Breast cancer is a leading cause of mortality among women in the United States. Women with chronic disabling conditions such as multiple sclerosis (MS) are less likely to participate in routine mammography screening than women without disabilities due to multiple barriers. Underuse of mammography screening may lead to a diagnosis of a later stage breast cancer and consequently higher breast cancer mortality rate. This study examined the influence of several factors including, severity of MS-related functional limitations, demographic characteristics, family history of breast cancer, beliefs related to mammography screening and breast cancer, and personal resources on usual screening mammography in a sample of women with MS. The conceptual framework guiding this study was synthesized from The Explanatory Model of Health Promotion and Quality of Life in Chronic and Disabling Conditions and the Health Belief Model. Data from an ongoing longitudinal study (R01NR003195) focused on health promotion of persons with MS were combined with primary data for this prospective descriptive correlational study. The nonprobability sample consisted of 274 women ages 39-85 years who were primarily White (92%), married (66.1%), and unemployed (64.1%) with a 22 year average length of diagnosis with MS. Data were collected over two years using a mailed survey. Descriptive statistics and hierarchical logistic regression analyses were used to address the research questions. The annual mammography rate in this sample was 62%. Perceived susceptibility to breast cancer (AOR = 3.0, p < .05), family history (AOR = 2.5, p < .05), economic adequacy (AOR = 1.6, p < .05), and perceived barriers to mammography (AOR = .98, p < .05) significantly predicted mammography use, adjusted for severity of functional limitations. Though severity of limitations was negatively associated with mammography, it was not a significant predictor in the overall model. These findings suggest that for women with chronic disabling conditions, health beliefs, family history, and personal resources influence mammography screening. Clinicians need to continue to eliminate the barriers to mammography screening to improve screening and reduce overall breast cancer mortality rate in this vulnerable population. / text

The aim of the study is to assess the connection between women’s participation in breast cancer screening and beliefs towards breast cancer, breast self-examination and mammography. The objectives of the study: 1. To assess validity and reliability of Champion Health Belief Model Scale for beliefs towards breast cancer, breast self-examination and mammography screening for Lithuanian women. 2. To estimate perceived susceptibility, perceived severity, perceived benefits, perceived barriers, confidence and health motivation. 3. To compare beliefs towards breast cancer, breast self-examination and mammography screening of participant and non-participant women in the screening program. 4. To assess perceived barriers towards mammography screening. 5. To investigate the role of information about breast cancer and mammography screening for women‘s beliefs towards breast cancer, breast self-examination and mammography screening. CONCLUSIONS 1. Champion Health Belief Model Scale is a valid and reliable to assess beliefs towards breast cancer, breast self- examination and mammography. The barriers- mammography item “Regular mammography screening would make me worry about breast cancer” was inappropriate to the scale and expunged from the questionnaire. 2. Surveyed women did not feel much threat to get breast cancer. They overvalued benefits of breast self-examination and positively rated mammography screening. However, confidence to perform breast self-examination was properly low... [to full text] / Šio darbo tikslas buvo įvertinti atvykusių ir neatvykusių tikrintis mamografiškai moterų nuostatų į krūties vėžį, krūtų savityrą ir atrankinę mamografinę patikrą skirtumus. Tikslui pasiekti iškelti tokie uždaviniai: 1. Įvertinti Champion VL sveikatos įsitikinimų modelio klausimyno tinkamumą tirti Lietuvos moterų nuostatoms į krūties vėžį, krūtų savityrą ir atrankinę mamografinę patikrą. 2. Nustatyti moterų suvoktą krūties vėžio grėsmę, apsaugančios nuo krūties vėžio pasekmių elgsenos naudą ir kliūtis šiai veiklai, sveikos gyvensenos motyvaciją. 3. Palyginti atvykusių ir neatvykusių tirtis mamografiškai dėl krūties vėžio moterų nuostatas į krūties vėžį, krūtų savityrą ir atrankinę mamografinę patikrą. 4. Įvertinti dalyvavusių atrankinėje mamografinėje patikroje dėl krūties vėžio moterų kliūtis tirtis mamografiškai. 5. Ištirti papildomos informacijos apie krūties vėžį, mamografinę patikrą įtaką moterų nuostatoms į krūties vėžį, savityrą bei atrankinę mamografinę patikrą ir moterų dalyvavimui atrankinės patikros programoje. Išvados: 1. Patikrintas ir įteisintas VL Champion sveikatos įsitikinimų modelio skalės klausimynas yra tinkamas Lietuvos moterų nuostatoms į krūties vėžį, krūtų savityrą ir atrankinę mamografinę patikrą tirti. Sveikos gyvensenos motyvacijos skalė turi būti padalinta į požiūrio į sveiką gyvenseną ir veiklos sveikatos labui subskales. Kliūčių tirtis mamografiškai teiginys “reguliarus mamografinis ištyrimas verstų mane nerimauti dėl krūties vėžio” išbrauktas... [toliau žr. visą tekstą]

