OLDER WOMEN AND THE PRACTICE OF BREAST SELF-EXAMINATION

Breast self-examination (BSE) for breast cancer is used by only a fraction of the women who might benefit from it, and some studies show that older women who are more at risk for breast cancer are less likely to use it. This article reports a community study of women ( n = 528) who were trained in BSE in women's group meetings, provided a behavioral management intervention, and followed for two years. The intervention consisted of monthly postcard cues for BSE and lottery ticket rewards whenever a BSE record was returned indicating a BSE had been done. During the second year, the intervention was withdrawn. Results show that although women over 50 are no more likely to report having done more BSEs than women under 50 prior to entering the study, they did tend to do more BSEs during the intervention year and were significantly more compliant during the follow-up year. A more detailed analysis by age decade showed the highest rates of compliance in both years were for women ages 60–69 and 70–87. An analysis of attitudinal, history, and sociodemographic factors indicated that the only consistent predictor of BSE practice other than age and the intervention was the woman's confidence in BSE.     

Psychological and social characteristics of attenders for breast screening

Abstract

Demographic characteristics, health behaviour and knowledge of breast cancer were assessed in 183 women from a regional breast screening unit and compared with those of 182 women from a breast clinic and 41 control subjects. A questionnaire yielded information on (i) demographic characteristics and cancer-related behaviours including breast self-examination (BSE), use of screening and promptness of presentation of breast symptoms in the clinic group, (ii) the extent and effects of knowledge about breast cancer and (iii) the role of Health Belief Model dimensions. Results showed the screening unit attenders to be significantly older and to be significantly more likely to be from higher social classes. Differences between the groups in health beliefs and knowledge did not remain once the effects of age and social class were partialled out. While attitudes towards BSE and its practice related to health beliefs. only a minority of the women indicated that they practised BSE with any regularity. The results suggest that screening is failing to attract a truly representative sample of the community and raise the possibility that this failure is a consequence of sociological as much as psychological factors.     

Effects of Message Framing on Breast-Cancer-Related Beliefs and Behaviors: The Role of Mediating Factors

The effects of gain-loss message framing on breast-cancer-related cognitions and behaviors were assessed among 539 women aged 30 to 70 years. The design involved a prebrochure telephone interview, followed by a brochure mailout, and a postbrochure telephone interview. The brochures contained information about breast cancer and the risk of family history. Recommended behaviors were framed to emphasize gains, losses, or were neutral; and statistical risk information was presented either positively or negatively. Measures included demographics, family history, breast self-examination (BSE) performance, BSE intention, self-efficacy in performing BSE, perceived early detection risk of breast cancer, perceived susceptibility to breast cancer, and anxiety about breast cancer. A loss-framed message led to greater positive change in BSE behavior. Interactions between framing effects and variables of issue involvement, perceived early detection risk, and self-efficacy indicated effects on behavior, but not beliefs.     

Relationship of social support and social burden to repeated breast cancer screening in the women's health initiative.

Direct and interactive effects of social support, social burden (caregiving, negative life events, and social strain), education, and income on repeated use of breast cancer screening among a large (N=55,278), national sample of postmenopausal women participating in the Women's Health Initiative observational study were examined. Repeated screening decreased as emotional/informational support and positive social interactions decreased (ps<.01). Repeated mammography decreased with frequent caregiving (p<.01). Less social strain reduced the frequency of repeated breast self-examinations (BSEs; ps<.01), but frequent caregiving and more negative life events increased repeated use of BSE (ps<.01). Interactive effects suggested that emotional/informational but not tangible support is associated with repeated mammography and clinical breast examinations (ps<.01) and may be particularly important among low-income older women, especially those burdened by caregiving.     

The impact of breast cancer on the lives of middle-aged women: results from the Australian longitudinal study of women's health.

This article investigated the impact of breast cancer (BC) in middle-aged Australian women (45-50 years). Two waves of data collected 2 years apart from a longitudinal survey of 12,177 women identified 3 groups: (a) 11,933 (98%) who reported never having had BC, (b) 181 (1.5%) who reported a diagnosis of BC at Time 1, and (c) 63 (0.5%) who reported onset of BC between Time 1 and Time 2. Repeated measures analysis of variance was used to compare the 3 groups. Women with recent onset of BC experienced significant changes across a range of functioning compared with the other 2 groups. Compared with women with no BC, women with longer established onset of BC had significantly worse health and social outcomes, but these were associated with small effect sizes. Both groups of women with BC reported less impact on mental and emotional health than on other areas of functioning.     

Psychological side effects of breast cancer screening

Evaluated the impact of receiving abnormal mammogram results on women's anxiety and breast cancer worries and on their breast self-examination (BSE) frequency and intentions to obtain subsequent mammograms. A telephone survey was conducted with 308 women 50 years old and older approximately 3 months following a screening mammogram. Subjects included women with suspicious abnormal mammograms, nonsuspicious abnormal mammograms, and normal mammograms. Women with suspicious abnormal mammograms exhibited significantly elevated levels of mammography-related anxiety and breast cancer worries that interfered with their moods and functioning, despite the fact that diagnostic work-ups had ruled out breast cancer. Women with moderate levels of impairment in mood or functioning were more likely to practice monthly BSE than women with either high or low levels of impairment. Breast cancer worries, perceived susceptibility to breast cancer, and physician encouragement to get mammograms all exhibited independent positive relationships to mammogram intentions.     

