ORIGINAL RESEARCH * NOUVEAUTES EN RECHERCHE
Age as a factor in breast cancer knowledge, attitudes and screening behaviour Zeva Mah, MSc; Heather Bryant, MD, PhD, CCFP, FRCPC 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.
Objectif: Determiner les ecarts de connaissance, d'attitude et de comportement lies a l'age et ayant trait au cancer du sein et leur pertinence en fonction des recommandations canadiennes specifiques selon l'age pour le depistage du cancer du sein. Conception: Sondage telephonique. Contexte: Deux villes, cinq villages et les regions voisines en Alberta. Participants: L'echantillon specifique selon l'age et aleatoire regroupait 1 284 femmes agees de 40 a 75 ans qui n'avaient pas le cancer du sein. Des 1 741 femmes admissibles avec lesquelles on a communiqu6, 1 350 (78 %) ont accepte de participer; on a exclu 66 Ms. Mah is research associate and Dr. Bryant the director of Screen Test: the Alberta Program for the Early Detection ofBreast Cancer. Reprint requests to: Ms. Zeva Mah, Alberta Cancer Board, Ste. 120, 1040-7 Ave. SW, Calgary, AB T2P 3G9 -
For prescribing information see page 2250
CAN MED ASSOC J 1992; 146 (12)
2167
-1.
-- --
--
--
femmes en raison de leur age ou d'ant6c6dents de cancer du sein. Principale mesure des resultats: Fr6quence des connaissances, des attitudes et du comportement ayant trait au cancer du sein, par groupe d'age. Resultats: La connaissance des facteurs de risque de cancer du sein etait generalement faible, et elle diminuait avec l'age. Peu de femmes connaissaient les recommandations canadiennes sur l'auto-examen des seins, l'examen physique des seins par un professionnel de la sante et la mammographie. Les femmes plus agees croyaient qu'elles etaient moins exposees au cancer du sein que les femmes plus jeunes, et elles risquaient davantage d'avoir une attitude negative envers le depistage. Quatre cent vingt-quatre femmes (33 %) pratiquaient l'auto-examen de 9 a 15 fois par annee, et 810 femmes (63 %) avaient subi un examen par un professionnel de la sante au cours de l'annee precedente. Bien que 664 femmes (52 %) aient subi une mammographie, la proportion diminuait avec l'age apres 59 ans. Les principaux obstacles a la mammographie etaient le non-aiguillage par les medecins et la conviction chez la femme que 1'intervention est inutile lorsqu'on est en bonne sante. Conclusions: Une formation s'impose pour accroitre les connaissances sur le cancer du sein, promouvoir les recommandations canadiennes pour le depistage precoce du cancer du sein et reduire les croyances negatives au sujet de la maladie. Des modifications du comportement des femmes et des medecins sont necessaires pour augmenter le recours 'a I'auto-examen des seins, l'examen clinique des seins par un professionnel de la sante et la mammographie. Pour promouvoir le depistage precoce du cancer du sein, l'objectif devrait etre de rejoindre les femmes dans les couches superieures (60 A 69 ans) du groupe cible pour la mammographie.
B reast cancer is the most frequently occurring cancer and the leading cause of death from cancer among Canadian women.',2 It is the leading cause of potential years of life lost among women, exceeding even coronary heart disease and motor vehicle accidents.3 The strongest predictor of breast cancer is age: the risk increases significantly after age 50 years and continues to increase thereafter.' The incidence of breast cancer has increased 20% over the past 15 years among women aged 65 years and over but has remained relatively constant among those 45 to 64.1 Despite much research into new therapeutic methods, the rates of death from breast cancer have remained relatively constant over the past two decades. Several prospective randomized controlled trials and case-control studies have shown that early detection of breast cancer by mammography can decrease the mortality rate by up to 40% in women 50 years of age and over.4-7 Therefore, the report of the workshop group formed to recommend a Canadian position on the early detection of breast cancer suggested that women aged 50 to 69 years perform monthly breast self-examination and every 2 years, beginning at age 50, undergo both physical examination of the breasts by a health care professional and mammography.8 However, like many other consensus groups,9 this one noted the lack of evidence supporting mammographic screening for younger women. It is expected that the Canadian National Breast Screening Study (NBSS) will provide relevant information. 0 Because age is the determinant in recommending mammography, women aged 50 to 69 years should be explicitly targeted for both education and 2168
CAN MED ASSOC J 1992; 146 (12)
