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Factors associated with mammography utilization: a systematic quantitative review of the literature.Journal of Women's Health (2002) Nov 2008A significant segment of women remains underscreened with mammography. We sought to summarize literature related to factors associated with receipt of mammography. For... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
A significant segment of women remains underscreened with mammography. We sought to summarize literature related to factors associated with receipt of mammography. For data sources, we used English language papers published between 1988 and 2007, including 221 studies describing 4,957,347 women.
METHODS
We calculated odds ratios (ORs) associated with receipt of mammography. Random effects modeling was used to assess trends in mammography utilization and to calculate summary multivariate point estimates. Results were stratified by age, race/ethnicity, and study year. We summarized results between 1988 and 2004 and compared recent years with these results.
RESULTS
Physician access barriers, such as not having a physician-recommend mammography (adjusted OR 0.16, 95% CI 0.08-0.33) and having no primary care provider (OR 0.41, 95% CI 0.32-0.53), were highly predictive of not obtaining mammography. Past screening behavior correlated strongly with receipt of mammography (clinical breast examination, adjusted OR 9.15, 95% CI 3.49-23.98) and Pap test (adjusted OR 3.45, 95% CI 2.12-5.62). With the exception of having no insurance (adjusted OR 0.47, 95% CI 0.39-0.57), several potential socioeconomic barriers did not appear to have an important impact on screening. Racial and ethnic differences were seen. Concerns about cost, mammography safety, and pain were more important to African American and Latina women, and having no insurance was more important to white and Chinese women. Cost concerns and the presence of a family history of breast cancer were less important to older women, whereas screening knowledge had a stronger impact on mammography use in women aged > or =65 years. When we compared study results before 2004 with those later, we found very little difference in the multivariate, adjusted ORs over time.
CONCLUSIONS
Women with poor access to physicians are much less likely to undergo mammography. Improving the frequency and scope of mammography recommendation by primary care providers is the single most important direct contribution the medical community can make toward increasing mammography use.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Ethnicity; Female; Health Behavior; Health Knowledge, Attitudes, Practice; Health Services Accessibility; Humans; Mammography; Middle Aged; Odds Ratio; Physician-Patient Relations; Risk Factors; Socioeconomic Factors; Young Adult
PubMed: 18954237
DOI: 10.1089/jwh.2007.0603 -
Medicine Jan 2017The recent controversy about using mammography to screen for breast cancer based on randomized controlled trials over 3 decades in Western countries has not only... (Meta-Analysis)
Meta-Analysis Review
Clarifying the debate on population-based screening for breast cancer with mammography: A systematic review of randomized controlled trials on mammography with Bayesian meta-analysis and causal model.
BACKGROUND
The recent controversy about using mammography to screen for breast cancer based on randomized controlled trials over 3 decades in Western countries has not only eclipsed the paradigm of evidence-based medicine, but also puts health decision-makers in countries where breast cancer screening is still being considered in a dilemma to adopt or abandon such a well-established screening modality.
METHODS
We reanalyzed the empirical data from the Health Insurance Plan trial in 1963 to the UK age trial in 1991 and their follow-up data published until 2015. We first performed Bayesian conjugated meta-analyses on the heterogeneity of attendance rate, sensitivity, and over-detection and their impacts on advanced stage breast cancer and death from breast cancer across trials using Bayesian Poisson fixed- and random-effect regression model. Bayesian meta-analysis of causal model was then developed to assess a cascade of causal relationships regarding the impact of both attendance and sensitivity on 2 main outcomes.
RESULTS
The causes of heterogeneity responsible for the disparities across the trials were clearly manifested in 3 components. The attendance rate ranged from 61.3% to 90.4%. The sensitivity estimates show substantial variation from 57.26% to 87.97% but improved with time from 64% in 1963 to 82% in 1980 when Bayesian conjugated meta-analysis was conducted in chronological order. The percentage of over-detection shows a wide range from 0% to 28%, adjusting for long lead-time. The impacts of the attendance rate and sensitivity on the 2 main outcomes were statistically significant. Causal inference made by linking these causal relationships with emphasis on the heterogeneity of the attendance rate and sensitivity accounted for the variation in the reduction of advanced breast cancer (none-30%) and of mortality (none-31%). We estimated a 33% (95% CI: 24-42%) and 13% (95% CI: 6-20%) breast cancer mortality reduction for the best scenario (90% attendance rate and 95% sensitivity) and the poor scenario (30% attendance rate and 55% sensitivity), respectively.
CONCLUSION
Elucidating the scenarios from high to low performance and learning from the experiences of these trials helps screening policy-makers contemplate on how to avoid errors made in ineffective studies and emulate the effective studies to save women lives.
