The role of past mammography and future intentions in screening mammography usage.

Screening mammography is effective in the early detection of breast cancer among women aged 50 through 69, but under utilization by the target age group is common. The present study determined how past mammography behavior and intentions to have a mammogram were related to screening behaviors, attitudes, and beliefs. Participants were 1211 Alberta women aged 40 through 75 without breast cancer who were surveyed in a population-based random digit dial telephone interview. The response rate was 78%. Based on the stages of change and adoption models, women were grouped as Screeners (N = 363, 30%), who had had a "checkup" mammogram in the past 24 months and intended to have another in the next 24 months; Intenders (N = 355, 28%), who had not had a mammogram in the past 24 months but intended to have one in the next 24 months; and Nonparticipants (N = 513, 42%), who neither had had a mammogram in the past 24 months nor intended to have one in the next 24 months. Compared with Screeners, both Intenders and Nonparticipants were more likely to live in the rural areas and to have lower educational levels. Nonparticipants were also older, less likely to be married, of lower income, and less likely to be employed outside of the home. Separate logistic regression analyses showed that both Intenders and Nonparticipants were significantly less able to encourage a friend to have a mammogram (OR = 2.7 and 4.4, respectively), more likely to believe that most women were not getting screening mammograms (OR = 1.7 and 2.9, respectively), and less likely to believe symptoms were not needed for mammograms (OR = 0.3 and 0.1, respectively). In addition, Nonparticipants were also significantly more likely to believe that getting a mammogram would not reassure others (OR = 4.0) and less able to talk to a doctor about getting a mammogram (OR = 5.2). Adoption of screening can be seen as a continuum in which Screeners had the most positive and Nonparticipants the most negative breast cancer screening attitudes, beliefs, and early detection behaviors. The importance of physician referral and utilization of other information dissemination channels was highlighted.

Quality assurance and cancer detection rates in a provincial screening mammography program. Work in progress.

In 1990, a provincial screening program was inaugurated in Alberta, a Canadian province of 2.4 million people. The goal of the program is to decrease the number of deaths from breast cancer by 30% in women aged 50-69 years. In the first 18 months of program operations, efforts were concentrated on high levels of quality assurance in all areas of program activities. In particular, the abnormality referral rates, cancer detection rates, and size and stage of mammographically detected cancers were evaluated. Of the 9,553 women seen, 8,524 were between the ages of 50 and 69 years. Reported abnormality rates were initially more than 16%, but were brought down steadily to less than 5%. Cancer detection rates increased with age, ranging from 1.9 cancers detected per 1,000 women aged 40-49 years to 14.1 cancers per 1,000 women aged 70 years and older. Forty-one of the 61 cancers detected (67%) were less than 1.5 cm in diameter. Forty-three of the 52 cancers (83%) in which the nodal status was known were node negative. At the conclusion of the first 18 months of operation, interpretation parameters were within the target zones expected for a population-based screening program.

Breast cancer screening attitudes and behaviors of rural and urban women.

This study was carried out to assess the breast cancer knowledge, attitudes, and awareness of women age 40 to 74 in Alberta, a Canadian province of 2.4 million people. This analysis compares the attributes of 538 rural women, defined as those living between 1 and 3 hr drive from the major cities in Alberta, and 735 urban women who lived in one of these two cities. Rural women were found to have the same basic knowledge of breast cancer or perceptions of barriers to mammography, but had more negative attitudes about breast cancer itself. Despite their similar access to physician care, they were less likely to have had a recent clinical breast examination or mammogram (P less than 0.001). These differences remained when adjustment was made for demographic background variables; the adjusted prevalence rate ratio for a screening mammogram in the past 2 years was 0.52 (95% C.I., 0.43, 0.64), and for intention to have a mammogram in the next 2 years, 0.75 (0.63, 0.90). The results suggest particular program delivery strategies when planning for provision of breast screening information and service to the large subgroup of rural women.

Age as a factor in breast cancer knowledge, attitudes and screening behaviour.

OBJECTIVE: To determine whether there are age-related differences in knowledge, attitudes and behaviour with respect to breast cancer and whether the differences reflect the age-specific Canadian recommendations on breast cancer screening. DESIGN: Telephone survey. SETTING: Two cities and five towns and their surrounding areas in Alberta. PARTICIPANTS: The age-specific, randomly selected sample comprised 1284 women aged 40 to 75 years who did not have breast cancer. Of the 1741 eligible women who were contacted, 1350 (78%) agreed to participate; 66 were excluded because of age ineligibility or a history of breast cancer. MAIN OUTCOME MEASURE: Frequency of knowledge, attitudes and behaviour with respect to breast cancer, by age group. RESULTS: Knowledge of breast cancer risk factors was generally low and decreased with age. Few women were aware of the Canadian recommendations on breast self-examination, physical examination of the breasts by a health care practitioner and mammographic screening. Older women believed they were less susceptible to breast cancer than younger women and were less likely to have positive attitudes toward screening. Self-examination was performed 9 to 15 times per year by 424 women (33%), and 810 (63%) had been examined by a health care professional in the past year. Although 664 (52%) had undergone mammography, the proportion decreased with age after age 59. The main barriers to mammography were lack of physician referral and the woman's belief that the procedure is unnecessary if she is healthy. CONCLUSIONS: Education is needed to increase breast cancer knowledge, promote the Canadian recommendations for early detection of breast cancer and decrease negative beliefs about the disease. Changes in the behaviour of women and physicians are needed to increase the use of breast self-examination, clinical breast examination by a health care professional and mammographic screening. Reaching women in the upper range (60 to 69 years) of the target group for mammographic screening should be a focus in promoting early detection of breast cancer.

Ontario walk-in clinics: a preliminary descriptive study.

Little has been reported about Canadian walk-in clinics. The authors identified and surveyed 34 Ontario walk-in clinics in a preliminary descriptive study. A walk-in clinic was operationally defined as "a clinic that is separate from a hospital, has extended hours, and normally accepts patients without an appointment or a referral." Results showed that most Ontario walk-in clinics are not identifiable by name, have increased in number dramatically in the past two years, have laboratory, X-ray, and electrocardiographic facilities, and have varied practice patterns. Implications for rising health care costs and changing views on family practice were noted and suggestions made for future research.