Knowledge, Attitudes, and Practices Surrounding Breast Cancer Screening in Educated Appalachian Women

Nan S. Leslie

Pamela Deiriggi

Suzanne Gross

M. Elizabeth DuRant

Cynthia Smith

Jennifer G. Veshnesky

ONF 2003, 30(4), 659-667. DOI: 10.1188/03.ONF.659-667

Purpose/Objectives: To determine how and what women learn about breast cancer and screening practices and which factors influence women's breast cancer screening practices.

Design: Descriptive analysis of questionnaire data collected at the time of enrollment in a clinical trial.

Setting: Breast care center of a mid-Atlantic academic health sciences center.

Sample: 185 women in a predominantly Appalachian, entirely rural state.

Methods: Participants completed the Modified Toronto Breast Self-Examination Inventory and questions related to personal mammogra-phy practices at the time of enrollment before randomization in a longitudinal clinical intervention study.

Main Research Variables: Women's demographics, knowledge of breast cancer screening practices, adherence to breast cancer screening guidelines, and motivation, knowledge, and practice proficiency surrounding breast cancer screening.

Findings: These educated women had knowledge deficits about breast cancer, breast cancer risk factors, and screening guidelines, particularly the timing and practice behaviors of breast self-examination. Women who had received healthcare and cancer-screening instruction by healthcare providers, including advanced practice nurses, had greater knowledge of breast cancer and detection practices.

Conclusions: Women still have knowledge deficits about breast cancer, breast cancer detection, and personal risk factors. In addition, some educated women in this study failed to practice breast cancer screening according to current guidelines.

Implications for Nursing: Practitioners must continue to remind and update women about breast disease, and women's cancer-screening practices must be reinforced. All levels of providers should improve their rates of performing clinical breast examinations with physical examinations. Nurses, who greatly influence women's health care, must remain current in their knowledge of breast disease, screening, and treatment.

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    References

    ABCNEWS.com. (1998). Betty Ford brings breast cancer to light: A first lady's struggle. Retrieved May 5, 2003, from http://more.abcnews.go.com/sections/living/DailyNews/cancer_bettyford980630.html

    Alagna, S., & Reddy, D. (1984). Predictors of proficient technique and successful lesion detection in breast self-examination. Health Psychology, 3, 113-127.

    Assaf, A., Cummings, K., Graham, S., Mettlin, C., & Marshall, J. (1985). Comparison of three methods of teaching women to perform breast self-examination. Health Education Quarterly, 12, 259-272.

    Avon Products, Inc. (2000). The Avon Breast Cancer Crusade. Retrieved May 5, 2003, from http://www.avoncompany.com/women/avoncrusade

    Becker, M., Haefner, D., Kasl, S., Kirscht, J., Maiman, L., & Rosenstock, I. (1977). Selected psychosocial models and correlates of individual health-related behaviors. Medical Care, 15(5 Suppl.), 27-46.

    Becker, M., & Maiman, L. (1975). Sociobehavioral determinants of compliance with health and medical care recommendations. Medical Care, 13, 10-24.

    Blackman, D., Bennett, E., & Miller, D. (1999). Trends in self-reported use of mammograms (1989-1997) and Papanicolaou tests (1991-1997) Behavioral risk factor surveillance system. Morbidity and Mortality Weekly Report: Centers for Disease Control and Prevention Surveillance Summaries, 48(6), 1-22.

    Brownson, R., Reif, J., Alaavanja, M., & Bal, D. (1993). Cancer. In R. Brown-son, P. Remington, & J. Davis (Eds.), Chronic disease epidemiology and control (pp. 137-167). Washington, DC: American Public Health Association.

    Butler, L., Potischman, N., Newman, B., Millikan, R., Brogan, D., Gammon, M., et al. (2000). Menstrual risk factors and early-onset breast cancer. Cancer Causes and Control, 11, 451-458.

    Champion, V. (1990). Breast self-examination in women 35 and older: A prospective study. Journal of Behavioral Medicine, 13, 523-528.

    Champion, V. (1992). Relationship of age to factors influencing breast self-examination practice. Health Care for Women International, 13(1), 1-9.

    Couto, R., Simpson, N., & Harris, G. (Eds.). (1994). Sewing seed in the mountains (NIH Publication No. 94-3779). Washington, DC: National Cancer Institute.

    Ferris, L., Shamian, J., & Tudiver, F. (1991). The Toronto Breast Self-Examination Instrument (TBSEI): Its development, reliability, and validity. Journal of Clinical Epidemiology, 44, 1309-1317.