Predicting Breast Self‐Examination: A Test of the Information‐Motivation‐Behavioral Skills Model1

The present research utilizes the information‐motivation‐behavioral skills (IMB) model (Fisher & Fisher, 1992, 2000) to predict breast self‐examination (BSE) and related behaviors in women. Results from a cross‐sectional survey study of 166 women found deficiencies in BSE‐related information, motivation, and behavioral skills, as well as insufficient rates of BSE‐related behaviors. Structural equation modeling indicated that IMB model variables account for significant variance in BSE and BSE‐related behaviors, and that the predicted relationships between the constructs of the 1MB model were supported. The present research extends the utility of the IMB model beyond preventive behaviors such as HIV prevention into the domain of detection behaviors such as BSE.     

Predictors of proficient technique and successful lesion detection in breast self-examination

Seventy-three women attending a health fair completed a questionnaire that measured demographic and health history variables, knowledge, and current practice of breast self-examination (BSE), Multidimensional Health Locus of Control (MHLC; Wallston, Wallston, & DeVellis, 1978), and components of the Health Belief Model (HBM; Rosenstock, 1974) in relation to breast cancer and BSE. These variables formed the basis of a conceptual model of BSE behavior that was examined by having each woman participate in a behavioral trial with a breast model in which her BSE technique and ability to detect simulated tumors was assessed. Regression analyses revealed that self-confidence in the efficacy of BSE was the best single predictor of proficient BSE. Powerful others HLC, knowledge of correct BSE behaviors, and chance HLC, respectively, also contributed significantly to the variance in performance. As anticipated, successful lesion detection was most strongly associated with more proficient BSE technique and higher frequency of BSE practice in the past six months. Internal HLC scores were not predictive of either behavioral measure. Similarly, except for perceived efficacy of BSE, HBM variables showed no strong relationships to observed behavior.     

An investigation of preconditions necessary for the introduction of a campaign to promote breast self-examination amongst Zimbabwean women

This study examines elements of the health belief model as predictors of intentions to self-examine breasts in two samples of women. Undergraduate samples from London and Harare are compared on levels of knowledge of breast cancer and breast self-examination (BSE), and on scales measuring perceived susceptibility to breast cancer, exposure to information and experience of breast cancer and perceived costs, barriers and benefits of BSE. Analysis of results indicates that an education campaign to promote awareness and the practice of BSE which incorporates factors of the health belief model could increase the number of Zimbabwean women performing this valuable preventive health behaviour.     

Affective States and Traits in the Workplace: Diary and Survey Data from Young Workers

This study investigated proposed paths of the affective events theory (AET; H. M. Weiss & R. Cropanzano, 1996), with part-time employees completing surveys at 2 points in time and completing an event-contingent diary over 2 weeks. In support of AET, negative affectivity (Time 1) related to negative emotional reactions at work. Negative emotional reactions were associated with intention to leave the job (Time 2). This relationship was especially strong for the sadness emotions (disappointed, depressed, unhappy). Positive affectivity (Time 1) directly related to job satisfaction (Time 2), but only weakly predicted positive emotional reactions at work (aggregated over 2 weeks). Qualitative data provided information about work affective events and affect-driven behaviors. Interpersonal mistreatment from customers were the most frequent cause of anger and resulted in faking expressions about 50% of the time. Recognition from supervisors for work performance was the main cause of pride.     

Posttraumatic Stress Among Women With Breast Cancer and Their Daughters: Relationship With Daughters' Breast Cancer Screening

Cancer-related posttraumatic stress (PTS) in women with breast cancer, perceived risk of cancer in these women's daughters, and daughters' PTS related to their mothers' breast cancer were tested for relationships to daughters' breast self-examination (BSE) and mammography activity. Daughters' mammography frequency was related to her own PTS, but not to her perceived risk or her mothers' PTS. In contrast, daughters who overperformed BSE had mothers reporting significantly greater PTS than those performing BSE at recommended rates or underperforming BSE. Daughters' BSE and mammography frequency were not correlated. Differing demands related to BSE and mammography, and their relationship to different distress variables are discussed.     

A threshold model of social support, adjustment, and distress after breast cancer treatment

This study examined a threshold model that proposes that social support exhibits a curvilinear association with adjustment and distress, such that support in excess of a critical threshold level has decreasing incremental benefits. Women diagnosed with a first occurrence of breast cancer (N = 154) completed survey measures of perceived support (Social Provisions Scale), quality of life (Functional Living Index--Cancer), adjustment (Psychological Adjustment to Illness Scale) and psychological distress (Brief Symptom Inventory) approximately 3 weeks after surgical treatment and 8-16 months later. Consistent with a threshold model, multiple regression analyses suggested a significant curvilinear relationship between social support and distress at Time 1 and Time 2 and between social support and adjustment at Time 2. Consistent with this model, the significant bivariate correlations between social support and outcomes were accounted for almost entirely by women in the lowest quartile of support. Social support among women in the highest 3 quartiles was unrelated or only marginally related to adjustment and distress.     

