p u b l i c h e a l t h 1 2 8 ( 2 0 1 4 ) 1 0 0 9 e1 0 1 6
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Original Research
Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey S.S.M. Ho a, K.C. Choi a, C.L. Wong a, C.W.H. Chan a, H.Y.L. Chan a, W.P.Y. Tang a, W.W.T. Lam b, A.T.Y. Shiu a, W.B. Goggins c, W.K.W. So a,* a
Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Sassoon Road, Hong Kong, China c Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China b
article info
abstract
Article history:
Objective: To examine the uptake of breast screening and its associated factors among Hong
Received 4 June 2013
Kong Chinese women aged 50 years.
Received in revised form
Study design: Cross-sectional population-based survey.
23 May 2014
Methods: A sample of Hong Kong Chinese women was recruited through telephone
Accepted 3 September 2014
random-digit dialling. The survey consisted of six sections: perceived health status, use of
Available online 4 November 2014
complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of
Keywords:
breast screening were analysed using logistic regression analysis.
Mammogram
Results: In total, 1002 women completed the (anonymous) telephone survey. The mean age was
Mammography
63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong
Breast cancer
Chinese women aged 50 years was 34%. The primary reasons for undertaking breast
Screening
screening were as part of a regular medical check-up (74%), prompted by local signs and
Uptake
symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram. Conclusions: This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies. © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Rm 731, 7/F, Esther Lee Building, The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China. Tel.: þ852 3943 1072; fax: þ852 2603 5935. E-mail address: [email protected] (W.K.W. So). http://dx.doi.org/10.1016/j.puhe.2014.09.001 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Introduction Breast cancer is one of the most common cancers and the leading cause of cancer death worldwide.1 According to the Hong Kong Cancer Registry,2 breast cancer is the most common cancer and the third leading cause of cancer death in the female population. The crude incidence and mortality rates in 2011 were 90.7 and 14.6 per 100,000, respectively. An increasing trend in these figures has been reported (incidence and mortality rates in 2002 were 59.4 and 12.3 per 100,000 women, respectively).2 The majority of these patients (62.8%) were aged 50 years. Death due to breast cancer can be prevented by early detection, and screening with mammography helps to identify abnormal changes in tissues or the presence of early-stage cancer.3 The evidence shows that earlier diagnosis allows more treatment options, thus leading to improved survival rates. One meta-analysis estimated that a 23% reduction in breast cancer mortality occurs 10e15 years after the introduction of mammography.4 Several major organizations have recommended that women aged between 50 and 69 years should have a mammogram every 1e2 years.3,5 Although routine mammography for breast cancer is not yet recommended in Hong Kong,6 people can receive secondary cancer preventive services in both the public and private health sectors. In the public sector, there are two options: general outpatient clinics (GOPC) and women's health centres, both of which provide low-cost government-subsidized services and are accessible concurrently. GOPCs are operated by Hong Kong Hospital Authority, and people usually attend clinics for medical consultation.7 The service fee is HK$45 (US$6 or £3.50) per attendance. When cancer is suspected, the physician will refer the case to a specialist outpatient clinic for further investigation and appropriate treatment. The Department of Health operates the women's health centres, which provide various services to promote the health of women at various stages of life once they enrol.8 The annual enrolment fee is HK$310 (US$40 or £24), and breast screening costs HK$ 225 (US$29 or £17) per episode.8 In the private sector, secondary cancer preventive services can be obtained from general practitioners or specialists in private practice. Fees are normally higher, and vary in accordance with the reputation of the general practitioner or specialist. The Health Belief Model (HBM) is a theoretical model commonly used to guide health behaviour, including cancer prevention.9,10 According to the HBM, people who believe that a course of action will produce better outcomes or overcome perceived barriers are more likely to take part in healthseeking behaviour.11 Thus, identifying both facilitators and barriers may help health care professionals to target a specific group of people and increase their awareness of breast screening. Numerous studies have been conducted to identify factors that may affect people's participation in breast screening. However, only a limited number of studies have been performed in Chinese populations living abroad.12,13 Perception of breast cancer risk, perceived need for screening, perceived health status, health insurance, reminders from health care professionals, age, level of education and language ability had
