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No description available.

Although there has been an increasing incidence of breast cancer among Non-English speaking background (NESB) women in many developed countries, existing screening services are being underused by these women. Studies show that the barriers to the accessibility of breast cancer screening by NESB women include their lack of awareness, low level of education, low self-efficacy and lack of social interaction with other women. This study aimed to investigate the knowledge relating to breast cancer and mammography, self-efficacy and barriers to mammography use among NESB women in an Australian regional city before and after their attendance at a health education session. This health education session aimed to increase the awareness and use of mammography among these NESB women. Two widely used behaviour theories, ‘Health belief model’ and ‘Social Cognitive Theory,’ were applied as the theoretical framework for this study. A quasi-experimental study was conducted in which the health education session was used as an intervention. Pre-test and post-test questionnaires were completed by study participants before and after the health education session. Their knowledge of breast cancer and mammography was assessed. In addition, their self-efficacy and barriers to the use of mammography were also analysed. Results indicated that informal recruitment strategies were more effective with these NESB women. Initially 49 women were recruited. Of these, 23 women (47%) attended the health education session. As data showed tertiary educated and employed women who already had mammogram/s were more likely to attend the session. After attending the health education session, the women’s knowledge relating to breast cancer and mammography was improved and the perceived barriers to the use of mammography were reduced. During a three month follow-up period, there was no change of mammogram use by the women. However, the results showed a trend of increased intention to use the mammogram over a period of two years (41.7%) compared to six months (25.0%). Based on these results, further studies are recommended to explore the beneficial outcomes of health promotion programs targeting NESB women who are not in the workforce or have a low level of education.

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Mammographic techniques used for screening programmes need to be of the highest quality; hence, the need of a good phantom to mimic breast response to radiation. The phantom materials must be sensitive to small changes in the mammography system and provide a means of evaluating the absorbed dose to the breast. These materials have to provide the same attenuation properties as the real tissues being simulated, for the radiation modalities being investigated. Cross-linked hydrophilic copolymers have the potential to be good phantom materials for the breast as their elemental compositions are similar to soft tissue. Two types of hydrophilic copolymer materials used in this study were designated as ED1S and ED4C. They were made from a certain proportionate mixture of methyl methacrylate and vinyl pyrrolidone. The physical properties of the materials such as liquid uptake and dimensional changes in hydration and dehydration processes were studied. The equilibrium water content of ED1S and ED4C fully hydrated in water was 55% and 70% respectively. The samples underwent distortion when dehydrated and a volume approximation formula for the dehydrated samples was derived. The linear attenuation coefficient and the mass attenuation coefficient of the hydrophilic copolymer materials at photon energies in the mammographic energy region were determined. Both a single beam transmission method and a photon transmission tomography method were used. The results were compared with XCOM calculated attenuation coefficients of water and average breasts using the elemental composition found in the literature. It was found that the mass attenuation coefficient of dry hydrophilic copolymer samples closely fit the XCOM calculated old-age breast (Breast 3) and samples fully hydrated in water fit the calculated young-age breast (Breast 1). Measurements were also carried out to determine the linear attenuation coefficient of normal and abnormal breast tissues at four photon energies in the mammographic energy region. The values found were in good accord with calculated average breast values. However, more studies need to be done as only three samples were used. The electron density of the hydrophilic copolymer materials was determined by using the Compton scattering technique. The electron density for dry ED1S sample was (3.1 +/- 0.4) x 1023 electrons per cm3 and for dry ED4C was (4.4 +/- 0.4) x 1023 electrons per cm3.

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Taiwanese lesbians have been found to utilize screening tests for breast cancer at lower rates when compared to women in general in Taiwan. However, there is a lack of evidence regarding the factors which influence Taiwanese lesbians' breast healthcare behaviour and intentions. A two-phase sequential exploratory mixed-methods study was employed to explore the factors influencing Taiwanese lesbians' breast healthcare behaviour and intentions, including semi-structured interviews and an online survey. Taiwanese women aged 20 years or above and who self-identified themselves as lesbians or as partnered with the same gender were targeted and recruited, using purposive and snowball sampling. Thirty-seven semi-structured interviews were conducted initially. According to the interview findings and two existing health psychology models (the health belief model and the theory of reasoned action), a questionnaire was developed and an online questionnaire survey was undertaken with a larger population. A total of 284 women completed the online survey. The findings showed that the lesbians' breast healthcare behaviour and intentions were directly or indirectly affected by their gender identity, gender role expression, patient-provider interaction and partners' support. In addition, it was also found that the lesbians may share similar views about breast cancer and breast cancer screenings, self-efficacy and cues to action with women in general in Taiwan. Some of these factors had an important effect on the lesbians' breast healthcare behaviour and/or intentions, in particular the perceived barriers to performing and/or having breast cancer screenings, the perceived susceptibility to breast cancer, self-efficacy and cues to action. Based on the PhD findings and social-ecological model, four levels of recommendations were proposed in order to encourage Taiwanese lesbians' utilization of breast cancer screenings and to promote their breast health.

