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Breast cancer screening is currently the most reasonable strategy for reducing the impact of breast cancer on women. However, increased perceived risk and psychological distress have been associated with lower screening rates. The specific aims for this study were to: (1) assess the psychological distress of women ages 50 to 85 who receive breast cancer risk appraisal and randomization to immediate or delayed group psychosocial counseling; (2) assess their breast cancer screening behaviors over 2 years from the time of enrollment; (3) evaluate the degree of association between perceived and estimated risk of breast cancer; (4) describe short-term psychological reactions to breast cancer risk appraisal; and (5) describe their sense of coherence, coping style, other health-related behaviors, social support, and perceived quality of life. This study was conducted to provide important information about women's reactions to breast cancer risk appraisal and ways to enhance positive health behaviors. A total of 343 women participated in the study (mean age, 62 years). Each participant completed a breast cancer risk assessment form and received an estimate of their risk. Participants were randomized to either an immediate or delayed psychosocial counseling intervention on breast health. Results of the intervention showed largely non-significant changes in psychological distress and breast cancer screening behaviors (p>O.05). Further analyses will be conducted to provide more detail about these unexpected findings.
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The study described perceived breast cancer risk compared subjective and objective risk estimates and examined the influence of heuristic reasoning in women's narratives. The survey used three probability scales (Verbal Comparative Numerical) and the Gail model to measure perceived and objective risk. Aim 3 was addressed with argument and heuristic reasoning analysis. We recruited a multicultural educated sample of 184 English-speaking women from community settings. Fifty four provided an in-depth interview. Participants held an optimistic bias regarding their breast cancer risk (comparative optimism and better-than-average) and underestimated their objective risk calculated with the Gail model. Breast cancer worry was a significant predictor of breast cancer risk. Better-educated and higher-income women reported lower levels of worry while Black women were more likely than Asian and White women to report higher levels of worry but not higher levels of perceived risk. Most participants did not know that older age is a breast cancer risk factor and older women did not perceive higher risk. These findings imply that women's knowledge of breast cancer risk factors was incomplete despite their high educational level. Age and family history are independent predictors of sporadic and hereditary/familial breast cancer risk; yet women could not distinguish between the two forms of the disease. Most participants (70%) were adherent to mammography and clinical breast exam (CBE) screening guidelines which can be attributed to high access to screening services and efforts from health care providers. Age having health insurance and higher 5-year Gail scores were significant predictors of frequency of screening mammograms and CBEs. Distrust of the health system was the single most important predictor of predisposition to use health services which in turn was another significant predictor of screening mammograms and CBEs.
Each year more than 180,000 new cases of breast cancer are diagnosed in women in the U.S. If cancer is detected when small and local, treatment options are less dangerous, intrusive, and costly-and more likely to lead to a cure. Yet those simple facts belie the complexity of developing and disseminating acceptable techniques for breast cancer diagnosis. Even the most exciting new technologies remain clouded with uncertainty. Mammography and Beyond provides a comprehensive and up-to-date perspective on the state of breast cancer screening and diagnosis and recommends steps for developing the most reliable breast cancer detection methods possible. This book reviews the dramatic expansion of breast cancer awareness and screening, examining the capabilities and limitations of current and emerging technologies for breast cancer detection and their effectiveness at actually reducing deaths. The committee discusses issues including national policy toward breast cancer detection, roles of public and private agencies, problems in determining the success of a technique, availability of detection methods to specific populations of women, women's experience during the detection process, cost-benefit analyses, and more. Examining current practices and specifying research and other needs, Mammography and Beyond will be an indispensable resource to policy makers, public health officials, medical practitioners, researchers, women's health advocates, and concerned women and their families.
Many Americans believe that people who lack health insurance somehow get the care they really need. Care Without Coverage examines the real consequences for adults who lack health insurance. The study presents findings in the areas of prevention and screening, cancer, chronic illness, hospital-based care, and general health status. The committee looked at the consequences of being uninsured for people suffering from cancer, diabetes, HIV infection and AIDS, heart and kidney disease, mental illness, traumatic injuries, and heart attacks. It focused on the roughly 30 million-one in seven-working-age Americans without health insurance. This group does not include the population over 65 that is covered by Medicare or the nearly 10 million children who are uninsured in this country. The main findings of the report are that working-age Americans without health insurance are more likely to receive too little medical care and receive it too late; be sicker and die sooner; and receive poorer care when they are in the hospital, even for acute situations like a motor vehicle crash.
This research project is aimed at examining psychological distress and processing of information associated with risk for breast cancer. Understanding the types and magnitude of women's distress and impaired processing of cancer-related information is critical because cancer-related distress has been associated with poorer compliance with screening behaviors, and impaired processing of cancer information may decrease women's knowledge and understanding of (and hence, compliance with) recommended screening guidelines. These concerns may be particularly salient among women who attend genetic counseling, as they receive complex, and oftentimes distressing information about their risk for the disease. To date, our findings indicate that women with family histories reported higher levels of cancer specific intrusive thoughts and avoidance, higher levels of initial vigilance to cancer stimuli, and interestingly, poorer memory for those stimuli, than did women without family histories of the disease. We found a similar pattern of findings when examining objective risk for breast cancer (Gail Model). Findings are important in that they raise the possibility that there may real-world deficits in the processing of information related to cancer among women who receiving information critical to their health care at an acutely distressing time (i.e., physician's or genetic counselor's office).
Tiivistelmä: Rintasyövän riskiä koskevia käsityksiä määrittävät tekijät ja käsitysten psyykkiset vaikutukset mammografiaseulontaprosessissa..
'This book gives plenty of examples of ad hominem attacks, intimidation, slander, threats of litigation, deception, dishonesty, lies and other violations of good scientific practice. For some years I kept a folder labeled Dishonesty in breast cancer screening on top of my filing cabinet, storing articles and letters to the editor that contained statements I knew were dishonest. Eventually I gave up on the idea of writing a paper about this collection, as the number of examples quickly exceeded what could be contained in a single article.' From the Introduction The most effective way to decrease women's risk of becoming a breast cancer patient is to avoid attending screening. Mammography screening is one of the greatest controversies in healthcare, and the extent to which some scientists have sacrificed sound scientific principles in order to arrive at politically acceptable results in their research is extraordinary. In contrast, neutral observers increasingly find that the benefit has been much oversold and that the harms are much greater than previously believed. This groundbreaking book takes an evidence-based, critical look at the scientific disputes and the information provided to women by governments and cancer charities. It also explains why mammography screening is unlikely to be effective today. All health professionals and members of the public will find these revelations disturbingly illuminating. It will radically transform the way healthcare policy makers view mammography screening in the future. 'If Peter Gotzsche did not exist, there would be a need to invent him ...It may still take time for the limitations and harms of screening to be properly acknowledged and for women to be enabled to make adequately informed decisions. When this happens, it will be almost entirely due to the intellectual rigour and determination of Peter Gotzsche.' From the Foreword by Iona Heath, President, RCGP 'If you care about breast cancer, and we all should, you must read this book. Breast cancer is complex and we cannot afford to rely on the popular media, or on information from marketing campaigns from those who are invested in screening. We need to question and to understand. The story that Peter tells matters very much.' From the Foreword by Fran Visco, President, National Breast Cancer Coalition.