a significant effect on uptake rates.12,13 While the findings of these studies can provide useful information about factors that may affect health-seeking behaviour among Chinese women, study results in populations living abroad may not be applicable to the local Chinese population because of the ‘acculturation effect’.14,15 Moreover, as many Chinese people believe that complementary or alternative medicine is effective for the promotion and restoration of health, the association between these forms of therapy and breast cancer is worth further investigation. To the authors' knowledge, local studies examining uptake of breast screening and the factors associated with the likelihood of older women undergoing breast screening have been limited. Kwok and Fong16 conducted a study to examine breast screening practice among 753 Hong Kong Chinese women aged >18 years. They reported that 43.9% of women (n ¼ 488) had ever had a mammogram, and 32.7% of 150 women aged 50e69 years had a mammogram every two years. Women with more positive attitudes towards health checkups were more likely to have had a mammogram. Another study interviewed 1704 women aged 65 years, recruited from the community in Hong Kong.17 Only 13.5% of these women had ever had a mammogram. Even in the subgroup of women who had a first-degree relative with breast cancer, only 25.9% of women had ever had a mammogram. A higher level of education was found to be associated with a higher likelihood of undergoing breast screening, and elderly and widowed women were found to be less likely to have undergone breast screening. This study was limited by the inclusion of older women, and did not provide information about the screening behaviour of women aged 50e64 years. Despite mammography being the most common breast cancer control strategy for older women in many countries with advanced technology,18 local research data are scarce regarding screening uptake and its associated factors among women aged 50 years. Thus, exploring the uptake of mammography and the factors associated with the likelihood that this particular group of women would take part in such screening is of great value. This study examined the screening uptake rate of 1002 Hong Kong Chinese women to identify factors significantly associated with the likelihood of undergoing mammography.
Methods Participants and procedures This study is part of a larger cross-sectional study, conducted in 2007, that aimed to examine knowledge and use of cancer screening tests among 2004 Hong Kong Chinese adults aged 50 years (males ¼ 1002 and females ¼ 1002; response rate ¼ 66.6%). The eligible subjects were Hong Kong Chinese women aged 50 years from domestic households who spoke Cantonese. Anonymous telephone interviews using a structured questionnaire were conducted by trained and experienced staff from the University Centre for Epidemiology and Biostatistics. Telephone numbers were selected at random from up-to-date residential directories covering over 95% of
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households in Hong Kong. The interviews were conducted from 6:30 pm to 10:30 pm to avoid over-representing the nonworking population. In the case of households with more than one eligible member, the person whose birthday was closest to the date of the interview was invited to join the study. At least three attempts were made to contact the household at different times or on various days of the week before ‘noncontact status’ was assigned to a number, to ensure that the survey's results were not biased by high non-contact or nonresponse rates. Eligible respondents were briefed about the study and their verbal consent was sought.
Instrument The cancer screening section of the 2005 cancer module of the National Health Interview Survey was adopted in this study.19 The questionnaire consists of six sections: (1) perceived health status, (2) use of complementary medicine, (3) use of breast screening tests, (4) perceived susceptibility to cancer, (5) family history and (6) demographic data. Section 1 consists of five items to establish participants' perceptions of their health status. The first item asks participants to rate their health as excellent, very good, good, fair or poor. The second item asks whether they have any chronic diseases, and the third item asks whether they have been diagnosed with a serious disease or cancer in the past. The fourth item asks the participant to indicate preventive health measures that they undertake regularly, such as taking exercise, maintaining a healthy diet, visiting a doctor regularly and taking dietary supplements. The last item asks about smoking habits. Section 2 covers the five most common types of complementary therapy used in Chinese society: acupuncture, cupping, Chinese herbal medicine, bone setting and Chinese massage.9 Participants are asked whether or not they have ever used any of these complementary therapies. This section aims to contribute to an understanding of any association between the use of complementary therapies and cancer screening behaviour. Section 3 consists of 20 items to establish the use of breast screening tests. Participants are asked whether they have ever had a mammogram, the frequency of attendance, time since the most recent mammogram, location, source of financing (e.g. health insurance), and the main reason for either attendance or non-attendance. They are also asked about who initiated the screening process, and whether they have ever received an abnormal screening result and any follow-up action required. Section 4 consists of a single item to assess participants' perceptions of their susceptibility to cancer, using a 10-point rating scale (1 ¼ not at all likely and 10 ¼ extremely likely). Section 5 deals with demographic data, which are included because evidence suggests that demographic factors (age, marital status, educational level, income and family history of cancer) are associated with the use of mammography.20e23