Topics: Breast Neoplasms; Humans; Mammography; Mass Screening; Medical Overuse; Patient Acceptance of Health Care; Randomized Controlled Trials as Topic; Sensitivity and Specificity
PubMed: 28099330
DOI: 10.1097/MD.0000000000005684 -
Acta Radiologica (Stockholm, Sweden :... Nov 2018Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce... (Review)
Review
Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56-0.73; P < 0.05, I= 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.
Topics: Breast Neoplasms; Emigrants and Immigrants; Europe; Female; Humans; Mammography; Mass Screening; Minority Groups; North America; Oceania
PubMed: 29451023
DOI: 10.1177/0284185118758132 -
Diabetologia Jan 2020Individuals with diabetes are at increased risk of developing and dying from cancer. Evidence-based guidelines recommend universal screening for breast, cervical and... (Meta-Analysis)
Meta-Analysis Review
AIMS/HYPOTHESIS
Individuals with diabetes are at increased risk of developing and dying from cancer. Evidence-based guidelines recommend universal screening for breast, cervical and colorectal cancer; however, evidence on the uptake of these tests in individuals with diabetes is mixed. We conducted a meta-analysis to quantify the association between diabetes and participation in breast, cervical and colorectal cancer screening.
METHODS
MEDLINE, EMBASE and CINAHL were searched systematically for publications between 1 January 1997 and 18 July 2018. The search was supplemented by handsearching of reference lists of the included studies and known literature reviews. Abstracts and full texts were assessed in duplicate according to the following eligibility criteria: study conducted in the general population; diabetes included as a predictor vs a comparison group without diabetes; and breast (mammography), cervical (Papanicolaou smear) or colorectal (faecal and endoscopic tests) cancer screening uptake included as an outcome. Random-effects meta-analyses were performed using the most-adjusted estimates for each cancer site.
RESULTS
Thirty-seven studies (25 cross-sectional, 12 cohorts) were included, with 27 studies on breast, 19 on cervical and 18 on colorectal cancer screening. Having diabetes was associated with significantly lower likelihood of breast (adjusted OR 0.83 [95% CI 0.77, 0.90]) and cervical (OR 0.76 [95% CI 0.71, 0.81]) cancer screening, relative to not having diabetes. Colorectal cancer screening was comparable across groups with and without diabetes (OR 0.95 [95% CI 0.86, 1.06]); however, women with diabetes were less likely to receive a colorectal cancer screening test than women without diabetes (OR 0.86 [95% CI 0.77, 0.97]).
CONCLUSIONS/INTERPRETATION
Our findings suggest that women with diabetes have suboptimal breast, cervical and colorectal cancer screening rates, compared with women without diabetes, although the absolute differences might be modest. Given the increased risk of cancer in this population, higher quality prospective evidence is necessary to evaluate the contribution of diabetes to cancer screening disparities in relation to other patient-, provider- and system-level factors.
REGISTRATION
PROSPERO registration ID CRD42017073107.
Topics: Female; Humans; Breast Neoplasms; Colonic Neoplasms; Colorectal Neoplasms; Cross-Sectional Studies; Early Detection of Cancer; Adult
PubMed: 31650239
DOI: 10.1007/s00125-019-04995-7 -
Atherosclerosis Mar 2015Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
Breast arterial calcifications (BAC), regularly observed at mammography, are medial calcifications and as such an expression of arteriosclerosis. Our objective was to evaluate and summarize the available evidence on the associations of BAC with cardiovascular risk factors and cardiovascular risk.
METHODS
A systematic literature review and meta-analysis were conducted. Embase and PubMed databases were searched. After critical appraisal, odds ratios were extracted from studies of moderate or good quality that examined risk factors for BAC or associations of BAC with cardiovascular disease. Random effects model meta-analyses were used to calculate pooled odds ratios and 95% confidence intervals (95%CIs).
RESULTS
BAC prevalence is around 12.7% among women in breast cancer screening programs. Increasing age (pooled OR 2.98 [95%CI 2.31-3.85] for every 10 years), diabetes (pooled OR: 1.88 [95%CI 1.36-2.59]) and parity as opposed to nulliparity (pooled OR 3.43 [95%CI 2.23-5.27]) are associated with higher BAC prevalence. Smoking is associated with lower BAC prevalence (pooled OR 0.48 [95%CI 0.39-0.60]). No associations were found with hypertension, obesity or dyslipidemia. Although longitudinal studies (n = 3) were scarce, BAC appear to be associated with an increased risk of cardiovascular disease events (adjusted hazard ratios for coronary heart disease ranging from 1.32 [95%CI 1.08-1.60] to 1.44 [95%CI1.02-2.05]).