mammographic screening. Nevertheless, studies have shown that women in this age group may undergo mammography less often than younger women. In a random telephone survey of urban women aged 45 to 75 years in the United States fewer of those aged 60 to 69 (50.8%) than of those aged 45 to 49 (56.8%) reported ever having undergone mammography.1' In a mixed rural and urban telephone survey in the United States 45% of women in their 60s compared with 49% and 52% of those in their 40s and 50s reported ever having undergone mammography.'2 A population survey of women in Rome showed that more women in their 40s than women aged 50 to 64 years had undergone mammography.'3 Nevertheless, age stratification was not a focus of these studies, and it is not known whether the results can be generalized to the Canadian
population. Reasons for poor participation of the target age group in mammographic screening vary. Some studies have identified poor knowledge of breast disease, lack of physician referral and the woman's belief that mammography is not required if she is healthy as reasons for not undergoing the procedure at least once.'4-'6 Other studies have shown that barriers include low education levels, low income levels, high mammography costs and less interaction with the health care system as a whole.'7-'9 It is not known, however, if these barriers are age-related or if they are relevant to the Canadian health care system. With the recent initiation of several provincial mammographic screening programs with dedicated centres,20 and in anticipation of results from the NBSS, it is essential to determine which age groups LE 1 5 JUIN 1992
of women are being adequately screened and which may be undergoing screening too seldom or too often. The purpose of the study reported here was to determine whether there are age-related differences in breast cancer knowledge and attitudes and whether these differences are related to participation in mammography and other related behaviour.
Methods The participants were 1284 Alberta women aged 40 to 75 years without breast cancer who were able to answer the questionnaire in English over the telephone. The women were grouped into four age categories: 40 to 49, 50 to 59, 60 to 69 and 70 to 75 years. Ethical approval was obtained for the study design and treatment of all participants. The main instrument was based on a pretested, standardized breast cancer and mammography questionnaire." It contained questions on sociodemographics and health history, as well as items measuring knowledge, beliefs, enabling factors and reinforcing factors. Responses included multiple-choice answers and some open-ended responses that were collapsed into categories for analysis. The questionnaire was developed for administration over the telephone and took about 20 minutes to complete. The study used an age-stratified random sample design. Lists of telephone numbers for the urban centres were generated by means of a random number generator.21,22 In the rural areas telephone prefixes were not saturated, so telephone numbers were randomly chosen from the most current directories.23 Because the necessary sample size was reached before the end of the study, the phone lists were not exhausted. Telephone interviewers were trained on-site. Standard protocols included determination of eligibility, invitation to participate and hAaviFtksn ofwat
administration of the questionnaire. Up to seven callbacks were allowed per phone number during at least three different times of the day before the number was eliminated. Data entry was completed weekly at a central site to provide ongoing quality assurance and feedback. Seven sites were surveyed in March 1991: two major cities and two rural health unit areas that included five towns and their surrounding areas. There were about 176 000 women (52.4% of the population) in the target age range in the urban areas and 160 000 (47.6%) in the other regions. Thus, approximately 59.5% of our sample were urban dwellers and 40.5% rural. Analyses were performed with contingency tables and x2 tests. The WilcoxonMann-Whitney test generalized as the KruskalWallis overall x2 test for differences in multiple comparisons was used to determine trends in independent samples.24
Results Of the 1741 women contacted who were poten-
tially eligible for the study 1350 (78%) agreed to participate; 38 had breast cancer and were excluded from the detailed study, as were 16 who declined to give their age or year of birth, 7 who were under 40 years old and 5 who were over 75. This resulted in a final sample size of 1284. For some variables responses were missing or not applicable. Women who refused to participate were asked three questions to allow comparison with those who agreed (Table 1). The refusers were similar to the participants in location of residence and history of breast cancer but were more often aged 60 to 75 years. Bias due to different response rates among the age groups is unlikely to have affected the results, which were analysed by age group. Demographic ipaFXts ,n4 n
f gtipa u...
~% of group* Participants Nonpaticipants (n=- 13 ) (n =391)....
-
Charactoerstic Urban Rural
Age.goup,.yr-
40-49 50-59 889 70-75 History of breast cancer No . Yost
.
-
-.
2284(,a)
788(i8) 582-(42) 523(41) 357(28)
1.4238) 101.(29) 79(23) ..98(2 70(20)
305-(4)
99 (8) . ....... 1312.(97). -(3) .-.-.-38
.
339(98.)
.7 (2").