Ethical considerations This study was approved by the Survey and Behavioural Ethics Committee of the Chinese University of Hong Kong. Verbal
Table 1 e Demographic characteristics and health status of the respondents (n ¼ 1002). n (%) Demographic characteristics Age (years)a 50e59 60e69 70e79 80 Education level Primary or below Secondary Matriculation or above Full/part-time employment No Yes Monthly household income (HK$) 5 59 (5.9%) Unsure 300 (29.9%) Use of complementary therapies Ever used the following complementary therapies Acupuncture Cupping Chinese herbal medicine Bone setting Chinese massage Use of complementary therapy index 0 (50th percentile) 1e2 (>50the75th percentile) 3 (>75th percentile)
179 118 356 235 159
(17.9%) (11.8%) (35.5%) (23.5%) (15.9%)
462 (46.1%) 268 (26.7%) 272 (27.1%)
Any health professional recommended a mammogram No/unsure 906 (90.4%) Yes 96 (9.6%) Ever had a mammogram No 662 (66.1%) Yes 336 (33.5%) Unsure 4 (0.4%) Among those who had ever had a mammogram (n ¼ 336) Time since the most recent test 6 years 46 Can't remember 21 Ever had an abnormal test result No 310 Yes 25 Unsure 1 Three main reasons for the most recent mammogram 1. Part of a regular medical check-up 247 31 2. Prompted by local signs and symptomsa 3. Physician's recommendation 22 Among those who had never had a mammogram (n ¼ Three main reasons for not having a mammogram 1. Not necessary 2. Believed to be healthy 3. No reason a
multivariable logistic regression model for the outcome are presented using odds ratios (OR) and associated 95% confidence intervals (CI) for the significant factors. All statistical analyses were performed using Statistical Package for the Social Sciences Version 18.0 (SPSS Inc., Chicago, IL, USA). All statistical tests were two-sided and P < 0.05 was considered to indicate statistical significance.
Results In total, 1002 women aged 50 years completed the survey and were included in the study (response rate 67%). The age distribution of the sample was highly comparable to the general population in Hong Kong in 2006 (Table 1).25
Demographic characteristics and health status The demographic characteristics and health status of the respondents are shown in Table 1. The mean age of the respondents was 63.5 (standard deviation 10.6) years and ranged from 50 to 99 years. Approximately half of the respondents had at least a secondary level of education (47%). The majority were unemployed (85%), and married or cohabiting (70%). Thirty-two percent of respondents reported that they had a moderate (HK$10,000e29,999, 1US$z7.8HK$) or high (HK$30,000þ) monthly household income. However, a considerable proportion of respondents (39%) did not know or declined to disclose their household income. Fewer than half of the respondents had a chronic illness (46%), and only 9%
(15.8%) (44.0%) (13.7%) (6.5%) (13.7%) (6.3%) (92.3%) (7.4%) (0.3%) (73.5%) (9.3%) (6.5%)
662) 404 (61.0%) 62 (9.4%) 50 (7.6%)
Have pain, lumps or bleeding.
had ever had cancer or another serious disease. Only 2.2% of the respondents were current smokers, and 22% had a family history of cancer.
Perceived health status, preventive health practices and use of complementary therapies Table 2 shows the respondents' perceived health status and use of complementary therapies. The majority of respondents perceived their health status as fair or poor (62%), and most took exercise (77%) and ate a healthy diet (75%) to maintain their health. Approximately half of the respondents visited a doctor regularly to keep healthy. Only one-quarter of respondents visited a Chinese herbalist regularly and took dietary supplements. The majority (64%) of respondents perceived that they were unlikely to be susceptible to cancer. The reported rates for ever using the five most common complementary therapies in Chinese society26 were small to moderate: acupuncture (18%), cupping (12%), Chinese herbal medicine (36%), bone setting (25%) and Chinese massage or ‘tuina’ (16%).
Breast screening behaviour Thirty-four percent of respondents had ever had a mammogram. The three main reasons for having their most recent mammogram were: (1) as part of a regular medical check-up (74%), (2) prompted by local signs and symptoms (9%) and (3)
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Table 4 e Factors associated with ever having had a mammogram. ORU
P-value
(42.4%) (33.6%) (23.8%) (19.1%)
1 0.69 0.43 0.32
0.025
Available online at www.sciencedirect.com
Public Health journal homepage: www.elsevier.com/puhe
Original Research
Uptake of breast screening and associated factors among Hong Kong women aged ≥50 years: a population-based survey S.S.M. Ho a, K.C. Choi a, C.L. Wong a, C.W.H. Chan a, H.Y.L. Chan a, W.P.Y. Tang a, W.W.T. Lam b, A.T.Y. Shiu a, W.B. Goggins c, W.K.W. So a,* a
Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China Centre for Psycho-oncology Research and Training, School of Public Health, The University of Hong Kong, Sassoon Road, Hong Kong, China c Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, China b
article info
abstract
Article history:
Objective: To examine the uptake of breast screening and its associated factors among Hong
Received 4 June 2013
Kong Chinese women aged 50 years.