    Fletcher, S., Black, W., Harris, R., Rimer, B., & Shapiro, S. (1993). Report on the international workshop on screening for breast cancer. Journal of the National Cancer Institute, 85, 1644-1656.

    Fletcher, S., O'Malley, M., Earp, T., Morgan, T., Lin, S., & Degnan, D. (1990). How best to teach women breast self-examination: A randomized controlled trial. Annals of Internal Medicine, 112, 772-779.

    Gardner, J., Mullan, P., Rosenman, K., Zhu, Z., & Swanson, G. (1995). Mammography usage and knowledge about breast cancer in a Michigan farm population before and after an educational intervention. Journal of Cancer Education, 10, 155-162.

    Gordon, N., Hiatt, R., & Lampert, D. (1993). Concordance for self-reported data and medical record audit for six cancer screening procedures. Journal of the National Cancer Institute, 85, 566-570.

    Greenlee, R., Murray, T., Bolden, S., & Wingo, P. (2000). Cancer statistics, 2000. CA: A Cancer Journal for Clinicians, 50, 7-11.

    Hallal, J. (1982). The relationship of health beliefs, health locus of control, and self-concept to practice of breast self-examination in adult women. Nursing Research, 31, 137-142.

    Harvey, B., Miller, A., Baines, C., & Corey, P.N. (1997). Effect of breast self-examination techniques on the risk of death from breast cancer. Canadian Medical Association Journal, 157, 1205-1212.

    Henson, R., Wyatt, S., & Lee, N. (1996). The National Breast and Cervical Cancer Early Detection Program: A comprehensive public health response to two major health issues for women. Journal of Public Health Management and Practice, 2(2), 36-47.

    Holtzman, D., & Celentano, D. (1983). The practice and efficacy of breast self-examination: A critical review. American Journal of Public Health, 73, 1324-1326.

    Holtzman, D., Powell-Griner, E., Bolen, J., & Rhodes, L. (2000). State- and sex-specific prevalence of selected characteristics—Behavioral risk factor surveillance system, 1996 and 1997. Morbidity and Mortality Weekly Report: Centers for Disease Control and Prevention Surveillance Summaries, 49(6), 1-39.

    Hopwood, P. (2000). Breast cancer risk perception: What do we know and understand? Breast Cancer Research, 2, 387-391.

    Jemal, A., Murray, T., Samuels, A., Ghafoor, A., Ward, E., & Thun, M. (2003). Cancer statistics, 2003. CA: A Cancer Journal for Clinicians, 53, 5-26.

    Jemal, A., Thomas, A., Murray, T., & Thun, M. (2002). Cancer statistics, 2002. CA: A Cancer Journal for Clinicians, 52, 23-47.

    Johnson, J., & Meischke, H. (1993). Cancer-related channel selection: An extension for a sample of women who have had a mammogram. Women and Health, 20(2), 31-44.

    Kelsey, J., Gammon, M., & John, E. (1993). Reproductive factors and breast cancer. Epidemiologic Reviews, 15, 36-47.

    Kurebayashi, J., Shimozuma, K., & Sonoo, H. (1994). The practice of breast self-examination results in the earlier detection and better clinical course of Japanese women with breast cancer. Surgery Today, 24, 337-341.

    Lane, D., & Messina, C. (1999). Current perspectives on physician barriers to breast cancer screening. Journal of the American Board of Family Practice, 12(1), 8-15.

    Lynch, H., & Lynch, J. (2002). Hereditary cancer: Family history, diagnosis, molecular genetics, ecogenetics, and management strategies. Biochimie, 84(1), 3-17.

    McCance, K., Mooney, K., Smith, K., & Field, R. (1990). Validity and reliability of a breast cancer knowledge test. American Journal of Preventive Medicine, 6, 93-98.

    Miller, A., & Champion, V. (1996). Mammography in older women: One-time and three-year adherence to guidelines. Nursing Research, 45, 239-245.

    O'Connor, A., & Perrault, D. (1995). Importance of physician's role highlighted in survey of women's breast screening practices. Canadian Journal of Public Health, 86(1), 42-45.

    Paul, C., Barratt, A., Redman, S., Cockburn, J., & Lowe, J. (1999). Knowledge and perceptions about breast cancer incidence, fatality and risk among Australian women. Australian and New Zealand Journal of Public Health, 23, 396-400.