CONCLUSION
BAC appear to be associated with an increased risk of cardiovascular disease events, while only being associated with some of the known cardiovascular risk factors, illustrating that medial arterial calcification might contribute to cardiovascular disease through a pathway distinct from the intimal atherosclerotic process.
Topics: Adult; Age Factors; Aged; Arteries; Breast; Breast Neoplasms; Calcinosis; Cardiovascular Diseases; Female; Humans; Middle Aged; Prevalence; Risk Factors; Sensitivity and Specificity; Smoking; Treatment Outcome
PubMed: 25568948
DOI: 10.1016/j.atherosclerosis.2014.12.035 -
Public Health Nursing (Boston, Mass.) May 2021The Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) are used to explain screening behavior. Although reviews of each model have been conducted... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
The Health Belief Model (HBM) and the Theory of Planned Behavior (TPB) are used to explain screening behavior. Although reviews of each model have been conducted independently, none have compared the application of both to mammography screening.
METHODS
A systematic review of literature published in five databases from 1974 to 2020 was performed. Meta-analysis of the explanatory value of the HBM and TPB and effect sizes of their cognitive variables was conducted.
RESULTS
Altogether, 673 papers reporting HBM studies and 577 reporting TPB studies were recovered, of which 43 HBM studies and 15 TPB studies met the eligibility criteria. Twelve studies reported on the explanatory value of either model. The explained variance for HBM ranged from 25% to 89% (mean R = .55), while the explained variance for TPB ranged from 16% to 81% (mean R = .24 [screening behavior as outcome] and 0.46 [intention as outcome]). The component of "cue to action" had the greatest effect size (mean OR 1.80 [95% CI: 1.58-2.04]).
CONCLUSIONS
While the HBM and TPB both demonstrated positive explanatory value, most studies examined the individual constructs of each model and failed to report consistently on the effectiveness of the models.
Topics: Early Detection of Cancer; Health Behavior; Health Belief Model; Humans; Intention; Mammography
PubMed: 33258163
DOI: 10.1111/phn.12842 -
BMC Cancer Feb 2022The aim of this systematic review was to evaluate the evidence and clinical outcomes of screening interventions and implementation trials in sub-Saharan Africa (SSA) and...
BACKGROUND
The aim of this systematic review was to evaluate the evidence and clinical outcomes of screening interventions and implementation trials in sub-Saharan Africa (SSA) and also appraise some ethical issues related to screening in the region through quantitative and qualitative narrative synthesis of the literature.
METHODS
We searched Pubmed, OvidMEDLINE, Embase, and Web of Science to identify studies published on breast cancer screening interventions and outcomes in SSA. Descriptive statistics were used to summarize the frequency and proportions of extracted variables, and narrative syntheses was used to evaluate the clinical outcomes of the different screening modalities. The mixed methods appraisal tool was used to assess the quality of studies included in the review.
RESULTS
Fifteen studies were included, which consisted of 72,572 women in ten countries in SSA. 63% (8/15) of the included publications evaluated Clinical Breast Examination (CBE), 47% (7/15) evaluated mammography and 7% (1/15) evaluated ultrasound screening. The cancer detection rate was < 1/1000 to 3.3/1000 and 3.3/100 to 56/1000 for CBE and mammography screening respectively. There was a lot of heterogeneity in CBE methods, target age for screening and no clear documentation of screening interval. Cost-effective analyses showed that CBE screening linked to comprehensive cancer care is most cost effective. There was limited discussion of the ethics of screening, including the possible harms of screening in the absence of linkage to care. The gap between conducting good screening program and the appropriate follow-up with diagnosis and treatment remains one of the major challenges of screening in SSA.
DISCUSSION
There is insufficient real-world data to support the systematic implementation of national breast cancer screening in SSA. Further research is needed to answer important questions about screening, and national and international partnerships are needed to ensure that appropriate diagnostic and treatment modalities are available to patients who screen positive.