Received in revised form
Study design: Cross-sectional population-based survey.
23 May 2014
Methods: A sample of Hong Kong Chinese women was recruited through telephone
Accepted 3 September 2014
random-digit dialling. The survey consisted of six sections: perceived health status, use of
Available online 4 November 2014
complementary medicine, uptake of breast screening, perceived susceptibility to cancer, family history of cancer and demographic data. The factors associated with uptake of
Keywords:
breast screening were analysed using logistic regression analysis.
Mammogram
Results: In total, 1002 women completed the (anonymous) telephone survey. The mean age was
Mammography
63.5 (standard deviation 10.6) years. The uptake rate of breast screening among Hong Kong
Breast cancer
Chinese women aged 50 years was 34%. The primary reasons for undertaking breast
Screening
screening were as part of a regular medical check-up (74%), prompted by local signs and
Uptake
symptoms (11%) and a physician's recommendation (7%). Higher educational level, married or cohabiting, family history of cancer, frequent use of complementary therapies, regular visits to a doctor or Chinese herbalist, and the recommendation of a health professional were all independently and significantly associated with increased odds of having had a mammogram. Conclusions: This study provides community-based evidence of the need for public health policy to promote broader use of mammography services among this target population, with emphasis on the active involvement of health care professionals, through the development and implementation of appropriate evidence-based and resource-sensitive strategies. © 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
* Corresponding author. Rm 731, 7/F, Esther Lee Building, The Nethersole School of Nursing, The Chinese University of Hong Kong, New Territories, Hong Kong, China. Tel.: þ852 3943 1072; fax: þ852 2603 5935. E-mail address: [email protected] (W.K.W. So). http://dx.doi.org/10.1016/j.puhe.2014.09.001 0033-3506/© 2014 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
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Introduction Breast cancer is one of the most common cancers and the leading cause of cancer death worldwide.1 According to the Hong Kong Cancer Registry,2 breast cancer is the most common cancer and the third leading cause of cancer death in the female population. The crude incidence and mortality rates in 2011 were 90.7 and 14.6 per 100,000, respectively. An increasing trend in these figures has been reported (incidence and mortality rates in 2002 were 59.4 and 12.3 per 100,000 women, respectively).2 The majority of these patients (62.8%) were aged 50 years. Death due to breast cancer can be prevented by early detection, and screening with mammography helps to identify abnormal changes in tissues or the presence of early-stage cancer.3 The evidence shows that earlier diagnosis allows more treatment options, thus leading to improved survival rates. One meta-analysis estimated that a 23% reduction in breast cancer mortality occurs 10e15 years after the introduction of mammography.4 Several major organizations have recommended that women aged between 50 and 69 years should have a mammogram every 1e2 years.3,5 Although routine mammography for breast cancer is not yet recommended in Hong Kong,6 people can receive secondary cancer preventive services in both the public and private health sectors. In the public sector, there are two options: general outpatient clinics (GOPC) and women's health centres, both of which provide low-cost government-subsidized services and are accessible concurrently. GOPCs are operated by Hong Kong Hospital Authority, and people usually attend clinics for medical consultation.7 The service fee is HK$45 (US$6 or £3.50) per attendance. When cancer is suspected, the physician will refer the case to a specialist outpatient clinic for further investigation and appropriate treatment. The Department of Health operates the women's health centres, which provide various services to promote the health of women at various stages of life once they enrol.8 The annual enrolment fee is HK$310 (US$40 or £24), and breast screening costs HK$ 225 (US$29 or £17) per episode.8 In the private sector, secondary cancer preventive services can be obtained from general practitioners or specialists in private practice. Fees are normally higher, and vary in accordance with the reputation of the general practitioner or specialist. The Health Belief Model (HBM) is a theoretical model commonly used to guide health behaviour, including cancer prevention.9,10 According to the HBM, people who believe that a course of action will produce better outcomes or overcome perceived barriers are more likely to take part in healthseeking behaviour.11 Thus, identifying both facilitators and barriers may help health care professionals to target a specific group of people and increase their awareness of breast screening. Numerous studies have been conducted to identify factors that may affect people's participation in breast screening. However, only a limited number of studies have been performed in Chinese populations living abroad.12,13 Perception of breast cancer risk, perceived need for screening, perceived health status, health insurance, reminders from health care professionals, age, level of education and language ability had
