Breast Cancer Risk Reduction Options: Awareness, Discussion, and Use among Women from Four Ethnic Groups
With recent advances in breast cancer risk reduction practices, it is increasingly important to assess both the breadth of and disparities in use across different racial/ethnic groups.
We conducted telephone interviews with 1,700 women ages 40 to 74, from four racial/ethnic groups, without prior history of breast cancer, who received mammograms at one of five mammography facilities in San Francisco. Main outcomes measured included recognition of tamoxifen, raloxifene, genetic testing, and prophylactic surgery. Global indicators (recognition of any therapy, discussion of breast cancer risk) were developed from original outcome measures and analyzed using logistic regression.
Multivariate analyses indicate that race/ethnicity and interview language affected recognition of therapies and discussion of risk. White women were more likely than all other women to recognize any therapy and more likely than Asian-Americans to discuss risk. Women at high risk, who had a prior abnormal mammogram, who perceived themselves to be at high risk, or who were exposed to breast health information were more likely to discuss risk.
Women are aware of preventive therapies, although discussion and use is limited. Interventions to increase use of therapies should focus on those at high risk.
Available from: Ilona Juraskova
- "The complexity in understanding breast density and the abstract nature of risk to these women may to some extent explain why uptake of chemoprevention is seemingly lower than expected among this group of women . Previous studies indicate that uptake also depends on clinician ' s recommendations ( Cyrus - David and Strom , 2001 ; Malek et al , 2004 ; Taylor and Taguchi , 2005 ) and discussion of tamoxifen as a risk management option ( Kaplan et al , 2006 ) . Clinicians should be aware of how beliefs surrounding tamoxifen prevention are constructed and the impact this may have on women ' s willingness to engage in preventive therapy . "
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Randomised trials of tamoxifen versus placebo indicate that tamoxifen reduces breast cancer risk by approximately 33%, yet uptake is low. Approximately 10% of women in our clinic entered the IBIS-I prevention trial. We assess the uptake of tamoxifen in a consecutive series of premenopausal women not in a trial and explore the reasons for uptake through interviews.
All eligible women between 33 and 46 years at ⩾17% lifetime risk of breast cancer and undergoing annual mammography in our service were invited to take a 5-year course of tamoxifen. Reasons for accepting (n=15) or declining (n=15) were explored using semi-structured interviews.
Of 1279 eligible women, 136 (10.6%) decided to take tamoxifen. Women >40 years (74 out of 553 (13.4%)) and those at higher non-BRCA-associated risk were more likely to accept tamoxifen (129 out of 1109 (11.6%)). Interviews highlighted four themes surrounding decision making: perceived impact of side effects, the impact of others' experience on beliefs about tamoxifen, tamoxifen as a ‘cancer drug', and daily reminder of cancer risk.
Tamoxifen uptake was similar to previously ascertained uptake in a randomised controlled trial (IBIS-I). Concerns were similar in women who did or did not accept tamoxifen. Decision making appeared to be embedded in the experience of significant others.
British Journal of Cancer 03/2014; 110(7). DOI:10.1038/bjc.2014.109 · 4.84 Impact Factor
- "Knowledge regarding breast cancer has been shown to be better among the more educated, and is generally satisfactory in developed countries [6,7]. Awareness and health seeking practices have been shown to be poor in many developing countries, necessitating the need for proper awareness programs [8,9]. "
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ABSTRACT: Breast cancer is the commonest cancer in women worldwide. Although programmes promoting breast cancer awareness are being carried out throughout Sri Lanka, few have targeted school students. We conducted this study to assess the knowledge, attitudes and practices regarding breast cancer with reference to screening, services available, breast self-examination, and sources of information, among adolescent schoolgirls in the Colombo District of Sri Lanka.
The knowledge, attitudes and practices related to breast cancer were assessed among 859 adolescent girls in schools within the Colombo District, using a self-administered questionnaire. Classes and students were selected using multi-stage stratified cluster sampling.
Of the total sample, approximately 60% of respondents identified 'history of breast lump', 'family history of breast cancer' & 'exposure to irradiation' as risk factors for breast cancer. Although most were aware that the presence of a breast lump was an important warning sign, awareness of other warning signs was poor. Only 35.6% identified mammogram as an effective screening method. One third of the sample maintained that they are unaware of symptoms, diagnostics and treatment of breast cancer. Of those who were aware, 90.6% named surgery as a treatment option for breast cancer, 79.4% were unaware that chemotherapy is used. Of the total sample, 17.1% knew how to perform breast self-examination, and only 9.4% were aware of currently available breast cancer screening services. Knowledge was significantly better among students who had a relative with breast cancer.
There were significant deficiencies in knowledge, attitudes and practices on breast cancer in the study population. In particular, knowledge on breast self examination was poor. There is a need for awareness programs aimed specifically at this important target group.
BMC Public Health 12/2013; 13(1):1209. DOI:10.1186/1471-2458-13-1209 · 2.26 Impact Factor
Available from: Jennifer McClure
- "A number of factors relating to women's knowledge and attitudes towards these drugs appear to contribute to the low uptake. First, women are not necessarily aware of their availability - previous research found women's awareness of tamoxifen varied widely between ethnic groups, with white women most frequently reporting awareness of the drugs . Second, women may not believe the drugs can truly reduce their risk of breast cancer [8,10-12]. "
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ABSTRACT: Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer.
We conducted a Randomized Clinical Trial, assessing the effect of a decision aid about breast cancer chemoprevention on informed choices about chemoprevention. Women (n=585) aged 46 to 74 years old completed online baseline, post-test, and 3-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a 3-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable "informed choice" [yes/no] to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes.
Analyses showed that more intervention than standard control participants (52.7% vs. 5.9%) made informed decisions at post-test, P<0.001. At the 3-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P=0.067.
The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. Trial registration: ClinicalTrials.gov; number NCT00967824.
Breast cancer research: BCR 09/2013; 15(5):R74. DOI:10.1186/bcr3468 · 5.49 Impact Factor
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