Ih du6matorvaries because if missng value.
tines. eiPants a*r not ncded hi fhef analyss, even If thiy agred b,
par~e.*
JUNE 15, 1992
CAN MED ASSOC J 1992; 146 (12)
2169
data (Table 2) for the final sample were comparable to those for the overall population as described in census information, which suggests that the study sample was representative of the population.
:*,J->.'s
aged 50 to 59 years, those 60 to 69 years old were significantly less likely to agree that undergoing mammography would give them peace of mind (p = 0.04) and reassure them (p = 0.02). The older group was more likely to feel that they had too many other health problems to worry about breast cancer (p < Knowledge and attitudes 0.001) and that they would not need mammography Questions were asked to determine the subjects' unless cancer symptoms developed (p < 0.001). They basic knowledge of risk factors for breast cancer were also significantly less likely to encourage a (Table 3). The number correctly answering that friend or relative to undergo physical examination of women aged 50 years or more are at highest risk of the breasts (p = 0.03) or mammography (p = 0.002) breast cancer decreased with age (p = 0.01); fewer or to bring up the subject of mammography with than a third were aware of this major risk factor. their physician (p = 0.002). Women 60 years and over were less likely than Although 80% of the subjects identified a woman whose mother or sister has had breast cancer as more women under 60 to believe that mammography likely to have breast cancer, this knowledge also could reveal new breast cancer (p < 0.001). The decreased with age (p = 0.001). A similar trend was older their group, the more likely participants evident among women who correctly answered that were to think that they would not have breast 1 woman in 10 would have breast cancer during her cancer some day (p < 0.001). Women in their 40s lifetime (p < 0.001). Thus, the younger the group, were significantly more likely to believe that they the higher the awareness of risk factors and of the would have breast cancer some day than women in their 50s (p = 0.005), whereas women in their incidence of breast-cancer. When beliefs and attitudes were considered, 60s (p = 0.002) and 70s (p < 0.001) were signifisignificant differences were again found, even within cantly less likely to believe that they would have the target age group. Compared with the women breast cancer some day.
-1. .. .l
f..
....
i44
1*
gmP.
t8
11
.!r4,
67 9
:8
2
922
-|e ': .,0s'^
:
..
.; ;.,o;e
..y .... ...
...
TjU.. "
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..3
: ,:L.,
£' '; '.'
l]L;., ..... ;:"
'wi
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^4
~~~~3
.'. ';'
!,
..
'0 ..
X
'"}''-^i''
%:.
v~~~~~~~
.: ~~~~~~~~~~~~~~~~~~~ X,' X * :.s
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-.X. .::. cRss.S*eR
?
o. .r ;}t;>
9
-
--
-
}18
20. 2170
CAN MED ASSOC J 1992; 146 (12)
-27
LElS5JUINl1992
Women
were
also asked about their intentions
regarding screening. over were
Women
60 years
of age and
less certain than those 50 to 59 years old
they would undergo physical examination of the by a health care professional in the next year (p < 0.00 1). The younger the group, the more likely that the woman was planning to undergo mammography in the next 2 years (p < 0.00 1). However, if mammography was recommended by a doctor, the
proportion responding that
they
would be
likely
to
ove.,r 90% for each
age procedure proportion of women i60 years of age and who intended to undergo mammography aldoubled if it was recommer rided by a doctor.
undergo
the
was
group. The
that
over
breasts
most
Other breast health behaviour About 85% of the
subjects
.eported having
been
: adatiue about breast calncer by age ,groUP Table &Knowledge Age, yr; % of group 40-49 50.-59. 60-69 70-7 5 Variable Knowldg of .general ratCne ik Awar tawoead50rmore, are. 34 27 35 19* atgratetrs. Aware'0 thtFaMily.hitor i 8 561 Awarethatllfetirnerlskisl *10 79 ~~85. 2 41 .44 Aw. otkno;-rb ~~48 8 38 281 BElieve stF'lM I oQt t*tcne 471, Beliefs about mammography .In. general BelIeve that women.. s'should un:dergov
M.ammograhaaeO7' mammography. evr
12
12
23
40
.35.
38.
~ 97
97-
.93.
60~~Co..
61
4f
231
96
95
'94
93
9 98
er
tofldnecnr Attitde about mamg fhfrsl Yew QrsQpmeWl gO"toudeg , It in next2y.!rs. . Ver.y orsrehtcr _nto :undergo itnetyears if. doctor .recomimends'.it
'Signifcaty different(p ic 0.05 fromi prprino Wujcs5 to 59 years old. tSlgnfBonty dfeUitp
Age as a factor in breast cancer knowledge, attitudes and screening behaviour Zeva Mah, MSc; Heather Bryant, MD, PhD, CCFP, FRCPC 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.