a significant effect on uptake rates.12,13 While the findings of these studies can provide useful information about factors that may affect health-seeking behaviour among Chinese women, study results in populations living abroad may not be applicable to the local Chinese population because of the ‘acculturation effect’.14,15 Moreover, as many Chinese people believe that complementary or alternative medicine is effective for the promotion and restoration of health, the association between these forms of therapy and breast cancer is worth further investigation. To the authors' knowledge, local studies examining uptake of breast screening and the factors associated with the likelihood of older women undergoing breast screening have been limited. Kwok and Fong16 conducted a study to examine breast screening practice among 753 Hong Kong Chinese women aged >18 years. They reported that 43.9% of women (n ¼ 488) had ever had a mammogram, and 32.7% of 150 women aged 50e69 years had a mammogram every two years. Women with more positive attitudes towards health checkups were more likely to have had a mammogram. Another study interviewed 1704 women aged 65 years, recruited from the community in Hong Kong.17 Only 13.5% of these women had ever had a mammogram. Even in the subgroup of women who had a first-degree relative with breast cancer, only 25.9% of women had ever had a mammogram. A higher level of education was found to be associated with a higher likelihood of undergoing breast screening, and elderly and widowed women were found to be less likely to have undergone breast screening. This study was limited by the inclusion of older women, and did not provide information about the screening behaviour of women aged 50e64 years. Despite mammography being the most common breast cancer control strategy for older women in many countries with advanced technology,18 local research data are scarce regarding screening uptake and its associated factors among women aged 50 years. Thus, exploring the uptake of mammography and the factors associated with the likelihood that this particular group of women would take part in such screening is of great value. This study examined the screening uptake rate of 1002 Hong Kong Chinese women to identify factors significantly associated with the likelihood of undergoing mammography.
Methods Participants and procedures This study is part of a larger cross-sectional study, conducted in 2007, that aimed to examine knowledge and use of cancer screening tests among 2004 Hong Kong Chinese adults aged 50 years (males ¼ 1002 and females ¼ 1002; response rate ¼ 66.6%). The eligible subjects were Hong Kong Chinese women aged 50 years from domestic households who spoke Cantonese. Anonymous telephone interviews using a structured questionnaire were conducted by trained and experienced staff from the University Centre for Epidemiology and Biostatistics. Telephone numbers were selected at random from up-to-date residential directories covering over 95% of
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households in Hong Kong. The interviews were conducted from 6:30 pm to 10:30 pm to avoid over-representing the nonworking population. In the case of households with more than one eligible member, the person whose birthday was closest to the date of the interview was invited to join the study. At least three attempts were made to contact the household at different times or on various days of the week before ‘noncontact status’ was assigned to a number, to ensure that the survey's results were not biased by high non-contact or nonresponse rates. Eligible respondents were briefed about the study and their verbal consent was sought.
Instrument The cancer screening section of the 2005 cancer module of the National Health Interview Survey was adopted in this study.19 The questionnaire consists of six sections: (1) perceived health status, (2) use of complementary medicine, (3) use of breast screening tests, (4) perceived susceptibility to cancer, (5) family history and (6) demographic data. Section 1 consists of five items to establish participants' perceptions of their health status. The first item asks participants to rate their health as excellent, very good, good, fair or poor. The second item asks whether they have any chronic diseases, and the third item asks whether they have been diagnosed with a serious disease or cancer in the past. The fourth item asks the participant to indicate preventive health measures that they undertake regularly, such as taking exercise, maintaining a healthy diet, visiting a doctor regularly and taking dietary supplements. The last item asks about smoking habits. Section 2 covers the five most common types of complementary therapy used in Chinese society: acupuncture, cupping, Chinese herbal medicine, bone setting and Chinese massage.9 Participants are asked whether or not they have ever used any of these complementary therapies. This section aims to contribute to an understanding of any association between the use of complementary therapies and cancer screening behaviour. Section 3 consists of 20 items to establish the