    Pender, N., Murdaugh, C., & Parsons, M.A. (2002). Health promotion in nursing practice (4th ed.). Upper Saddle River, NJ: Prentice Hall.

    Price, J. (1994). Economically disadvantaged females' perceptions of breast cancer and breast cancer screening. Journal of the National Medical Association, 86, 899-906.

    Rutledge, D. (1987). Factors related to women's practice of breast self-examination. Nursing Research, 36, 117-121.

    Schootman, M., & Fuortes, L. (2001). Early indicators of the effect of a breast cancer screening program for low-income women. Cancer Detection and Prevention, 25, 138-146.

    Seffrin, J. (2000). An end-game for cancer. CA: A Cancer Journal for Clinicians, 50, 4-5.

    Semiglazov, V., Moiseyenko, V., Bavli, J., Migmanova, N., Seleznyov, N., Popova, R., et al. (1992). The role of breast self-examination in early breast cancer detection (results of the 5-year USSR/WHO randomized study in Leningrad). European Journal of Epidemiology, 8, 498-502.

    Semiglazov, V., Sagaidak, V., Moiseyenko, V., & Mikhailov, E. (1993). Study of the role of breast self-examination in reduction of mortality from breast cancer. The Russian Federation/World Health Organization Study. European Journal of Cancer, 29A, 2039-2046.

    Shepperd, S., Solomon, L., Atkins, E., Foster, R., & Frankowski, B. (1990). Determinants of breast self-examination among women of lower income and lower education. Journal of Behavioral Medicine, 13, 359-371.

    Smith, R., Cokkinides, V., von Eschenbach, A., Levin, B., Cohen, C., Runowicz, C., et al. (2002). American Cancer Society guidelines for the early detection of cancer. CA: A Cancer Journal for Clinicians, 52, 8-22.

    Smith, R., Mettlin, C., Davis, K., & Eyre, H. (2000). American Cancer Society guidelines for the early detection of cancer. CA: A Cancer Journal for Clinicians, 50, 34-49.

    Smith-Warner, S., Spiegelman, D., Yaun, S., van den Brandt, P., Folsom, A., Goldbohm, R., et al. (1998). Alcohol and breast cancer in women: A pooled analysis of cohort studies. JAMA, 279, 535-540.

    Spicer, D., Krecker, E., & Pike, M. (1995). The endocrine prevention of breast cancer. Cancer Investigation, 13, 495-504.

    Susan G. Komen Breast Cancer Foundation. (2001). Yoplait® USA named as national series presenting sponsor for the Susan G. Komen Breast Cancer Foundation Race for the Cure® series. Retrieved May 21, 2003, from http://www.komenseattle.org/puget/press_2.html

    Thomas, D., Gao, D., Ray, R., Wang, W., Allison, C., Chen, F., et al. (2002). Randomized trial of breast self-examination in Shanghai: Final results. Journal of the National Cancer Institute, 94, 1445-1457.

    Thomas, D., Gao, D., Self, S., Allison, C., Tao, Y., Mahloch, J., et al. (1997). Randomized trial of breast self-examination in Shanghai: Methodology and preliminary results. Journal of the National Cancer Institute, 89, 355-365.

    Turnbull, E. (1978). Effect of basic preventive health practices and mass media on the practice of breast self-examination. Nursing Research, 27, 98-102.

    U.S. Preventive Task Force. (1996). Guide to clinical preventive services (2nd ed.). Baltimore: Williams and Wilkins.

    Vachon, C., Cerhan, J., Vierkant, R., & Sellers, Y. (2001). Investigation of an interaction of alcohol intake and family history of breast cancer risk in the Minnesota breast cancer family study. Cancer, 92, 240-248.

    van den Brandt, P., Goldbohm, R., & van't Veer, P. (1995). Alcohol and breast cancer: Results from the Netherlands cohort study. American Journal of Epidemiology, 141, 907-915.

    Vogel, V. (2000). Breast cancer prevention: A review of current evidence. CA: A Cancer Journal for Clinicians, 50, 156-170.

    West Virginia Department of Health and Human Services. (1999). 1999 West Virginia vital statistics annual report. Charleston, WV: Author.

    Woolam, G. (2000). Cancer statistics, 2000: A benchmark for the new century. CA: A Cancer Journal for Clinicians, 50, 6.

    Yoplait®. (2001). Even the lid is good for you. Good Housekeeping, 233(3), 150.

    Zapka, J., Stoddard, A., Maul, L., & Costanza, M. (1991). Interval adherence to mammography screening guidelines. Medical Care, 29, 697-707.