Objectif: Determiner les ecarts de connaissance, d'attitude et de comportement lies a l'age et ayant trait au cancer du sein et leur pertinence en fonction des recommandations canadiennes specifiques selon l'age pour le depistage du cancer du sein. Conception: Sondage telephonique. Contexte: Deux villes, cinq villages et les regions voisines en Alberta. Participants: L'echantillon specifique selon l'age et aleatoire regroupait 1 284 femmes agees de 40 a 75 ans qui n'avaient pas le cancer du sein. Des 1 741 femmes admissibles avec lesquelles on a communiqu6, 1 350 (78 %) ont accepte de participer; on a exclu 66 Ms. Mah is research associate and Dr. Bryant the director of Screen Test: the Alberta Program for the Early Detection ofBreast Cancer. Reprint requests to: Ms. Zeva Mah, Alberta Cancer Board, Ste. 120, 1040-7 Ave. SW, Calgary, AB T2P 3G9 -
For prescribing information see page 2250
CAN MED ASSOC J 1992; 146 (12)
2167
-1.
-- --
--
--
femmes en raison de leur age ou d'ant6c6dents de cancer du sein. Principale mesure des resultats: Fr6quence des connaissances, des attitudes et du comportement ayant trait au cancer du sein, par groupe d'age. Resultats: La connaissance des facteurs de risque de cancer du sein etait generalement faible, et elle diminuait avec l'age. Peu de femmes connaissaient les recommandations canadiennes sur l'auto-examen des seins, l'examen physique des seins par un professionnel de la sante et la mammographie. Les femmes plus agees croyaient qu'elles etaient moins exposees au cancer du sein que les femmes plus jeunes, et elles risquaient davantage d'avoir une attitude negative envers le depistage. Quatre cent vingt-quatre femmes (33 %) pratiquaient l'auto-examen de 9 a 15 fois par annee, et 810 femmes (63 %) avaient subi un examen par un professionnel de la sante au cours de l'annee precedente. Bien que 664 femmes (52 %) aient subi une mammographie, la proportion diminuait avec l'age apres 59 ans. Les principaux obstacles a la mammographie etaient le non-aiguillage par les medecins et la conviction chez la femme que 1'intervention est inutile lorsqu'on est en bonne sante. Conclusions: Une formation s'impose pour accroitre les connaissances sur le cancer du sein, promouvoir les recommandations canadiennes pour le depistage precoce du cancer du sein et reduire les croyances negatives au sujet de la maladie. Des modifications du comportement des femmes et des medecins sont necessaires pour augmenter le recours 'a I'auto-examen des seins, l'examen clinique des seins par un professionnel de la sante et la mammographie. Pour promouvoir le depistage precoce du cancer du sein, l'objectif devrait etre de rejoindre les femmes dans les couches superieures (60 A 69 ans) du groupe cible pour la mammographie.
B reast cancer is the most frequently occurring cancer and the leading cause of death from cancer among Canadian women.',2 It is the leading cause of potential years of life lost among women, exceeding even coronary heart disease and motor vehicle accidents.3 The strongest predictor of breast cancer is age: the risk increases significantly after age 50 years and continues to increase thereafter.' The incidence of breast cancer has increased 20% over the past 15 years among women aged 65 years and over but has remained relatively constant among those 45 to 64.1 Despite much research into new therapeutic methods, the rates of death from breast cancer have remained relatively constant over the past two decades. Several prospective randomized controlled trials and case-control studies have shown that early detection of breast cancer by mammography can decrease the mortality rate by up to 40% in women 50 years of age and over.4-7 Therefore, the report of the workshop group formed to recommend a Canadian position on the early detection of breast cancer suggested that women aged 50 to 69 years perform monthly breast self-examination and every 2 years, beginning at age 50, undergo both physical examination of the breasts by a health care professional and mammography.8 However, like many other consensus groups,9 this one noted the lack of evidence supporting mammographic screening for younger women. It is expected that the Canadian National Breast Screening Study (NBSS) will provide relevant information. 0 Because age is the determinant in recommending mammography, women aged 50 to 69 years should be explicitly targeted for both education and 2168
CAN MED ASSOC J 1992; 146 (12)
mammographic screening. Nevertheless, studies have shown that women in this age group may undergo mammography less often than younger women. In a random telephone survey of urban women aged 45 to 75 years in the United States fewer of those aged 60 to 69 (50.8%) than of those aged 45 to 49 (56.8%) reported ever having undergone mammography.1' In a mixed rural and urban telephone survey in the United States 45% of women in their 60s compared with 49% and 52% of those in their 40s and 50s reported ever having undergone mammography.'2 A population survey of women in Rome showed that more women in their 40s than women aged 50 to 64 years had undergone mammography.'3 Nevertheless, age stratification was not a focus of these studies, and it is not known whether the results can be generalized to the Canadian