Topics: Adolescent; Adult; Africa South of the Sahara; Breast Neoplasms; Early Detection of Cancer; Ethics, Medical; Female; Health Plan Implementation; Humans; Mammography; Middle Aged; Patient Acceptance of Health Care; Qualitative Research; Young Adult
PubMed: 35197002
DOI: 10.1186/s12885-022-09299-5 -
Clinical Breast Cancer Jun 2023Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has... (Review)
Review
Breast cancer is a global health problem with a high rate of incidence and annual death. The protection motivation model (PMT) is a health psychology theory that has been introduced to motivate health behaviors using coping appraisal and threat appraisal. We aimed to systematically review the applicability of PMT to predict and improve the knowledge and intention (the patient's intent to undergo breast cancer screening with self/clinical breast exam or mammography) for protective behaviors among women. A systematic search was performed in May 2022 in electronic databases to investigate the role of PMT in the prediction of protection behaviors in addition to improving the knowledge about the prevention of breast cancer using specific keywords. The relevant studies were then included for data extraction. Seventeen articles including 7 interventional and 10 prediction studies were selected for data assessment. Findings demonstrated that PMT could be used to predict the rate of knowledge and intention about breast cancer risk among women. It was also shown that PMT could be considered as a framework for the prevention of breast cancer by changing the behaviors of individuals by training the participants. Fear arousal, response efficacy, and response cost were found as the main determinants of knowledge and intention rate. PMT can provide a useful framework to evaluate the factors associated with women's intentions about breast cancer. Periodical educational programs should be implemented to improve protection behaviors by increasing the intention of women to regular self-examination.
Topics: Humans; Female; Motivation; Breast Neoplasms; Health Knowledge, Attitudes, Practice; Self Efficacy; Intention
PubMed: 37045635
DOI: 10.1016/j.clbc.2023.02.013 -
European Journal of Public Health Oct 2016Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher... (Comparative Study)
Comparative Study Meta-Analysis Review
BACKGROUND
Breast cancer is the leading cause of female cancer in Europe and is estimated to affect more than one in 10 women. Higher socioeconomic status has been linked to higher incidence but lower case fatality, while the impact on mortality is ambiguous.
METHODS
We performed a systematic literature review and meta-analysis on studies on association between socioeconomic status and breast cancer outcomes in Europe, with a focus on effects of confounding factors. Summary relative risks (SRRs) were calculated.
RESULTS
The systematic review included 25 articles of which 8 studied incidence, 10 case fatality and 8 mortality. The meta-analysis showed a significantly increased incidence (SRR 1.25, 1.17-1.32), a significantly decreased case fatality (SRR 0.72, 0.63-0.81) and a significantly increased mortality (SRR 1.16, 1.10-1.23) for women with higher socioeconomic status. The association for incidence became insignificant when reproductive factors were included. Case fatality remained significant after controlling for tumour characteristics, treatment factors, comorbidity and lifestyle factors. Mortality remained significant after controlling for reproductive factors.
CONCLUSION
Women with higher socioeconomic status show significantly higher breast cancer incidence, which may be explained by reproductive factors, mammography screening, hormone replacement therapy and lifestyle factors. Lower case fatality for women with higher socioeconomic status may be partly explained by differences in tumour characteristics, treatment factors, comorbidity and lifestyle factors. Several factors linked to breast cancer risk and outcome, such as lower screening attendance for women with lower socioeconomic status, are suitable targets for policy intervention aimed at reducing socioeconomic-related inequalities in health outcomes.
Topics: Adult; Aged; Aged, 80 and over; Breast Neoplasms; Cause of Death; Europe; Female; Forecasting; Humans; Incidence; Middle Aged; Mortality; Risk Factors; Socioeconomic Factors
PubMed: 27221607
DOI: 10.1093/eurpub/ckw070 -
Danish Medical Bulletin Mar 2011The mammography screening trials have shown varying results. This could be because screening was better in some trials than in others at advancing the time of diagnosis.... (Review)
Review
The mammography screening trials have shown varying results. This could be because screening was better in some trials than in others at advancing the time of diagnosis. If so, more cancers would be identified in such trials relative to the control group, and fewer of the cancers would have reached an advanced stage. I performed a systematic review of the mammography screening trials using metaregression. Finding many cancers was not related to the size of the reduction in breast cancer mortality (p = 0.19 after seven and p = 0.73 after 13 years of follow-up). In contrast, finding few cancers in stage II and above predicted a larger reduction in breast cancer mortality (p = 0.04 and p = 0.006). This expected association was also found for node-positive cancers (p = 0.008 and p = 0.04). However, a screening effectiveness of zero (same proportion of node-positive cancers in the screened group as in the control group) predicted a significant 16% reduction in breast cancer mortality after 13 years (95% confidence interval, 9% to 23% reduction). This can only occur if there is bias. Further analyses uncovered bias in both assessment of the cause of death and of the number of cancers in advanced stages. Consequently, the differences in the reported reductions in breast cancer mortality cannot be explained by differences in screening effectiveness. Given that the size of the bias was similar to the estimated screening effect, screening appeared ineffective.
Topics: Adult; Breast Neoplasms; Early Detection of Cancer; Female; Humans; Mammography; Middle Aged; Regression Analysis
PubMed: 21371403
DOI: No ID Found