Early Detection and Screening for Breast Cancer.

OBJECTIVE: To review the history, current status, and future trends related to breast cancer screening. DATA SOURCES: Peer-reviewed articles, web sites, and textbooks. CONCLUSION: Breast cancer remains a complex, heterogeneous disease. Serial screening with mammography is the most effective method to detect early stage disease and decrease mortality. Although politics and economics may inhibit organized mammography screening programs in many countries, the judicious use of proficient clinical and self-breast examination can also identify small tumors leading to reduced morbidity. IMPLICATIONS FOR NURSING PRACTICE: Oncology nurses have exciting opportunities to lead, facilitate, and advocate for delivery of high-quality screening services targeting individuals and communities. A practical approach is needed to translate the complexities and controversies surrounding breast cancer screening into improved care outcomes.

[How can family doctors improve the participation rate in mammographic screening. The role of prevention nurses]. / Mit tehet a háziorvos a mammográfiás szuréseken való részvétel javításáért? A prevenciós novér szerepe.

INTRODUCTION: In our country the participation rate in screenings, including mammographic screening is very low. Restructuring of primary care system through the development of practice teams is an important task. AIM: The authors examined the effectiveness of prevention nurses' work as a member of the practice team on the organization of mammographic screening. METHOD: Prevention nurses looked up women who did not participate in mammographic screening two years before proceeding the reference period according to a protocol. The program was gradually extended to all family doctor practices in Kecskemét. RESULTS: In the author's own practice is that the turnout could be achieved and sustained over 60% with this method. During the extension of the program on a representative sample respect of Kecskemét 36.7% of patients who did not participate in screening in the previous two years were involved in mammographic screening again. Extending the entire target population of Kecskemét authors found that the 16-20% of non-screened patients participated again and whole screening rate rose above 70% in the city. CONCLUSIONS: The program proved that a prevention nurse as a practice team member can coordinate the tasks of screening effectively making a connection among the family doctors, screening centers and patients. Orv. Hetil., 2017, 158(8), 311-315.

Face-to-face Information and Emotional Support from Trained Nurses Reduce Pain During Screening Mammography: Results from a Randomized Controlled Trial.

Pain and discomfort during breast examination can affect a woman's adherence to breast cancer-screening programs. The aim of this study was to determine whether a nursing intervention protocol that provides verbal information and support to women could reduce pain during mammography. A randomized controlled trial of 436 Spanish women aged 50-69 who attended a breast-screening program was performed. The experimental group received a customized nursing intervention that provided face-to-face information and emotional support during the examination. Pain and anxiety were measured using a visual analogue scale and the State-Trait Anxiety Inventory, respectively. Data regarding several potential confounders were also collected. The adjusted means of pain level in the study group were obtained from multiple linear regressions, and the adjusted odds ratios (OR) and 95% confidence intervals (CI) were obtained via logistic regression. After the intervention, the level of pain was significantly lower (p = .03) in the experimental group (0.98 ± 2.28) compared with the group treated with normal care (1.48 ± 2.29). Consequently, the probability of feeling pain during mammography was lower among women in the experimental group (OR = 0.44; 95% CI: 0.24-0.81). The intervention was more effective among women with the highest anxiety levels (OR = 0.33; 95% CI: 0.11-0.98), who did not expect pain (OR = 0.28; 95% CI: 0.08-0.97), and who did not fear the outcome of the mammography (OR = 0.18; 95% CI: 0.04-0.85). Providing verbal information, as well as supporting the women during the test, is a simple and achievable intervention for nurses and can help to reduce pain during screening mammography.

A brief nursing intervention reduces anxiety before breast cancer screening mammography.

BACKGROUND: Anxiety experienced by women during their participation in breast cancer screening programs can condition their adherence to the program. The aim was to determine whether a brief nursing intervention could reduce anxiety before screening mammography. METHOD: A randomized controlled trial carried out with 436 Spanish women aged between 50-69 years, who attended a population breast cancer screening program. The experimental group received an ad-hoc tailored intervention, which consisted of offering information about the screening program and the mammography exam, as well as of providing personal emotional support. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Fear of screening outcome and fear of breast cancer were also assessed. RESULTS: Women of the experimental group had 60% less probability of having a high anxiety state (OR = 0.40; 95%: CI [0.25, 0.65]), after adjusting for sociodemographic and clinical variables. Regarding trait anxiety, no differences were observed between groups. The stratified analysis showed that this positive impact was greater in women who did not fear the screening outcome (OR = 0.24; 95% CI [0.11, 0.52]) or breast cancer (OR = 0.07; 95% CI [0.01, 0.41]). CONCLUSIONS: A protocolized nursing intervention reduced the probability of being anxious when undergoing a screening mammography.