population. Reasons for poor participation of the target age group in mammographic screening vary. Some studies have identified poor knowledge of breast disease, lack of physician referral and the woman's belief that mammography is not required if she is healthy as reasons for not undergoing the procedure at least once.'4-'6 Other studies have shown that barriers include low education levels, low income levels, high mammography costs and less interaction with the health care system as a whole.'7-'9 It is not known, however, if these barriers are age-related or if they are relevant to the Canadian health care system. With the recent initiation of several provincial mammographic screening programs with dedicated centres,20 and in anticipation of results from the NBSS, it is essential to determine which age groups LE 1 5 JUIN 1992
of women are being adequately screened and which may be undergoing screening too seldom or too often. The purpose of the study reported here was to determine whether there are age-related differences in breast cancer knowledge and attitudes and whether these differences are related to participation in mammography and other related behaviour.
Methods The participants were 1284 Alberta women aged 40 to 75 years without breast cancer who were able to answer the questionnaire in English over the telephone. The women were grouped into four age categories: 40 to 49, 50 to 59, 60 to 69 and 70 to 75 years. Ethical approval was obtained for the study design and treatment of all participants. The main instrument was based on a pretested, standardized breast cancer and mammography questionnaire." It contained questions on sociodemographics and health history, as well as items measuring knowledge, beliefs, enabling factors and reinforcing factors. Responses included multiple-choice answers and some open-ended responses that were collapsed into categories for analysis. The questionnaire was developed for administration over the telephone and took about 20 minutes to complete. The study used an age-stratified random sample design. Lists of telephone numbers for the urban centres were generated by means of a random number generator.21,22 In the rural areas telephone prefixes were not saturated, so telephone numbers were randomly chosen from the most current directories.23 Because the necessary sample size was reached before the end of the study, the phone lists were not exhausted. Telephone interviewers were trained on-site. Standard protocols included determination of eligibility, invitation to participate and hAaviFtksn ofwat
administration of the questionnaire. Up to seven callbacks were allowed per phone number during at least three different times of the day before the number was eliminated. Data entry was completed weekly at a central site to provide ongoing quality assurance and feedback. Seven sites were surveyed in March 1991: two major cities and two rural health unit areas that included five towns and their surrounding areas. There were about 176 000 women (52.4% of the population) in the target age range in the urban areas and 160 000 (47.6%) in the other regions. Thus, approximately 59.5% of our sample were urban dwellers and 40.5% rural. Analyses were performed with contingency tables and x2 tests. The WilcoxonMann-Whitney test generalized as the KruskalWallis overall x2 test for differences in multiple comparisons was used to determine trends in independent samples.24
Results Of the 1741 women contacted who were poten-
tially eligible for the study 1350 (78%) agreed to participate; 38 had breast cancer and were excluded from the detailed study, as were 16 who declined to give their age or year of birth, 7 who were under 40 years old and 5 who were over 75. This resulted in a final sample size of 1284. For some variables responses were missing or not applicable. Women who refused to participate were asked three questions to allow comparison with those who agreed (Table 1). The refusers were similar to the participants in location of residence and history of breast cancer but were more often aged 60 to 75 years. Bias due to different response rates among the age groups is unlikely to have affected the results, which were analysed by age group. Demographic ipaFXts ,n4 n
f gtipa u...
~% of group* Participants Nonpaticipants (n=- 13 ) (n =391)....
-
Charactoerstic Urban Rural
Age.goup,.yr-
40-49 50-59 889 70-75 History of breast cancer No . Yost
.
-
-.
2284(,a)
788(i8) 582-(42) 523(41) 357(28)
1.4238) 101.(29) 79(23) ..98(2 70(20)
305-(4)
99 (8) . ....... 1312.(97). -(3) .-.-.-38
.
339(98.)
.7 (2").
