Asia-Pacific Journal of Clinical Oncology 2016; 12: e229–e233
doi: 10.1111/ajco.12168
ORIGINAL ARTICLE
Predictors in breast cancer screening behaviors of South Asian women Jananie C PERERA, Vimukthini PEIRIS, Dakshitha P WICKRAMASINGHE and Ishan DE ZOYSA Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
Abstract Aim: Screening is important in minimizing breast cancer-related morbidity. It is prudent to identify the factors that affect women’s choice in participation in mammographic screening. Our objective was to identify the factors that influence the breast screening behaviors in Sri Lankan women. Methods: Data on referral, sociodemographic factors and relevant personal history of all the women visiting a single mammography center were prospectively collected during a 4-year period. Results: Of the 2695 participants, 1580 had sought mammographic services for screening purposes while 1115 were due to symptoms. A majority had Advanced Level (AL) or higher education (n = 1570, 58.3%) and were parous. Only a minority had past history (n = 221, 8.2%) or family history (n = 357, 13.3%) of breast cancer. Majority has normal mammographic findings with detection of 289 (10.7%) benign lesions. The mean age was 50.2 years in screening participants, 45.9 years in symptomatic women. Use of hormone replacement therapy, age >50 years, AL or higher education, having had undergone hysterectomy, past history of breast cancer, family history of breast cancer, family history of other cancer and self-referral were statistically significant contributors to mammography participation. In the logistic regression analysis age >50 years, AL or higher education, premenopausal status, having undergone hysterectomy and self-referral were significantly associated with screening participation and the model predicted 72.1% of the cases accurately. Conclusion: Five statistically significant predictors of mammographic screening among Sri Lankan women were identified. These suggest that higher health awareness and exposure to health care providers are important predictors. Key words: breast cancer, developing country, screening.
INTRODUCTION The participation of women in breast cancer screening programs is affected by various sociodemographic factors. Studies conducted in countries with established
Correspondence: Dr Dakshitha Wickramasinghe MBBS, Professorial Surgical Unit, National Hospital of Sri Lanka, Kynsey Road, Colombo 08, Sri Lanka. Email: [email protected] Conflict of interest: none Accepted for publication 14 November 2013.
© 2014 Wiley Publishing Asia Pty Ltd
screening programs or where screening facilities are freely accessible and available have shown that participation in breast cancer screening increases with the presence of a systematic and organized screening program.1–3 There is little or no data from developing countries especially in the South Asian region. Although limited breast cancer awareness programs have been carried out in Sri Lanka from late 1990s, data on their effectiveness are lacking. The sociodemographic and other factors that increase the likelihood of women participating in screening are almost unknown with regard to this region. This information is important in planning awareness programs and reaching the population that has not yet realized the importance of screening.
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JC Perera et al.
OBJECTIVES This study was planned to identify the sociodemographic and other factors that influence the breast screening behavior of Sri Lankan women.
missing data. Approval was obtained from the ethical review committee of the National Hospital of Sri Lanka. Written informed consent for participation in the study was obtained from participants.