A brief nursing intervention reduces anxiety before breast cancer screening mammography / Una intervención enfermera breve disminuye la ansiedad antes de una mamografía de screening de cáncer de mama

BACKGROUND: Anxiety experienced by women during their participation in breast cancer screening programs can condition their adherence to the program. The aim was to determine whether a brief nursing intervention could reduce anxiety before screening mammography. METHOD: A randomized controlled trial carried out with 436 Spanish women aged between 50-69 years, who attended a population breast cancer screening program. The experimental group received an ad-hoc tailored intervention, which consisted of offering information about the screening program and the mammography exam, as well as of providing personal emotional support. Anxiety was assessed using the State-Trait Anxiety Inventory (STAI). Fear of screening outcome and fear of breast cancer were also assessed. RESULTS: Women of the experimental group had 60% less probability of having a high anxiety state (OR = 0.40; 95%: CI [0.25, 0.65]), after adjusting for sociodemographic and clinical variables. Regarding trait anxiety, no differences were observed between groups. The stratified analysis showed that this positive impact was greater in women who did not fear the screening outcome (OR = 0.24; 95% CI [0.11, 0.52]) or breast cancer (OR = 0.07; 95% CI [0.01, 0.41]). CONCLUSIONS: A protocolized nursing intervention reduced the probability of being anxious when undergoing a screening mammography

ANTECEDENTES: la ansiedad experimentada por las mujeres durante su participación en el examen de detección precoz del cáncer de mama puede condicionar su adherencia al programa. El objetivo fue determinar si una intervención enfermera breve disminuye la ansiedad antes de una mamografía de screening. MÉTODO: ensayo clínico controlado y randomizado en 436 mujeres españolas de 50 a 69 años participantes en el programa de screening. El grupo experimental recibió una intervención diseñada ad-hoc, consistente en ofrecer información sobre el programa y la mamografía, así como proporcionar apoyo emocional. La ansiedad fue medida con el inventario de ansiedad estado-rasgo (STAI). También se evaluaron el miedo a los resultados y al cáncer de mama. RESULTADOS: la probabilidad de tener ansiedad estado elevada fue un 60% menor en las mujeres del grupo experimental (OR = 0,40; IC95%: 0,25-0,65), tras ajustar por variables sociodemográficas y clínicas. Respecto a la ansiedad rasgo no se observaron diferencias entre grupos. El análisis estratificado mostró que el impacto positivo fue mayor en las mujeres sin miedo a los resultados (OR = 0,24; IC95%: 0,11-0,52) ni al cáncer de mama (OR = 0,07; IC95%: 0,01-0,41). CONCLUSIONES: una intervención enfermera protocolizada disminuyó la probabilidad de tener ansiedad antes de la realización de una mamografía de screening

Psychological distress, social withdrawal, and coping following receipt of an abnormal mammogram among different ethnicities: a mediation model.

PURPOSE/OBJECTIVES: To explore ethnic differences in psychological distress and social withdrawal after receiving an abnormal mammogram result and to assess if coping strategies mediate ethnic differences. DESIGN: Descriptive correlational. SETTING: Two urban mobile mammography units and a rural community hospital in the state of Washington. SAMPLE: 41 Latina and 41 non-Latina Caucasian (NLC) women who had received an abnormal mammogram result. METHODS: Women completed standard sociodemographic questions, Impact of Event Scale-Revised, the social dimension of the Psychological Consequences Questionnaire, and the Brief COPE. MAIN RESEARCH VARIABLES: Ethnicity, psychological distress, social withdrawal, and coping. FINDINGS: Latinas experienced greater psychological distress and social withdrawal compared to NLC counterparts. Denial as a coping strategy mediated ethnic differences in psychological distress. Religious coping mediated ethnic differences in social withdrawal. CONCLUSIONS: Larger population-based studies are necessary to understand how ethnic differences in coping strategies can influence psychological outcomes. This is an important finding that warrants additional study among women who are and are not diagnosed with breast cancer following an abnormal mammogram. IMPLICATIONS FOR NURSING: Nurses may be able to work with Latina patients to diminish denial coping and consequent distress. Nurses may be particularly effective, given cultural values concerning strong interpersonal relationships and respect for authority figures.