Early breast cancer in women is best identified through high quality mammographic screening. This is achieved by well trained health professionals and appropriate imaging. Traditionally this has used X-ray film but is rapidly changing to utilise digital imaging with the resultant mammograms visually examined on high resolution clinical workstations. These digital images can also be viewed on a range of display devices, such as standard computer monitors or PDAs. In this thesis the potential of using such non-clinical workstation display devices for training purposes in breast screening has been investigated. The research introduces and reviews breast screening both in the UK and internationally where it concentrates upon China which is beginning screening. Various imaging technologies used to examine the breast are described, concentrating upon the move from using X-ray film to digital mammograms. Training in screening in the UK is detailed and it is argued that there is a need to extend this. Initially, a national survey of all UK mammography screeners within the National Health Breast Screening Programme (NHSBSP) was undertaken. This highlighted the current main difficulties of mammographic (film) interpretation training being tied to the device for inspecting these images. The screeners perceived the need for future digital imaging training that could be outside the breast screening centre; namely 3W training (Whatever training required, Whenever and Wherever). This is largely because the clinical workstations would logistically not be available for training purposes due to the daily screening demand. Whilst these workstations must be used for screening and diagnostic purposes to allow visualisation of very small detail in the images, it is argued here that training to identify such features can be undertaken on other devices where there is not the time constraints that exist during breast screening. A series of small pilot studies were then undertaken, trialling experienced radiologists with potential displays (PDAs and laptops) for mammographic image examination. These studies demonstrated that even on a PDA small mammographic features could be identified, albeit with difficulty, even with a very limited HCI manipulation tool. For training purposes the laptop, studied here with no HCI tool, was supported. Such promising results of display acceptability led to an investigation of mammographic inspection on displays of various sizes and resolutions. This study employed radiography students, potentially eventual screeners, who were eye tracked as they examined images on various sized displays. This showed that it could be possible to use a small PDA to deliver training. A detailed study then investigated whether aspects of an expert radiologist s visual inspection behaviour could be used to develop various training approaches. Four approaches were developed and examined using naïve observers who were eye tracked as they were trained and tested. The approaches were found to be all feasible to implement but of variable usefulness for delivering mammographic interpretation training; this was confirmed by opinions from a focus group of screeners. On the basis of the previous studies, over a period of eight months, a large scale study involving 15 film readers from major breast screening centres was conducted where they examined series of digital mammograms on a clinical workstation, monitor and an iPhone. Overall results on individuals performance, image manipulation behaviour and visual search data indicated that a standard monitor could be employed successfully as an alternative for the digital workstation to deliver on-demand mammographic interpretation training using the full mammographic case images. The small iPhone, elicited poor performance, and was therefore judged not suitable for delivering training with the software employed here. However, future software developments may well overcome its shortcomings. The potential to implement training in China was examined by studying the current skill level of some practicing radiologists and an examination of how they responded to the developed training approaches. Results suggest that such an approach would be also applicable in other countries with different levels of screening skills. On-going further work is also discussed: the improvement of performance evaluation in mammography; new visual research on other breast imaging modalities and using visual search with computer aided detection to assist mammographic interpretation training.

Background: Based on previous research, conventional mammography screening has been found to be ineffective for women at high risk, mainly because high-risk women have high breast density and a fast progression rate of breast cancer. Recently, MRI screening was proposed as an additional complementary screening for high-risk women in Ottawa. The addition of MRI to mammography to screen the high-risk population is worth exploring as it may well address the limitations of mammography, especially since MRI has higher sensitivity. Purpose: The goal of this study is to assess the cost-effectiveness off adding MRI to mammography screening for early detection among women of the high-risk population in Ottawa by using conventional values for the society’s/government’s willingness to pay for one life year gained (US$ 50,000). Methods: A discrete-event simulation model was developed to evaluate the cost-effectiveness of adding MRI screening to mammography for high risk women breast screening in Ottawa. Three risk groups were considered; BRCA1, BRCA2 and other high risk. Based on breast annual incidence, screening features, breast cancer progression among high-risk women, treatment and breast cancer survival rates, the model simulates a hypothetical cohort consisting of 5000 women progressing from age 30 to 100 (or to natural death) and calculates the accumulated life years and costs in order to predict the cost of one life year gained by each screening strategy. Univariate sensitivity analysis was performed on the key parameters to determine the robustness of the simulation outcomes. Paired t-tests were used to determine whether the parameters’ variations are statistically significant or not. Results: In the base-case scenario, the incremental cost-effectiveness ratio (ICER) of mammography compared to both screening was CAN$30,043.48 /life year gained (95%CI ±2524.40) which means the addition of MRI to mammography is a cost-effective intervention according to the commonly used willingness-to-pay threshold of US$50,000 per life-year gained. The findings of the sensitivity analysis indicate that the cost-effectiveness of adding MRI screening is statistically significant for most of the parameter variations, however, the degree of change in the ICER is not hugely impactful as in all cases the ICER remained well below the commonly used willingness-to-pay threshold per life year gained. Conclusion: Study results suggested that the addition of MRI has an important role in improving high risk women screening in terms of increasing life years gained compared to receiving mammography screening only. The results of this study support the recommendations of Cancer Care Ontario and the Ontario Health Technology Advisory Committee guidelines of expanding the Ontario Screening Program to integrate MRI with mammography screening for high risk women aged 30 to 69 years.