The Theory of Planned Behavior and Breast Self-Examination: Distinguishing Between Perceived Control and Self-Efficacy

This paper reports an application of the theory of planned behavior (TPB) to the prediction of breast self-examination (BSE) intentions and behavior. The study also considered the distinction between perceived control and self-efficacy within the TPB and the additional predictive utility of past behavior. A sample of 95 women completed questionnaires based on the TPB and were followed up at 1 month. Support for the distinction between perceived control and self-efficacy was provided by principal components analysis. The TPB was found to be highly predictive of intention to perform BSE and subsequent BSE behavior. Regression analyses revealed self-efficacy and attitude to be predictive of intention to perform BSE. Intention, in turn, was the sole predictor of BSE at 1-month follow-up. Past behavior was found to explain additional variance in intention, but not BSE behavior at 1-month follow-up. The results are discussed in relation to the conceptual status of the perceived behavioral control construct, and the practical implications of the results are highlighted.     

To Picture or Not to Picture: Levels of Erotophobia and Breast Self-Examination Brochure Techniques1

People's level of erotophobia influences their acceptance of sexually related situations, including the likelihood of engaging in sexually related health care such as breast self-examinations (BSE). Female college students (n= 61) completed a measure of erotophobia and read a BSE brochure that either did or did not contain instructional photographs showing a woman's breasts. As hypothesized when the brochure contained photographs, women high in erotophobia felt less competent in giving themselves BSE and were less likely to claim that they did things to improve their health. When the brochure contained no photographs, women low in erotophobia thought that the information was easier to understand and that BSE was more important.     

A Longitudinal Investigation of Psychological Disorders in Patients Prior and Subsequent to a Diagnosis of Ovarian Cancer

This longitudinal study investigated levels of anxiety and depression in women who underwent clinical investigations to diagnose a possible ovarian cancer. Women completed the Hospital Anxiety and Depression Scale (HADS), prior to clinical investigations (Time 1), after receiving diagnostic results (Time 2) and at 3 months follow-up (Time 3). Thirty women completed the assessments at Time 1 and Time 2, and 22 women were re-assessed at Time 3. The majority of the sample (56%) scored as a case of anxiety prior to clinical investigations. A significant decrease in anxiety and depression across time was found. Levels of anxiety and depression between women with a subsequent cancer diagnosis and women with a benign result were not significantly different. This study showed that clinical investigations are a highly anxiety-provoking event. In addition, the diagnosis of cancer did not significantly elevate or maintain levels of anxiety and depression compared to a benign diagnosis.     

Factors Predisposing Women to Take Precautions Against Breast and Cervix Cancer

The utility of the Theory of Reasoned Action (TRA), the Health Belief Model (HBM), and the Subjective Probability Model (SPM) in a health education diagnosis to discover predisposing factors for performing breast self-examination (BSE) and having a Pap test was explored in a survey of 123 women. Each model was a significant predictor of BSE and Pap test intentions. However, a composite model comprising the TRA's attitudinal and normative components supplemented by the barriers component of the HBM was the most useful in performing a health education diagnosis in relation to breast self-examination and the Pap test. "Psychological relevance" scores of particular beliefs obtained by SPM procedures tended to confirm the TRA's correlational method of identifying primary beliefs that would be the targets of persuasion to change BSE and Pap test intentions.     

Experiences of Women Who Underwent Predictive BRCA 1/2 Mutation Testing Before the Age of 30

This qualitative interview study focuses on the experiences of a sample of British female BRCA 1/2 carriers who had predictive testing before the age of 30, which is the minimum age for breast screening in the UK. Following appropriate informed consent procedures participants were recruited through the Cancer Genetics Service for Wales. Semi-structured interviews were conducted face-to-face with seven participants, transcribed in full and analyzed using thematic analysis. The motives for testing and perceived advantages described by participants were similar to those identified in previous studies with older participants, such as increased awareness and knowledge and feeling more in control. However some of the perceived disadvantages were specific to younger women, including feeling pressured to make important life decisions earlier than they would have liked, such as about family planning and risk reducing surgery. Participants also reported feeling abandoned or forgotten because of lack of ongoing clinical contact, or feeling “stuck waiting” for screening to begin. However, none felt that these disadvantages were a reason to regret having testing. Findings in this small study suggest that having BRCA 1/2 predictive testing can have positive outcomes for young women even though they may be unable to access interventions such as breast screening. However it may be helpful to encourage young women during pre-test counseling to explore the decisions and choices they may face. These young women could benefit from ongoing support and follow up and increased interaction with healthcare professionals.