breast cancer screening among women affected by mental illness or homelessness who have contact with community-based agencies.

Aged↗
PubMed1997

Attitudes and beliefs toward mammography among women using an urban public hospital.

Although overall use of mammography is steadily increasing, low-income and minority women consistently have relatively lower screening rates than white, middle-class women. To assess the mammography-seeking behavior of low-income women using an urban public hospital, this study sought to understand why women in this population decide whether or not to obtain a screening mammogram. Two qualitative techniques, elicitation interviews and focus groups, were used to develop an understanding of attitudes, concerns, and barriers of this group relative to mammography. Fear, embarrassment, susceptibility to breast cancer, inconvenience, cost, concerns about efficacy of mammography, fear of acquiring cancer, and scheduling difficulties were identified as important concerns. "People in the news" were the most influential social referents for mammography decision making, followed by physicians, family members, and friends. The insights gained from these women will assist in developing interventions that encourage mammography-seeking behavior by low-income women.

Aged↗
PubMed1994

Mammography screening: how important is cost as a barrier to use?

OBJECTIVES: Recent legislation will improve insurance coverage for screening mammography and effectively lower its cost to many women. Although cost has been cited as a barrier to use, evidence of the magnitude of its effect on use is limited. METHODS: Mammography use in the past 2 years among women aged 50 to 75 residing in four suburban or rural counties in Washington State was estimated from 1989 survey data. Logistic regression analysis was used to estimate the odds ratio of mammography use as a function of economic and other variables. Within a residential area, averages were used to measure the market price of mammography and the time cost to obtain a mammogram. RESULTS: Use was lower among women who faced a higher net price or who preferred to obtain a mammogram during weekend or evening hours and higher among women with higher incomes. Visiting no doctor regularly and smoking were predictors of failure to use mammography. CONCLUSION: The effects of economic variables on mammography use are important and stable across subsets of the population, but they are modest in size.

Aged↗
PubMed1998

The use of mammography by survivors of breast cancer.

OBJECTIVES: Survivors of breast cancer are at high risk for development of a second breast cancer and are thus a group for whom annual mammography screening is recommended. However, survivors' use of mammography rarely has been examined. METHODS: We surveyed a representative population sample of survivors who lived in rural communities about their mammography use after cancer. RESULTS: Of these women, 30% had not received a mammogram in the preceding year. Predictors of mammography use included physician recommendation and whether the original cancer had been detected by mammography. CONCLUSIONS: Physicians should recommend mammography to survivors of breast cancer to ensure regular use.

Aged↗
PubMed2006

Evaluation of tumor angiogenesis of breast carcinoma using contrast-enhanced digital mammography.

OBJECTIVE: The purpose of this article is to assess the accuracy of contrast-enhanced digital mammography in the detection of breast carcinoma and to correlate the findings on the images with those of histologic analysis using microvessel quantification. SUBJECTS AND METHODS: Twenty patients with a suspicious breast abnormality underwent contrast-enhanced digital mammography using a full-field digital mammography unit that was modified to detect iodinated enhancement. For each patient, a total of six contrast-enhanced craniocaudal views were acquired from 30 seconds to 7 minutes after the injection of a bolus of 100 mL of an iodinated contrast agent. Image processing included a logarithmic subtraction and the analysis of enhancement kinetic curves. Contrast-enhanced digital mammography findings were compared with histologic analysis of surgical specimens, including intratumoral microvessel density quantification evaluated on CD34-immunostained histologic sections obtained from all patients. RESULTS: An area of enhancement was depicted on contrast-enhanced digital mammograms in 16 of the 20 histologically proven breast carcinomas. Excellent correlation was seen between the size of enhancement and the histologic size of tumors, which ranged from 9 to 22 mm. Early enhancement with washout was observed in four cases, early enhancement followed by a plateau in four cases, gradual enhancement in seven cases, and unexpected decrease of enhancement in one case. Intratumoral microvessel density ranged from 11.7 to 216.6 microvessels per square millimeter. A poor correlation was found between data measured on contrast-enhanced digital mammography and intratumoral microvessel density measured on CD34-immunostained histologic sections. CONCLUSION: Contrast-enhanced digital mammography is able to depict angiogenesis in breast carcinoma. Breast compression and projective images acquisition alter the quantitative assessment of enhancement parameters.

Adult↗
PubMed1979

Computed tomographic mammography (CTM).

