An Analysis of the Factors Affecting Willingness to Decrease Mammogram Frequency Among Women at Low Risk for Hereditary Breast Cancer Pubblico
Pencea, Ioana (Summer 2018)
Published
Abstract
Background In 2009, The US Preventative Services Task Force changed mammography screening recommendations, recommending that women start having mammograms later in life and that women have less frequent mammograms, based on their risk of breast cancer. These changes were meant to maximize the positive aspects of mammography while minimizing the negative aspects, which can often be sizeable. However, mammography recommendation changes have not resulted in a decrease in mammography. Hereditary breast cancer tends to be early onset and aggressive. Women at high risk of hereditary breast cancer benefit from early and frequent mammography, whereas women at low risk of hereditary breast cancer do not. Family history can be used to determine whether a woman has a high genetic risk of hereditary breast cancer, however convincing low risk women to forgo frequent mammography will likely prove challenging. This study seeks to understand the factors that influence willingness to decrease mammogram frequency among women at low risk of hereditary breast cancer.
Methods 157 participants were recruited from Emory clinic breast imaging centers. Women who completed a breast cancer genetics referral screening tool (B-RST) and received a negative result were sent a survey which included items evaluating women’s risk understanding, recall of B-RST result, demographics, past mammogram frequency, healthcare trust, perceived risk of breast cancer, breast cancer worry, acceptance of B-RST result, and willingness to decrease their mammogram frequency based on their low risk. Analysis was conducted by calculating descriptive statistics for survey items and significant differences between questionnaire responses between those who were willing, unsure, and unwilling to decrease their mammogram frequency using ANOVAs and Chi-Square tests. Binomial logistic regressions were conducted to assess the association between study variables and willingness to decrease mammogram frequency, as well as to assess the association between study variables and being undecided of willingness.
Results Overall, 57.3% of the women included were either willing to decrease their mammogram frequency based on their genetic risk or uncertain of their willingness. Chi square analysis showed a significant differences in past mammogram frequency between willingness variables, with 94.0% of women who had had yearly mammograms or more unwilling to decrease their mammogram frequency (p<0.00). Differences were also found in breast cancer worry frequency, with the majority of those who were unwilling, 65.7%, reporting having experienced breast cancer worry (p=0.02). Those who were willing to decrease their mammogram frequency were less likely to report experiencing a high perceived risk of breast cancer (p=0.01). Binomial logistic regression showed significant associations between being willing to decrease mammogram frequency and both past mammogram frequency (p<0.00) and perceived risk of breast cancer (p=0.07).
Conclusion The majority of the study population were either willing to decrease their mammogram frequency based on their genetic risk or were uncertain of their willingness and could potentially be swayed. Past mammogram frequency, breast cancer worry, and perceived risk were all found to be associated with willingness to decrease mammogram frequency. This knowledge can be used to create future guidelines and education efforts, improving patient understanding of breast cancer genetic risk and providing patients to tools necessary to make informed decisions.
Table of Contents
CHAPTER 1: INTRODUCTION………………………………………………………………1
STATEMENT OF PROBLEM…………………………………………………………...1
POPULATION SCREENING……………………………………………………………2
AVAILABLE INTERVENTIONS TO REDUCE BREAST CANCER…………………4
MORTALITY FOR THOSE AT HIGH RISK
DE-IMPLEMENTATION OF MAMMOGRAPHY…………………………………......6
CHALLENGES OF USING RISK STRATIFICATION IN GUIDING HEALTH……...7 SERVICE DELIVERY
THEORETICAL FRAMEWORK………………………………………………………..8
PURPOSE OF STUDY…………………...……………………………………………..12
SIGNIFICANCE OF STUDY…………………………………………………………...13
LIMITATIONS………………………………………………………………………….14
DEFINITION OF TERMS………………………………………………………………14
CHAPTER 2: LITERATURE REVIEW…………………………………………………….18
PUBLIC HEALTH BURDEN OF BREAST CANCER……………………………….18
BREAST CANCER SCREENING: UNCLEAR MAMMOGRAM……………………19 RECOMMENDATIONS
LIMITED ACCESS TO MAMMOGRAPHY…………………………………………..20
DRAWBACKS OF MAMMOGRAPHY SCREENING………………………………..22
RISK STRATIFICATION………………………………………………………………24
BRCA1/BRCA2 increase in risk……………………………………………………….24
B-RST…………………………………………………………………………………….25
DE-IMPLEMENETATION…………………………………………………………….26
PREVIOUS REACTIONS IN CHANGES IN GUIDELINES…………………………29
STUDY CORRELATES WITHINT WATERS ET AL THEORETICAL……………..30
FRAMEWORK
Health Communication Messages…………………………………………………….31
Demographics……………………………………………………………………………32
Health History……………………………………………………………………………33
Institutional Trust………………………………………………………………………..34
Cognitive and Emotional Processes…………………………………………………..36
SUMMARY……………………………………………………………………………..38
CHAPTER 3: METHODS……………………………………………………………………..40
AIM OF STUDY………………………………………………………………………...40
PARTICIPANT RECRUITEMENT METHODS……………………………………….40