RESULTS
METHODS Data of all the women visiting a breast screening center (Breast Health Centre, National Hospital of Sri Lanka) were prospectively collected by the use of a selfadministered validated questionnaire during a 4-year period from August 2002. Data on referral, sociodemographic factors and relevant personal history were obtained. The sociodemographic variables included age, highest education level reached and occupation. All patients underwent mammography and ultrasound assessment, irrespective of age. The mammography findings were recorded according to the BI-RADS system and when significant, ultrasonographic and histological findings were also recorded. The data were analyzed using SPSS 15.0 package (SPSS Inc, Chicago, IL, USA). The chi-square test and odds ratios were used to analyze data pertaining to risk factors and sociodemographic factors associated with patient participation in breast screening. These same factors were then analyzed using a logistic regression model with bootstrapping. All factors identified to be associated with the participation could not be included in multivariate analysis due to
A total of 4805 patients obtained services of the clinic during the study period. A total of 4093 patients complied with the request and filled the questionnaire. Questionnaires from men (n = 4) and incomplete questionnaires were excluded from the analysis. A total of 2695 participants were included in the analysis. A total of 1580 had sought mammographic services for screening purposes while 1115 were imaged due to symptoms. Table 1 shows the baseline characteristics of the participants of the study. The majority has normal mammographic findings with detection of 289 (10.7%) benign lesions, 94 (3.5%) BI-RADS grade 3 lesions, 90 (3.3%) BI-RADS grade 4 lesions and 140 (5.2%) malignancies. The characteristics of the 1580 screening participants were analyzed and compared with the patients who attended the center for diagnostic purposes. The mean age of the screening participants was 50.2 (SD 8.2, range 26–86) years and the mean age of participants with symptoms was 45.9 (SD 8.0, range 26–86) years. Odds ratio and chi-square values were calculated for sociodemographic and health-related factors for
Table 1 Characteristics of the participants of the study Characteristic Education level
Menopausal status Parity
Breast-feeding
Past history of breast cancer
Family history of breast cancer
Grade 5 or less Grade 6 (OL) AL Higher education Premenopausal Postmenopausal Nulliparous Multiparous Missing Yes No Missing Yes No Missing No Positive in first-degree relatives Positive in second-degree relatives
Frequency
Percentage (%)
97 1038 1053 517 1684 1011 255 1616 824 1834 37 823 221 1600 874 1466 239 118
3.6 38.2 39.1 19.2 62.5 37.5 9.5 60.0 31.5 68.1 1.4 30.5 8.2 59.4 32.4 54.4 8.9 4.4
AL, Advanced Level; OL, Ordinary Level.
© 2014 Wiley Publishing Asia Pty Ltd
Asia-Pac J Clin Oncol 2016; 12: e229–e233
e231
Breast cancer screening in Asian women
Table 2
Associations between patient characteristics and screening behavior
Factor HRT Age
doi: 10.1111/ajco.12168
ORIGINAL ARTICLE
Predictors in breast cancer screening behaviors of South Asian women Jananie C PERERA, Vimukthini PEIRIS, Dakshitha P WICKRAMASINGHE and Ishan DE ZOYSA Department of Surgery, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
Abstract Aim: Screening is important in minimizing breast cancer-related morbidity. It is prudent to identify the factors that affect women’s choice in participation in mammographic screening. Our objective was to identify the factors that influence the breast screening behaviors in Sri Lankan women. Methods: Data on referral, sociodemographic factors and relevant personal history of all the women visiting a single mammography center were prospectively collected during a 4-year period. Results: Of the 2695 participants, 1580 had sought mammographic services for screening purposes while 1115 were due to symptoms. A majority had Advanced Level (AL) or higher education (n = 1570, 58.3%) and were parous. Only a minority had past history (n = 221, 8.2%) or family history (n = 357, 13.3%) of breast cancer. Majority has normal mammographic findings with detection of 289 (10.7%) benign lesions. The mean age was 50.2 years in screening participants, 45.9 years in symptomatic women. Use of hormone replacement therapy, age >50 years, AL or higher education, having had undergone hysterectomy, past history of breast cancer, family history of breast cancer, family history of other cancer and self-referral were statistically significant contributors to mammography participation. In the logistic regression analysis age >50 years, AL or higher education, premenopausal status, having undergone hysterectomy and self-referral were significantly associated with screening participation and the model predicted 72.1% of the cases accurately. Conclusion: Five statistically significant predictors of mammographic screening among Sri Lankan women were identified. These suggest that higher health awareness and exposure to health care providers are important predictors. Key words: breast cancer, developing country, screening.
INTRODUCTION The participation of women in breast cancer screening programs is affected by various sociodemographic factors. Studies conducted in countries with established
Correspondence: Dr Dakshitha Wickramasinghe MBBS, Professorial Surgical Unit, National Hospital of Sri Lanka, Kynsey Road, Colombo 08, Sri Lanka. Email: [email protected] Conflict of interest: none Accepted for publication 14 November 2013.