Breasts of 724 patients were studied by physical examination, mammography, and computed tomographic mammography (CTM) using a scanner designed for evaluation of the breast. Among cases in which CTM was not accompanied by use of contrast material, there were 60 malignant lesions, of which 10% were missed by mammography, 32% by CTM, and 8% by both. Among cases where CTM was supplemented by a 50 ml injection of 75% contrast material, there were 63 malignant lesions, of which 14% were missed by mammography, 16% by CTM, and 3% by both. Among cases where CTM was supplemented by a 300 ml infusion of 30% contrast material, there were 41 malignant lesions, of which 7% were missed by mammography and 5% by CTM, but none by both. Clinically, 22% of the malignant lesions in the infusion series were occult. There were 44 benign lesions in patients studied with the infusion technique. With mammography 68% were suspicious for malignancy, and with CTM, 56%.

Adenocarcinoma↗
PubMed1983

Breast cancer detection with sonography and mammography: comparison using state-of-the-art equipment.

This prospective study, involving 1,000 women referred for routine mammography, compares the breast cancer detecting abilities of state-of-the-art mammography and sonography using an automated water-path scanner. Mammography was found to be the superior technique, detecting 62 (97%) of the 64 pathologically proven cancers, while sonography detected only 37 (58%). When considering those cancers most amenable to cure, mammography detected over 90% in all categories, but sonography detected only 48% of the cancers that had not yet spread to axillary lymph nodes, only 30% of the nonpalpable malignancies, and only 8% of the cancers smaller than 1 cm. These data indicate that sonography is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. The data further suggest that radiologists who wish to improve the cancer-detecting ability of their current breast imaging operation should upgrade their mammography to state-of-the-art status before adding an automated whole-breast ultrasound scanner.

Breast Neoplasms↗
PubMed1984

Breast cancer detection with transillumination and mammography.

This prospective study of 1239 women compares the breast cancer detecting abilities of state-of-the-art mammography and transillumination. Mammography was found to be the superior technique, detecting 80 (96%) of the 83 pathologically proven cancers, while transillumination detected only 44 (53%). Among cancers having the best prognosis, transillumination was even less accurate relative to mammography, detecting only 43% of malignancies that had not yet spread to axillary lymph nodes and only 19% of the nonpalpable cancers and cancers smaller than 1 cm, whereas mammography detected over 90% in each of these categories. None of the three cancers missed by mammography were detected by transillumination. Clearly, transillumination is not an acceptable substitute for mammography in the detection and diagnosis of breast cancer. Therefore, the current commercial promotion of transillumination seems to be premature.

Axilla↗
PubMed1987

Survey of mammography practices.

Of the 319 radiologists who responded to a survey concerning mammography practices, 50% were employed in a private hospital and 26% in a private office. Film-screen mammography was used most often (54%) followed by xeromammography (30%) and a combination of film-screen and xeromammography (16%). Of the respondents, 62% had changed their method of performing mammography in the last 10 years. Of these, 50% had switched from xeromammography to film-screen, 23% from direct film to film-screen, 15% from direct film to xeromammography, and 6% from film-screen to xeromammography. Mammographic equipment had been purchased by 71% of respondents after 1983. Most respondents (71%) monitored mammography equipment doses, usually at 6- to 12-month intervals. Manual breast examinations were done at the time of mammography at 42% of the facilities, and breast self-examination was taught at 32%. For screening, 87.4% used a two-view examination, 92% required the name of a referring physician to whom the report could be sent, 28% accepted self-referred patients, and only 12% charged a reduced fee for screening. Breast sonography was performed by 53% (93% hand-held vs 7% automated), but none used sonography for screening. Only one respondent reported using thermography; three used light scanning. A need for postgraduate mammography courses for radiologists was indicated by 81%, while 69% recommended technologist courses and 64% recommended 1-week fellowships for radiologists.

Breast Neoplasms↗
PubMed1990

Mammography-guided stereotactic fine-needle aspiration cytology of nonpalpable breast lesions: prospective comparison with surgical biopsy results.

We assessed the usefulness of fine-needle aspiration cytology (FNAC) in evaluating nonpalpable breast abnormalities by prospectively performing stereotactic mammography-guided FNAC on 100 women undergoing surgical excisional biopsy. Mammographic and cytologic diagnoses, on a scale of 1 (benign) to 4 (malignant), were assigned for each case and compared with the surgical pathologic diagnosis. Sensitivity and specificity were examined at different diagnostic cutoff points for regarding a mammographic or cytologic diagnosis as positive or negative. Of the 100 breast biopsy specimens, 70 were benign and 30 were malignant. For both mammography and FNAC, the optimal diagnostic cutoff point was between diagnosis 2 (mammography, probably benign; cytology, atypical) and 3 (mammography and cytology both suspicious for malignancy). At this cutoff point, FNAC had a sensitivity of 0.77 and specificity of 1.00, vs 0.73 sensitivity and 0.79 specificity for mammography. Pearson coefficient analysis revealed significant correlations between both mammographic and FNAC diagnoses and surgical pathology (p less than .001 for both). Our results suggest that use of mammography-guided FNAC may reduce the number of breast biopsies performed for benign lesions.

Adult↗