Transformative learning theory: facilitating mammography screening in rural women.

PURPOSE/OBJECTIVES: To use transformative learning to investigate what experiences serve as catalysts for mammography screening, the cognitive and affective responses that result from the catalyst, and how screening behavior is impacted. RESEARCH APPROACH: A descriptive qualitative study. SETTING: Southeastern Wyoming. PARTICIPANTS: 25 low-income, rural women aged 40 years and older. METHODOLOGIC APPROACH: Four focus group interviews. FINDINGS: Cancer experiences triggered universal responses of fear by screeners and nonscreeners. The manner in which that fear response was interpreted was a critical factor in the facilitation of, or impedance to, screening. Dichotomous interpretations of fear responses provided the context for screening behavior. Immobilizing and isolating experiences were associated with nonscreening behavior, whereas motivation and self-efficacy were associated with screening behavior. CONCLUSIONS: Transformative learning theory is a useful framework from which to explain differences in mammography screening behavior. Creating opportunities that facilitate dialogue and critical reflection hold the potential to change immobilizing and isolating frames of reference in nonscreening women. INTERPRETATION: To help women transcend their fear and become self-efficacious, nurses can assess how cancer and the screening experience is viewed and, if indicated, move beyond standard education and offer opportunities for dialogue and critical reflection.

Breast cancer screening practices among Hong Kong Chinese women.

BACKGROUND: Although the incidence rates of breast cancer have been increasing remarkably in Hong Kong over the last 2 decades, little is known on breast cancer screening practices among this group of women. OBJECTIVES: This study aimed to report breast cancer screening practices among Hong Kong Chinese women and to examine the relationship between (1) demographic factors and (2) the modified Chinese Breast Cancer Screening Beliefs Questionnaire (CBCSB) score and women's breast screening behaviors. METHODS: A descriptive and cross-sectional method was used. Both English and Chinese versions of the modified CBCSB were administered. Of 946 Hong Kong Chinese women older than 18 years and invited to participate in the study, 753 (79.6%) completed and returned the questionnaire. RESULTS: The majority of participants (70%-90%) had heard of breast self-examination (BSE), clinical breast examination (CBE), and mammograms. Only 33.3% performed a BSE monthly; 37.8% and 32.7% of women within the targeted age group had a CBE annually and had a mammogram every 2 years, respectively. Being married and part-time employment were positively associated with women who performed BSE as recommended. In terms of modified CBCSB score, women who had BSE, CBE, and mammogram as recommended had significantly higher scores on the subscale attitudes to health check-up. CONCLUSION: Attitudes toward health check-up was influential in compliance with breast cancer screening practices among Chinese-Australian women. IMPLICATIONS FOR PRACTICE: Effort should be focused on specific subgroups of Hong Kong Chinese women, to fully understand the barriers involved in participating in breast cancer screening practices.

Differences in health beliefs across stage of adoption of mammography in Iranian women.

BACKGROUND: Despite evidence that screening for breast cancer is effective, adherence with screening recommendations in Iranian women is low. OBJECTIVES: The aims of this study were to (a) examine the relationships between related beliefs and (b) to determine to what extent women in stages of mammography adoption differ in their agreement of individual perceived health beliefs. METHODS: A sample of 686 Iranian women completed a questionnaire including selected constructs of the Health Belief Model and stages of mammography adoption. RESULTS: Proportions of participants who were in the preadoption and adoption stages were 75% and 17.8%, respectively. Precontemplators showed significantly lower positive attitude and greater agreement for most of the barrier items than did those in other adoption stages. In terms of specific items, women in the relapse and maintenance stages endorsed greatest agreement for the barrier items "not knowing how to get a mammogram" and "forget to schedule," respectively. Common barriers for women in preadoption stages were being painful, taking much time, and embarrassing. CONCLUSION: Iranian women are less likely than other Asian women to be in the maintenance and action stages. Identifying the associations between perceived related beliefs items and stages of mammography adoption may provide detailed information to allow for future research and guide the development of interventions not only for Iranian women but also for similar cultural and immigrant groups that have been neglected to date in the breast cancer literature. IMPLICATIONS FOR PRACTICE: Examining the interactions between perceived related beliefs items and other beliefs such as perceived control and self-efficacy to having a mammography is warranted.

Breast cancer screening barriers and disability.