use of breast screening tests. Participants are asked whether they have ever had a mammogram, the frequency of attendance, time since the most recent mammogram, location, source of financing (e.g. health insurance), and the main reason for either attendance or non-attendance. They are also asked about who initiated the screening process, and whether they have ever received an abnormal screening result and any follow-up action required. Section 4 consists of a single item to assess participants' perceptions of their susceptibility to cancer, using a 10-point rating scale (1 ¼ not at all likely and 10 ¼ extremely likely). Section 5 deals with demographic data, which are included because evidence suggests that demographic factors (age, marital status, educational level, income and family history of cancer) are associated with the use of mammography.20e23
Ethical considerations This study was approved by the Survey and Behavioural Ethics Committee of the Chinese University of Hong Kong. Verbal
Table 1 e Demographic characteristics and health status of the respondents (n ¼ 1002). n (%) Demographic characteristics Age (years)a 50e59 60e69 70e79 80 Education level Primary or below Secondary Matriculation or above Full/part-time employment No Yes Monthly household income (HK$) 5 59 (5.9%) Unsure 300 (29.9%) Use of complementary therapies Ever used the following complementary therapies Acupuncture Cupping Chinese herbal medicine Bone setting Chinese massage Use of complementary therapy index 0 (50th percentile) 1e2 (>50the75th percentile) 3 (>75th percentile)
179 118 356 235 159
(17.9%) (11.8%) (35.5%) (23.5%) (15.9%)
462 (46.1%) 268 (26.7%) 272 (27.1%)
Any health professional recommended a mammogram No/unsure 906 (90.4%) Yes 96 (9.6%) Ever had a mammogram No 662 (66.1%) Yes 336 (33.5%) Unsure 4 (0.4%) Among those who had ever had a mammogram (n ¼ 336) Time since the most recent test 6 years 46 Can't remember 21 Ever had an abnormal test result No 310 Yes 25 Unsure 1 Three main reasons for the most recent mammogram 1. Part of a regular medical check-up 247 31 2. Prompted by local signs and symptomsa 3. Physician's recommendation 22 Among those who had never had a mammogram (n ¼ Three main reasons for not having a mammogram 1. Not necessary 2. Believed to be healthy 3. No reason a
multivariable logistic regression model for the outcome are presented using odds ratios (OR) and associated 95% confidence intervals (CI) for the significant factors. All statistical analyses were performed using Statistical Package for the Social Sciences Version 18.0 (SPSS Inc., Chicago, IL, USA). All statistical tests were two-sided and P < 0.05 was considered to indicate statistical significance.
Results In total, 1002 women aged 50 years completed the survey and were included in the study (response rate 67%). The age distribution of the sample was highly comparable to the general population in Hong Kong in 2006 (Table 1).25
Demographic characteristics and health status The demographic characteristics and health status of the respondents are shown in Table 1. The mean age of the respondents was 63.5 (standard deviation 10.6) years and ranged from 50 to 99 years. Approximately half of the respondents had at least a secondary level of education (47%). The majority were unemployed (85%), and married or cohabiting (70%). Thirty-two percent of respondents reported that they had a moderate (HK$10,000e29,999, 1US$z7.8HK$) or high (HK$30,000þ) monthly household income. However, a considerable proportion of respondents (39%) did not know or declined to disclose their household income. Fewer than half of the respondents had a chronic illness (46%), and only 9%
(15.8%) (44.0%) (13.7%) (6.5%) (13.7%) (6.3%) (92.3%) (7.4%) (0.3%) (73.5%) (9.3%) (6.5%)
662) 404 (61.0%) 62 (9.4%) 50 (7.6%)
Have pain, lumps or bleeding.
had ever had cancer or another serious disease. Only 2.2% of the respondents were current smokers, and 22% had a family history of cancer.
Perceived health status, preventive health practices and use of complementary therapies Table 2 shows the respondents' perceived health status and use of complementary therapies. The majority of respondents perceived their health status as fair or poor (62%), and most took exercise (77%) and ate a healthy diet (75%) to maintain their health. Approximately half of the respondents visited a doctor regularly to keep healthy. Only one-quarter of respondents visited a Chinese herbalist regularly and took dietary supplements. The majority (64%) of respondents perceived that they were unlikely to be susceptible to cancer. The reported rates for ever using the five most common complementary therapies in Chinese society26 were small to moderate: acupuncture (18%), cupping (12%), Chinese herbal medicine (36%), bone setting (25%) and Chinese massage or ‘tuina’ (16%).
Breast screening behaviour Thirty-four percent of respondents had ever had a mammogram. The three main reasons for having their most recent mammogram were: (1) as part of a regular medical check-up (74%), (2) prompted by local signs and symptoms (9%) and (3)
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Table 4 e Factors associated with ever having had a mammogram. ORU
P-value
(42.4%) (33.6%) (23.8%) (19.1%)
1 0.69 0.43 0.32
0.025