Ih du6matorvaries because if missng value.
tines. eiPants a*r not ncded hi fhef analyss, even If thiy agred b,
par~e.*
JUNE 15, 1992
CAN MED ASSOC J 1992; 146 (12)
2169
data (Table 2) for the final sample were comparable to those for the overall population as described in census information, which suggests that the study sample was representative of the population.
:*,J->.'s
aged 50 to 59 years, those 60 to 69 years old were significantly less likely to agree that undergoing mammography would give them peace of mind (p = 0.04) and reassure them (p = 0.02). The older group was more likely to feel that they had too many other health problems to worry about breast cancer (p < Knowledge and attitudes 0.001) and that they would not need mammography Questions were asked to determine the subjects' unless cancer symptoms developed (p < 0.001). They basic knowledge of risk factors for breast cancer were also significantly less likely to encourage a (Table 3). The number correctly answering that friend or relative to undergo physical examination of women aged 50 years or more are at highest risk of the breasts (p = 0.03) or mammography (p = 0.002) breast cancer decreased with age (p = 0.01); fewer or to bring up the subject of mammography with than a third were aware of this major risk factor. their physician (p = 0.002). Women 60 years and over were less likely than Although 80% of the subjects identified a woman whose mother or sister has had breast cancer as more women under 60 to believe that mammography likely to have breast cancer, this knowledge also could reveal new breast cancer (p < 0.001). The decreased with age (p = 0.001). A similar trend was older their group, the more likely participants evident among women who correctly answered that were to think that they would not have breast 1 woman in 10 would have breast cancer during her cancer some day (p < 0.001). Women in their 40s lifetime (p < 0.001). Thus, the younger the group, were significantly more likely to believe that they the higher the awareness of risk factors and of the would have breast cancer some day than women in their 50s (p = 0.005), whereas women in their incidence of breast-cancer. When beliefs and attitudes were considered, 60s (p = 0.002) and 70s (p < 0.001) were signifisignificant differences were again found, even within cantly less likely to believe that they would have the target age group. Compared with the women breast cancer some day.
-1. .. .l
f..
....
i44
1*
gmP.
t8
11
.!r4,
67 9
:8
2
922
-|e ': .,0s'^
:
..
.; ;.,o;e
..y .... ...
...
TjU.. "
'AP
..3
: ,:L.,
£' '; '.'
l]L;., ..... ;:"
'wi
-.^.i:,r;,
^4
~~~~3
.'. ';'
!,
..
'0 ..
X
'"}''-^i''
%:.
v~~~~~~~
.: ~~~~~~~~~~~~~~~~~~~ X,' X * :.s
l:
-.X. .::. cRss.S*eR
?
o. .r ;}t;>
9
-
--
-
}18
20. 2170
CAN MED ASSOC J 1992; 146 (12)
-27
LElS5JUINl1992
Women
were
also asked about their intentions
regarding screening. over were
Women
60 years
of age and
less certain than those 50 to 59 years old
they would undergo physical examination of the by a health care professional in the next year (p < 0.00 1). The younger the group, the more likely that the woman was planning to undergo mammography in the next 2 years (p < 0.00 1). However, if mammography was recommended by a doctor, the
proportion responding that
they
would be
likely
to
ove.,r 90% for each
age procedure proportion of women i60 years of age and who intended to undergo mammography aldoubled if it was recommer rided by a doctor.
undergo
the
was
group. The
that
over
breasts
most
Other breast health behaviour About 85% of the
subjects
.eported having
been
: adatiue about breast calncer by age ,groUP Table &Knowledge Age, yr; % of group 40-49 50.-59. 60-69 70-7 5 Variable Knowldg of .general ratCne ik Awar tawoead50rmore, are. 34 27 35 19* atgratetrs. Aware'0 thtFaMily.hitor i 8 561 Awarethatllfetirnerlskisl *10 79 ~~85. 2 41 .44 Aw. otkno;-rb ~~48 8 38 281 BElieve stF'lM I oQt t*tcne 471, Beliefs about mammography .In. general BelIeve that women.. s'should un:dergov
M.ammograhaaeO7' mammography. evr
12
12
23
40
.35.
38.
~ 97
97-
.93.
60~~Co..
61
4f
231
96
95
'94
93
9 98
er
tofldnecnr Attitde about mamg fhfrsl Yew QrsQpmeWl gO"toudeg , It in next2y.!rs. . Ver.y orsrehtcr _nto :undergo itnetyears if. doctor .recomimends'.it
'Signifcaty different(p ic 0.05 fromi prprino Wujcs5 to 59 years old. tSlgnfBonty dfeUitp