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2016-02-20T13:58:02Z No. of bitstreams: 1 Katucha Rocha de Almeida.pdf: 1145204 bytes, checksum: 8da70f49b690eb6b7404c3f5f0a86b27 (MD5) / Made available in DSpace on 2016-02-20T13:58:02Z (GMT). No. of bitstreams: 1 Katucha Rocha de Almeida.pdf: 1145204 bytes, checksum: 8da70f49b690eb6b7404c3f5f0a86b27 (MD5) Previous issue date: 2015-12-10 / Introduction: Breast cancer is the most common type of cancer among women, in both developing and developed countries, represented by 25% of all types of diagnosed cancer. Mammography screening for breast cancer is a public health strategy in situations with high incidence numbers and mortality from cancer, as observed in Brazil. Objective: To analyze the performance of mammography screening in Praia Grande city female residents. Methods: A public survey in Praia Grande city, in the state of São Paulo. For the study on undergoing mammography screening exam among 50- to 69 year-old women, according to mammographic screening recommendations, a subsample of 257 women was used, with a non response rate of 0%. Results: Among the 50 to 69 female age-group (257), 70 (27%) underwent mammography screening in the 12 months prior to the survey, more than half (60%) used the public sector service. In the multivariate analysis, breast ultrasound was positively associated with mammography in the last 12 months. Conclusion: Women with recommended ages for tracking the Grand Beach County have low achievement of mammography. The awareness through implementation of public policies on the importance of this examination within what is recommended, to reduce the mortality from the disease, which is a leading cause of death among women in Brazil and worldwide. / Introdução: O câncer de mama é o tipo mais prevalente entre as mulheres, tanto em países em desenvolvimento quanto em países desenvolvidos, representado por 25% de todos os tipos de câncer diagnosticados. O exame de mamografia como rastreamento para o câncer de mama é uma estratégia de saúde pública em situações onde há elevados números de incidência e mortalidade pela neoplasia, como observado no Brasil. Objetivo: Analisar a realização do exame de mamografia em mulheres residentes do Município de Praia Grande. Métodos: Inquérito populacional no Município de Praia Grande, Estado de São Paulo. Para o estudo sobre realização do exame de mamografia entre mulheres de 50 a 69 anos, referente ao preconizado para realização de rastreamento mamográfico, foi utilizada para análise uma subamostra de 257 mulheres, com taxa de não respostas de 0%. Resultados: Das mulheres na faixa etária dos 50 aos 69 anos (257), 70 (27%) realizaram o exame de mamografia nos últimos doze meses que antecederam a pesquisa, sendo mais da metade (60%) pelo setor público. Na análise múltipla, manteve-se associada positivamente apenas a realização do ultrassom de mamas nos últimos doze meses. Conclusão: Mulheres com idades preconizadas para rastreamento do Município de Praia Grande apresentam baixa realização do exame mamográfico. A conscientização por meio de implementação de políticas públicas sobre a importância da realização deste exame dentro do que é preconizado, visa diminuir a mortalidade pela doença, que é uma das principais causas de morte entre as mulheres no Brasil e no mundo. Descritores: Mamografia; Rastreamento; Câncer

While sisters of breast cancer patients are at increased risk for developing breast cancer due to their family cancer history and age, little research with first-degree relatives of cancer patients has focused solely on sisters. To address this issue, the current study examined sisters screening and health behaviors and the predictors of these behaviors. In accordance with the Parallel Processing Theory, the current study assessed the relationship of cognitive and emotional factors to screening and health-promoting behaviors among sisters of breast cancer patients. In addition, this study expanded upon the Parallel Processing Theory by also examining the relationship of interpersonal factors to screening and health-promoting behaviors. One-hundred-twenty sisters of breast cancer patients from 89 different families completed questionnaires assessing perceived risk of breast cancer, perceived response efficacy of mammography, diet, and exercise, breast cancer worry, trait anxiety, involvement in sister's cancer care, satisfaction with the sister relationship, mammography screenings, physical activity, and amount of fruits and vegetables consumed. Findings indicated that cognitive, emotional, and relational factors were significantly related to mammography screenings, but not to diet or exercise. Specifically, response efficacy for mammography screening was positively related to mammography screening; while trait anxiety and involvement in sister's care were negatively related to mammography screening. Additional analyses indicated that breast cancer worry had a curvilinear relationship with mammography screenings, such that no relationship was seen for women with lower breast cancer worry; for women with higher levels of worry, the greater their worry, the less likely they were to obtain mammography screenings. Breast cancer worry was also found to interact with involvement in care, such that among women less involved in their sister's care, greater breast cancer worry was associated with having fewer mammography screenings. However, for women more involved in their sister's care, greater breast cancer worry was associated with having more mammography screenings. Future research should further assess whether a teachable moment exists related to the family member's cancer diagnosis and treatment during which to encourage the FDR to engage in screening health-promoting behaviors.