© 2014 Wiley Publishing Asia Pty Ltd
screening programs or where screening facilities are freely accessible and available have shown that participation in breast cancer screening increases with the presence of a systematic and organized screening program.1–3 There is little or no data from developing countries especially in the South Asian region. Although limited breast cancer awareness programs have been carried out in Sri Lanka from late 1990s, data on their effectiveness are lacking. The sociodemographic and other factors that increase the likelihood of women participating in screening are almost unknown with regard to this region. This information is important in planning awareness programs and reaching the population that has not yet realized the importance of screening.
e230
JC Perera et al.
OBJECTIVES This study was planned to identify the sociodemographic and other factors that influence the breast screening behavior of Sri Lankan women.
missing data. Approval was obtained from the ethical review committee of the National Hospital of Sri Lanka. Written informed consent for participation in the study was obtained from participants.
RESULTS
METHODS Data of all the women visiting a breast screening center (Breast Health Centre, National Hospital of Sri Lanka) were prospectively collected by the use of a selfadministered validated questionnaire during a 4-year period from August 2002. Data on referral, sociodemographic factors and relevant personal history were obtained. The sociodemographic variables included age, highest education level reached and occupation. All patients underwent mammography and ultrasound assessment, irrespective of age. The mammography findings were recorded according to the BI-RADS system and when significant, ultrasonographic and histological findings were also recorded. The data were analyzed using SPSS 15.0 package (SPSS Inc, Chicago, IL, USA). The chi-square test and odds ratios were used to analyze data pertaining to risk factors and sociodemographic factors associated with patient participation in breast screening. These same factors were then analyzed using a logistic regression model with bootstrapping. All factors identified to be associated with the participation could not be included in multivariate analysis due to
A total of 4805 patients obtained services of the clinic during the study period. A total of 4093 patients complied with the request and filled the questionnaire. Questionnaires from men (n = 4) and incomplete questionnaires were excluded from the analysis. A total of 2695 participants were included in the analysis. A total of 1580 had sought mammographic services for screening purposes while 1115 were imaged due to symptoms. Table 1 shows the baseline characteristics of the participants of the study. The majority has normal mammographic findings with detection of 289 (10.7%) benign lesions, 94 (3.5%) BI-RADS grade 3 lesions, 90 (3.3%) BI-RADS grade 4 lesions and 140 (5.2%) malignancies. The characteristics of the 1580 screening participants were analyzed and compared with the patients who attended the center for diagnostic purposes. The mean age of the screening participants was 50.2 (SD 8.2, range 26–86) years and the mean age of participants with symptoms was 45.9 (SD 8.0, range 26–86) years. Odds ratio and chi-square values were calculated for sociodemographic and health-related factors for
Table 1 Characteristics of the participants of the study Characteristic Education level
Menopausal status Parity
Breast-feeding
Past history of breast cancer
Family history of breast cancer
Grade 5 or less Grade 6 (OL) AL Higher education Premenopausal Postmenopausal Nulliparous Multiparous Missing Yes No Missing Yes No Missing No Positive in first-degree relatives Positive in second-degree relatives
Frequency
Percentage (%)
97 1038 1053 517 1684 1011 255 1616 824 1834 37 823 221 1600 874 1466 239 118
3.6 38.2 39.1 19.2 62.5 37.5 9.5 60.0 31.5 68.1 1.4 30.5 8.2 59.4 32.4 54.4 8.9 4.4
AL, Advanced Level; OL, Ordinary Level.
© 2014 Wiley Publishing Asia Pty Ltd
Asia-Pac J Clin Oncol 2016; 12: e229–e233
e231
Breast cancer screening in Asian women
Table 2
Associations between patient characteristics and screening behavior
Factor HRT Age
