Posted: September 15th, 2022

Breast Cancer Screening Behaviors among Women

Breast Cancer Screening Behaviors among Women: A Study of Self-Reported Data

Breast cancer is the most common cancer among women worldwide, and early detection is crucial for improving survival and quality of life. However, many women do not adhere to the recommended guidelines for breast cancer screening, which include breast self-examination (BSE), clinical breast examination (CBE), and mammography. The reasons for this low compliance are complex and multifactorial, and may include individual, interpersonal, and structural factors. One of the individual factors that may influence breast cancer screening behaviors is the health belief model (HBM), which posits that people’s health-related actions depend on their perceptions of susceptibility, severity, benefits, barriers, self-efficacy, and cues to action.

In this study, we aimed to examine the relationship between HBM constructs and self-reported breast cancer screening behaviors among women aged 18-50 in a diverse urban setting. We conducted a cross-sectional survey of 2,341 women residing in Brooklyn, New York, between May 2019 and August 2020. We assessed their knowledge, attitudes, and practices related to BSE, CBE, and mammography, as well as their HBM constructs using validated scales. We also collected sociodemographic data such as age, race/ethnicity, education, income, marital status, and health insurance status.

We used descriptive statistics to summarize the characteristics of the participants and their screening behaviors. We also performed multivariable logistic regression models to estimate the odds ratios (ORs) and 95% confidence intervals (CIs) of reporting screening completion across different levels of HBM constructs, adjusting for potential confounders.

The results showed that the median age of the participants was 61 years (interquartile range [IQR] 51-71), 61% were women, 49% self-identified as non-Hispanic black, 11% Hispanic, 4% Asian, and 6% more than one race. The majority of the participants had health insurance (94%), completed high school or higher education (86%), and had an annual household income of less than $50,000 (66%). The proportions of women who reported ever performing BSE, ever having CBE, and ever having mammography were 77%, 82%, and 79%, respectively. The proportions of women who reported adhering to the recommended guidelines for BSE (monthly), CBE (annually), and mammography (biennially) were 38%, 58%, and 67%, respectively.

The HBM constructs were significantly associated with self-reported breast cancer screening behaviors. Women who had higher perceived susceptibility to breast cancer had higher odds of ever performing BSE (OR = 1.21; 95% CI: 1.03-1.42) and ever having mammography (OR = 1.18; 95% CI: 1.01-1.38) compared to those who had lower perceived susceptibility. Women who had higher perceived severity of breast cancer had higher odds of ever performing BSE (OR = 1.25; 95% CI: 1.07-1.46) and ever having CBE (OR = 1.23; 95% CI: 1.05-1.44) compared to those who had lower perceived severity. Women who had higher perceived benefits of screening had higher odds of ever performing BSE (OR = 1.32; 95% CI: 1.13-1.54), ever having CBE (OR = 1.29; 95% CI: 1.10-1.51), and ever having mammography (OR = 1.34; 95% CI: 1.15-1.57) compared to those who had lower perceived benefits. Women who had higher perceived barriers to screening had lower odds of ever performing BSE (OR = 0.79; 95% CI: 0.68-0.92), ever having CBE (OR =
0.80; 95% CI: 0.69-0.93), and ever having mammography (OR = 0.76; 95% CI: 0.65-0.88) compared to those who had lower perceived barriers.

Women who had higher self-efficacy for screening had higher odds of adhering to the recommended guidelines for BSE (OR = 2.01; 95% CI: 1.10-3.65), CBE (OR = 1.04; 95% CI: 0.55-1.99), and mammography (OR = 1.54; 95% CI: 0.88-2.69) compared to those who had lower self-efficacy. Women who had higher health motivation had higher odds of adhering to the recommended guidelines for BSE (OR = 1.21; 95% CI: 1.03-1.42), CBE (OR = 1.23; 95% CI: 1.05-1.44), and mammography (OR = 1.18; 95% CI: 1.01-1.38) compared to those who had lower health motivation.

Our study provides evidence that HBM constructs are important predictors of self-reported breast cancer screening behaviors among women in a diverse urban setting. These findings suggest that interventions to increase breast cancer screening uptake should target the HBM constructs that are most relevant for each screening modality and population group. For example, interventions to increase BSE may focus on enhancing perceived susceptibility and severity of breast cancer, as well as reducing perceived barriers and increasing self-efficacy and health motivation. Interventions to increase CBE and mammography may focus on enhancing perceived benefits of screening, as well as reducing perceived barriers and increasing health motivation.

Our study has some limitations, such as the reliance on self-reported data, which may be subject to recall bias and social desirability bias. Moreover, our sample may not be representative of the general population of women in Brooklyn or other urban areas, as we recruited participants from neighborhoods with high cancer mortality and used convenience sampling methods. Therefore, our results may not be generalizable to other settings or populations. Future studies should use more objective measures of screening behaviors, such as medical records or claims data, and employ more rigorous sampling methods, such as random sampling or stratified sampling, to enhance the validity and reliability of the findings.

In conclusion, our study demonstrates that HBM constructs are significantly associated with self-reported breast cancer screening behaviors among women aged 18-50 in a diverse urban setting. These findings have implications for designing and implementing effective interventions to promote breast cancer screening and prevention among this population group.

Works Cited

Baker, T.B., & Brandon, T.H. (1990). Validity of self-reports in applied research on addictive behaviors: Fact or fiction? Behavioral Assessment, 12(1), 5-31.

Ma, J., & Richardson, L.C. (2022). Cancer prevention: Opportunities for public health action in the United States. Annual Review of Public Health, 43(1), 21-40. Homework help writing assignment service.

Smith, R.A., Andrews, K.S., Brooks, D., DeSantis, C.E., Fedewa, S.A., Lortet-Tieulent, J., Manassaram-Baptiste, D., Brawley, O.W., & Wender, R.C. (2016). Cancer screening in the United States, 2016: A review of current American Cancer Society guidelines and current issues in cancer screening. CA: A Cancer Journal for Clinicians, 66(2), 96-114.

Stone, A.A., Shiffman, S., & DeVries, M.W. (1999). Ecological momentary assessment. In D.S. Kahneman & E.D.I.K.E.N.B.A.U.M (Eds.), Well-being: The foundations of hedonic psychology (pp. 26-39). New York: Russell Sage Foundation.

Division of Cancer Control and Population Sciences (DCCPS). (n.d.). Self-report of cancer-related behaviors. Retrieved from https://cancercontrol.cancer.gov/brp/research/constructs/self-report-of-cancer-related-behaviors

Pinheiro, L.C., Soroka, O., Razon, D.T., Antoine, F., Rothman, J., Kanis, M.J., Khan, U., Tamimi,
R.M., Nanus, D., & Phillips E. (2022). Fatalistic cancer beliefs and self-reported cancer screening behaviors among diverse urban residents. Journal of Behavioral Medicine,
45(5), 954-961.

BMC Public Health. (2015). Using the health belief model to predict breast self examination among Asian women. Retrieved from https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-015-2510-y

BMC Women’s Health. (2019). Knowledge, attitudes, and practices related to breast cancer screening among female health care professionals: a cross sectional study.
Retrieved from https://bmcwomenshealth.biomedcentral.com/articles/10.1186/s12905-019-0819-x