Darbo tikslas - įvertinti krūties vėžio mamografinės patikros rezultatus ir pacienčių išgyvenamumą. Darbo uždaviniai: 1. Išanalizuoti mamografinių pakitimų struktūrą skirtingose amžiaus grupėse bei įvertinti jų sąsają su krūties vėžio rizikos veiksniais tarp mamografinėje patikroje dalyvavusių moterų. 2. Palyginti dviejų nepriklausomų radiologų mamografinio tyrimo vertinimo patikimumą. 3. Įvertinti mamografinės diagnostikos tikslumą, palyginant mamografinių ir patologinių–morfologinių tyrimų duomenis. 4. Įvertinti moterų, kurioms buvo nustatytas krūties vėžys, penkerių metų išgyvenamumą ir jo ryšį su prognostiniais veiksniais. / The aim of the study - to evaluate the results of mammography screening and survival of breast cancer patients. Objectives: 1. To analyse mammography findings structure in different age groups and evaluate their correlation with breast cancer risk factors in women participants of mammography screening. 2. To evaluate the benefit of independent double reading in mammography screening 3. To evaluate the accuracy of mammography diagnostics by comparing radiological and histological findings. 4. To estimate five year survival of breast cancer patients and establish its correlation with prognostic indicators of the tumour.

Objectives: Ductal carcinoma in situ (DCIS) is a non-invasive lesion of an increasing clinical importance. Individual risk assessment is essential for an optimal treatment. Our objective was to identify clinical and molecular characteristics of a subgroup of DCIS with an unfavorable prognosis. Methods: In a population study, we analyzed women with DCIS diagnosed within one mammography screening unit. In the experimental part of this work, we conducted a comparative analysis of five biological markers in normal tissue, DCIS and invasive breast cancer by means of gene expression analysis and analysis of loss of heterozygosity (LOH). Results: We demonstrated a high proportion of pure (no invasive component) DCIS (14.41%) of all breast lesions described as malignant. In our sample, we saw a homogeneous distribution of risk factors without noting a clear pattern identifying high-risk subtypes. We noted significant differences in clinical management of tumors with similar characteristics, which demonstrates the present state of limited use of clinical predictors. In the laboratory experiment, we showed differences in loss of heterozygosity (LOH) between DCIS and invasive breast cancer for BRCA1 (8.69% vs. 44.74%) and BRCA2 (9.52% vs. 45.0%). In contrast, we did not find any differences for p53 (31.82%...

Objectives: Ductal carcinoma in situ (DCIS) is a non-invasive lesion of an increasing clinical importance. Individual risk assessment is essential for an optimal treatment. Our objective was to identify clinical and molecular characteristics of a subgroup of DCIS with an unfavorable prognosis. Methods: In a population study, we analyzed women with DCIS diagnosed within one mammography screening unit. In the experimental part of this work, we conducted a comparative analysis of five biological markers in normal tissue, DCIS and invasive breast cancer by means of gene expression analysis and analysis of loss of heterozygosity (LOH). Results: We demonstrated a high proportion of pure (no invasive component) DCIS (14.41%) of all breast lesions described as malignant. In our sample, we saw a homogeneous distribution of risk factors without noting a clear pattern identifying high-risk subtypes. We noted significant differences in clinical management of tumors with similar characteristics, which demonstrates the present state of limited use of clinical predictors. In the laboratory experiment, we showed differences in loss of heterozygosity (LOH) between DCIS and invasive breast cancer for BRCA1 (8.69% vs. 44.74%) and BRCA2 (9.52% vs. 45.0%). In contrast, we did not find any differences for p53 (31.82%...