There is evidence that early detection from breast cancer screening is an effective means to reduce overall mortality from breast cancer. Findings from multiple research studies suggest that women with chronic disabling conditions are less likely to participate in breast cancer screening due to the multiple barriers they face. Barriers include those related to finances, environment, physical limitations, health carers' attitudes and lack of knowledge, and psychosocial issues. The purpose of this article is to provide an overview of the existing evidence of the barriers to breast cancer screening experienced by women with physical disabilities. Rehabilitation nurses that work with women who have chronic disabling conditions can be instrumental in eliminating these barriers to breast cancer screening through their efforts to promote health which is consistent with the philosophy of maximizing the health potential and quality of life of these women whose needs are often overlooked.

The role of community nurses and residential staff in supporting women with intellectual disability to access breast screening services.

BACKGROUND: Women with intellectual disability (ID) are surviving to the age group at greatest risk of developing breast cancer (50-69 years). These women are more likely to experience a greater number of risk factors placing them at an advanced threat of developing breast cancer. However, as a result of cognitive deficits and communication difficulties these women are dependent upon staff to support them to attend the breast screening clinics. AIM: The aim of this paper was to examine how community nurses and residential staff support women with ID to access breast screening services. METHODOLOGY: Six focus groups were held with community nurses and residential staff who work in the field of ID in one region of the UK. The focus groups were tape recorded and the transcriptions were subjected to a thematic content analysis. FINDINGS: Although many of the participants recognised the risk factors and signs/symptoms of breast cancer, there was still a deficit of knowledge. Both positive and negative experiences of women with ID attending for breast screening were reported; however, greater discussion focused on the latter. The participants identified 'a lack of health educational material' and also negative 'emotions, attitudes and physical barriers' as inhibiting factors for attendance. DISCUSSION: This paper highlights the need for developing a health promotion programme for women with ID focusing on breast awareness and information on screening, and also healthier lifestyles. Breast awareness via visual checks was identified for women with ID who refused to attend the breast clinics; however, issues of informed 'consent' and 'vulnerability' were raised for staff and also family carers having to undertake these checks. Development of user-friendly health educational literature using 'pictures, symbols, signs' and simplified words should be accessible to all ID staff, healthcare staff, and also women with ID.

Psychosocial correlates of mammography screening in older African American women.

PURPOSE/OBJECTIVES: To explore psychosocial correlates of older African American women's adherence to annual mammography screening, including cancer fatalism, dispositional optimism, social support, knowledge of breast cancer screening guidelines, perceptions of general health, and components of the Health Belief Model (HBM), and to examine factors associated with annual mammography screening. DESIGN: Cross-sectional survey. SETTING: Central North Carolina. SAMPLE: 198 African American women aged 50-98 years living in low-income housing. METHODS: Women attended group sessions at low-income housing complexes and completed questionnaires. Differences between women who had or did not have a mammogram in the previous year were explored using correlate variables associated with the HBM. Stepwise multivariable regression models were fit to explore factors associated with social support and significant components of the HBM. MAIN RESEARCH VARIABLES: Demographics, cancer fatalism, dispositional optimism, social support, perceptions of general health, components of the HBM, and mammography in the past year. FINDINGS: The groups did not differ by age, education, marital status, having a friend or family member with breast cancer, ever having had a clinical breast examination, self-rated health, cancer fatalism, dispositional optimism, or feelings about the seriousness of and their susceptibility to breast cancer. The groups differed significantly on mammogram-related variables, how often women should have clinical breast examinations, benefits and barriers to mammography screening, and social support. Stepwise multivariable regression analyses showed that dispositional optimism and social support were related significantly to perception of benefits; education, dispositional optimism, and cancer fatalism were related to barriers; and dispositional optimism was related to social support. CONCLUSIONS: Older, low-income, African American women have perceived barriers to cancer screening, educational and cancer knowledge detriments, and a lack of health-related social support that may decrease adherence to mammography screening. IMPLICATIONS FOR NURSING: The next step is to develop culturally appropriate educational interventions that increase knowledge about breast cancer and screening guidelines, enhance health-related social support, and address barriers and perhaps cancer fatalism in older, low-income, African American women.

Radiology nursing.

Radiology nursing is a relatively new field in which nurses can use multiple skills in caring for adult and pediatric patients. The authors present an overview of the role nurses play in interventional radiology, nuclear medicine, ultrasound, magnetic resonance imaging, computed tomography, and mammography. In addition, information about the professional affiliations and certification in the American Radiological Nurses Association is provided.