CONSENT METHODS…………………………………………………………………41
COMPLETION OF B-RST…………………..………………………………………….42
DATA COLLECTION PROCEDURES………………………………………………..42
SURVEY MEASURE DEVELOPMENT………………………………………………45
Health Communication Messages…………………………………………………….45
Understanding of BRCA RISK……………………………………………….45
Understanding of Population Level Breast Cancer Risk…………………45
Recall of B-RST Results……………………………………………………….45
Demographics……………………………………………………………………….45
Race and Age……………………………………………………………….45
Income and Education…………………………………………………….46
Health History………………………………………………………………………..46
Reason for Current Mammogram………………………………………..46
Past Mammogram Frequency…………………………………………….46
Institutional Trust……………………………………………………………………46
Healthcare Trust……………………………………………………………46
Cognitive and Emotional Processes……………………………………………….47
Perceived Risk of Breast Cancer………………………………………….47
Breast Cancer Worry Frequency………………………………………....47
Breast Cancer Negative Affect…………………………………………….47
Acceptance of B-RST……………………………………………………..…48
Health Behavior: Willingness to Decrease Mammogram Frequency………….48
Measures within Theoretical Framework……………………………………….…49
TREATMENT OF DATA………………………………………………………….….49
PRELIMINARY ANALYSIS……………………………………………………….….49
VARIABLE DEVELOPMENT…………………………………………………………49
Health Communication Messages……………………………………………….…….49
Understanding of BRCA RISK………………………………………….…….49
Understanding of Population Level Breast Cancer Risk……………..…..50
Recall of B-RST Results………………………………………………………..50
Demographics…………………………………………………………………………….50
Race…………………………………………………………………………….50
Age…………………………………………………………………………..….50
Income and Education……………………………………………………….50
Health History……………………………………………………………………….….51
Reason for Current Mammogram……………………………………………51
Past Mammogram Frequency………………………………………………..51
Institutional Trust………………………………………………………………………..51
Healthcare Trust………………………………………………………………..51
Cognitive and Emotional Processes…………………………………………………..51
Perceived Risk of Breast Cancer…………………………………………….51
Breast Cancer Worry Frequency………………………………………….…51
Breast Cancer Negative Affect………………………………………………51
Acceptance of B-RST….………………………………………………………51
Health Behavior: Willingness to Decrease Mammogram Frequency……………51
DESCRIPTIVE STATISTICS…………………………………………………………..52
VARIABLE CORRELATIONS…………………………………………………………52
VARIABLE SELECTION FOR FINAL MODEL………………………………………53
MULTICOLLINEARITY ANALYSIS………………………………………………….54
SPECIFIC ANALYSIS BY STUDY QUESTION………………………..……………..54
Question 1………………………..………………………………………..……………...54
Question 2. ……………………………………………………………………………….54
CHAPTER 4: RESULTS…………………………………………………………………….55
DESCRIPTIVE STATISTICS……………………………………………………………..55
MAMMOGRAPHY CORRELATES DESCRIPTIVES………………………………..….56
Health Communication Messages……………………………………………………56
Understanding of BRCA RISK………………………………………………..56
Understanding of Population Level Breast Cancer Risk…………….……56
Recall of B-RST Results…………………………………………………..……56
Health History…………..………………………………………………………………..57
Past Mammogram Frequency……………………………………………..…..57
Reason for Current Mammogram……………………………………….……58
Institutional Trust………………………………………………………………………..58
Trust in the Healthcare System………………………………..………...........58
Cognitive and Emotional Processes…………………………………………….…….58
Perceived Risk of Breast Cancer……………………………………..………59
Breast Cancer Worry Frequency……………………………………………..59
Breast Cancer Negative Affect……………………..…………………………59
Acceptance of B-RST……………………………………………………………60
Health Behavior: Willingness to Decreae Mammogram Frequency…….………..60
BIVARIATE ASSOCIATIONS WITH WILLINGNESS………………………….………62
Those willing to decrease mammogram frequency…………………………...……..62
compared to those unsure and unwilling
Health Communication Messages………………………………….…………62
Health History ……………………………………………………………62
Institutional Trust………………………………………………………..63
Cognitive and Emotional Processes………………………………….63
Those undecided of their willingness to decrease mammogram…………..65
frequency compared to those who have decided
Health Communication Messages………………………………………65
Health History …………………………………………………………….65
Institutional Trust……………….…………………………………………65
Cognitive and Emotional Processes………………….…………………65
Variables Included in Final Analysis………………..…………………………..67
MULTICOLLINEARITY ANALYSIS…………………………………………….67
MULTIVARIATE ASSOCIATIONS BY STUDY QUESTIONS………………….69
Question 1. …………………………………………………………………………..69
Question 2. ………………………………………………………………………….69
Those willing to decrease mammogram frequency……………………69
compared to those unsure and those unwilling
Those undecided of their willingness to decrease……………………71
mammogram frequency compared to those who have decided
CHAPTER 5: DISCUSSION…………………………………………………………………72
FINDINGS……………………………………………………………………………….72
Willingness to Decrease Mammogram Frequency……………………………….…72
Demographics……………………………………………………………………………72
Question 1……………………………………….. ……………………………………73
Question 2……………………………………………….. …………………………..74
Health Communication Messages…………………………………………74
Health History……………………………………….. ……………………...76
Institutional Trust………………………………………………………………76
Cognitive and Emotional Processes………………………………………….76
CONCLUSION. ……………………………………….. ………………………………………77
STUDY STRENGTHS AND LIMITATIONS……………………………………….. ……78
IMPLICATIONS……………………………………….. ………………………………………78
FUTURE DIRECTIONS AND RECOMMENDATIONS…………………………………80
REFERENCES……………………………………….. ……………………………………………..……83
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