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This dissertation focuses on women’s participation in mammography screening, which is a vital component of early detection and effective management of breast cancer. All Swedish women in the age group of 40-74 receive an invitation by mail at regular intervals of 18-24 months. However, about 20% of Swedish women fail to attend the mammography screening they were offered. The impact on mortality within a population is contingent on theparticipation rate, underscoring the importance of making efforts to attain a high level of participation. This thesis is an attemt to improve understanding and awareness of the women’s choices and actions that can influence life or death, especially considering that being a woman is the most significant risk factor for breast cancer. The overall aim of this thesis was to explore the phenomenon of women’s participation in mammography screening by exploring the reasons why women refrain from mammography screening from the perspective of non-attending women (Paper I) and factors that affect women’s participation in mammography screening in the Nordic countries. The research was conducted through qualitative and mixed studies review method studies. The data collection methods comprised ten personal interviews (Paper I), and 16 articles (Paper II). Qualitative content analysis was used to analyse the interviews in an indictive approach (Paper I). A deductive approach with segregated mixed research synthesis was used to analyse and summarise findings from articles in systematic review (Paper II). Health Promotion Model by N. Pender was used as a theoretical framework. Participation in mammography screening is a complex phenomenon that has many dimensions. The thesis results underscore the significance of comprehending the unique and subjective encounters of women in the context of mammography screening. These experiences hold substantial sway over their perspectives and actions regarding this procedure. Additionally, the research suggests that effective communication and prior experiences, whether positive or negative, play pivotal roles in shaping women's knowledge and attitudes towards mammography. These findings align with the biopsychosocial perspective, which underscores the intricate interplay of biological, psychological, and social factors in individuals' lives. Mammography screening, as demonstrated in Paper I, operates as a standardized system aimed at addressing the diverse and individual needs of women. Various factors, such as individual characteristics, past experiences, cognitive factors related to behavior, emotional aspects, competing priorities, and the organizational aspects of screening, collectively influence women's participation in both positive and negative ways (Paper II). Promotional efforts are essential to motivate women to actively engage in their healthcare.

Background The debate regarding the lower age limit for mammography service screening is old and lively; a product in part of the lower breast cancer risk in younger ages as well as the limited data available for studies of the younger age group. Recently the idea of inviting only high risk groups has gained momentum, however high risk might not be equivalent to greater benefit from screening. Therefore, there is a need for information on effectiveness of screening as it relates to young women and to specific risk groups. To this end, this thesis evaluates mammography screening for the age group – 40 to 49 year old women – in terms of breast cancer mortality reduction in total and in subgroups based on breast cancer risk factors. Overdiagnosis of mammography screening is also evaluated for women 40 to 49 years old. In addition, this thesis presents a statistical method to estimate this effectiveness and to test for differences in effectiveness between subgroups adjusted for non-compliance and contamination. Methods The studies of this thesis are based on data from the Screening of Young Women (SCRY) database. The SCRY database consists of detailed information on diagnosis, death, screening exposure and risk factors for breast cancer cases and population size by year (between 1986 and 2005) and municipality for women in Sweden between 40 and 49 years old. The material was divided into a study group consisting of the counties that invited women in the age group 40-49 years to mammography screening, and a contemporaneous control group consisting of the counties that did not. Effectiveness was estimated in terms of rate ratios for two different exposures (invitation to and participation in screening), and overdiagnosis for subsequent screening was estimated adjusting for lead time bias. Defining a reference period enabled adjustment for possible underlying differences in breast cancer mortality and incidence. A statistical model for adjusting for non-compliance and contamination in randomised controlled trials was further developed to allow for adjustment in cohort studies using a Poisson model with log-linear structure for exposure and background risk. Results During the study period (1986-2005), there were 619 and 1205 breast cancer deaths and 6047 and 7790 breast cancer cases in the study group and the control groups, respectively. For women between 40 and 49 years old, the breast cancer mortality reduction was estimated at 26% [95% CI, 17 to 34%] for invited to screening and 29% [95% CI, 20 to 38%] for attending screening. The RR estimates for the high-risk groups based on the risk factors parity, age at birth of first child, and socio-economic status were equal to or higher than that of the low risk groups. The new statistical method showed that the decrease in effectiveness with parity was not a statistically significant trend. The overdiagnosis from subsequent screening for 40 to 49 year old women was estimated at 1% [95 % CI, -6 to 8 %] (i.e., not statistically significant). Conclusion Subgroup specific effectiveness was also estimated. The relative effectiveness of screening for breast cancer with mammography for women age 40 to 49 years appears to be comparable to that for older women. These findings and the fact that there was no statistically significant overdiagnosis from subsequent screening speak for inviting women 40 to 49 years old to screening. High-risk screening for nulliparous women aged 40 to 49 years, for example, might be an alternative in countries where population-based screening for all women between 40 and 49 years old is not possible. However, the matter of risk factors and the effect of their combinations is complex and risk group screening presents ethical and practical difficulties. The new statistical model is a useful tool for analysing cohorts with exposed and non-exposed populations where non-compliance and contamination is a potential source of bias.