Journal of Preventive Medicine and Public Health

Original Articles

Factors Affecting Breast Self-examination Behavior Among Female Healthcare Workers in Iran: The Role of Social Support Theory: saeed bashirian, Majid Barati, Leila Moaddab Shoar, Younes Mohammadi, Mitra Dogonchi; J Prev Med Public Health. 2019;52(4):224-233. Published online June 26, 2019; DOI: https://doi.org/10.3961/jpmph.18.277

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Objectives
In women, breast cancer is the most common cancer and the leading cause of cancer death. Screening tests are the basis for early diagnosis. In Iranian women, the mortality rate of breast cancer is high due to insufficient screening examinations and delayed visits for care. Therefore, this study aimed to determine the factors affecting breast self-examinations among Iranian women employed in medical careers.
Methods
This cross-sectional study included 501 women working in the medical professions at Hamadan University of Medical Sciences in western Iran in 2018. The subjects were selected by stratified random sampling. Data were collected using a researcher-developed, self-report questionnaire that contained demographic information and questions based on protection motivation theory and social support theory. Descriptive data analysis was conducted using SPSS version 23 and model fitting with PLS version 2.
Results
The mean age of the participants was 37.1±8.3 years, and most of the women (80.4%) were married. Most women had a bachelor’s degree (67.5%). The findings of this study showed that the coping appraisal construct was a predictor of protection motivation (β=0.380, p<0.05), and protection motivation (β=0.604, p<0.05) was a predictor of breast self-examination behavior. Additionally, social support theory (β=0.202, p<0.05) had a significant positive effect on breast self-examination behavior.
Conclusions
The frequency of practicing self-examinations among women employees in the medical sector was low; considering the influence of social support as a factor promoting screening, it is necessary to pay attention to influential people in women’s lives when designing educational interventions.

Summary

Citations

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Risk Reduction of Breast Cancer by Childbirth, Breastfeeding, and Their Interaction in Korean Women: Heterogeneous Effects Across Menopausal Status, Hormone Receptor Status, and Pathological Subtypes: Seok Hun Jeong, Yoon Suk An, Ji-Yeob Choi, Boyoung Park, Daehee Kang, Min Hyuk Lee, Wonshik Han, Dong Young Noh, Keun-Young Yoo, Sue K. Park; J Prev Med Public Health. 2017;50(6):401-410. Published online November 10, 2017; DOI: https://doi.org/10.3961/jpmph.17.152

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Abstract PDF Supplementary Material

Objectives
The purpose of this study was to examine the associations of childbirth, breastfeeding, and their interaction with breast cancer (BC) risk reduction, and to evaluate the heterogeneity in the BC risk reduction effects of these factors by menopause, hormone receptor (HR) status, and pathological subtype.
Methods
BC patients aged 40+ from the Korean Breast Cancer Registry in 2004-2012 and controls from the Health Examinee cohort participants were included in this study after 1:1 matching (12 889 pairs) by age and enrollment year. BC risk according to childbirth, breast-feeding, and their interaction was calculated in logistic regression models using odds ratios (ORs) and 95% confidence intervals (CIs).
Results
BC risk decreased with childbirth (3+ childbirths relative to 1 childbirth: OR, 0.66; 95% CI, 0.56 to 0.78 and OR, 0.80; 95% CI, 0.68 to 0.95 in postmenopausal and premenopausal women, respectively); and the degree of risk reduction by the number of children was heterogeneous according to menopausal status (p-heterogeneity=0.04), HR status (p-heterogeneity<0.001), and pathological subtype (p-heterogeneity<0.001); whereas breastfeeding for 1-12 months showed a heterogeneous association with BC risk according to menopausal status, with risk reduction only in premenopausal women (p-heterogeneity<0.05). The combination of 2 more childbirths and breastfeeding for ≥13 months had a much stronger BC risk reduction of 49% (OR, 0.51; 95% CI, 0.45 to 0.58).
Conclusions
This study suggests that the combination of longer breastfeeding and more childbirths reduces BC risk more strongly, and that women who experience both 2 or more childbirths and breastfeed for ≥13 months can reduce their BC risk by about 50%.

Summary

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English Abstracts

Association Between Socioeconomic Status and All-Cause Mortality After Breast Cancer Surgery: Nationwide Retrospective Cohort Study.: Mi Jin Park, Woojin Chung, Sunmi Lee, Jong Hyock Park, Hoo Sun Chang; J Prev Med Public Health. 2010;43(4):330-340.; DOI: https://doi.org/10.3961/jpmph.2010.43.4.330

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Abstract PDF

OBJECTIVES
This study aims to evaluate and explain the socioeconomic inequalities of all-cause mortality after breast cancer surgery in South Korea. METHODS: This population based study included all 8868 females who underwent radical mastectomy for breast cancer between January 2002 and June 2003. Follow-up for mortality continued from January 2002 to June 2006. The patients were divided into 4 socioeconomic classes according to their socioeconomic status as defined by the National Health Insurance contribution rate. The relationship between socioeconomic status and all-cause mortality after breast cancer surgery was assessed using the Cox proportional hazards model with adjusting for age, the Charlson's index score, emergency hospitalization, the type of hospital and the hospital ownership. RESULTS: Those in the lowest socioeconomic status group had a significantly higher hazard ratio of 2.09 (95% CI =1.50 - 2.91) compared with those in the highest socioeconomic group after controlling for all the identifiable confounding variables. For all-cause mortality after radical mastectomy, all the other income groups showed significantly higher 3-year mortality rates than did the highest income group. CONCLUSIONS: The socioeconomic status of breast cancer patients should be considered as an independent prognostic factor that affects all-cause mortality after radical mastectomy, and this is possibly due to a delayed diagnosis, limited access or minimal treatment leading to higher mortality. This study may provide tangible support to intensify surveillance and treatment for breast cancer among low socioeconomic class women.

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The Factors Associated with Changes in the Stage of Breast Cancer Screening Behavior among the Woman who are Eligible for the Korean National Cancer Screening Program.: Hyo Kyung Son, Sin Kam, Ki Soo Park, Jang Rak Kim, Rock Bum Kim, Sun Kyun Park; J Prev Med Public Health. 2009;42(2):109-116.; DOI: https://doi.org/10.3961/jpmph.2009.42.2.109

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Abstract PDF

OBJECTIVES
This study was performed to evaluate the relationships between psychosocial characteristics and changes in the stage of breast cancer screening behavior. METHODS: The 474 study subjects were randomly sampled from 21,459 women (age range, 40-70 years) who were eligible for the Korean National Cancer Screening Program in 2006 in Jinju, Gyeongsangnam-do. The information, including behaviors and sociodemographic characteristics, attitudes, subjective norms and self-efficacy, was collected by trained interviewers via home visits. The breast cancer screening stages were grouped as precontemplation, contemplation, action, maintenance and relapse, according to Rakowski. RESULTS: Of the 474 women, 18.8% were in the precontemplation stage, 23.3% were in the contemplation stage, 13.1% were in the action stage, 36.6% were in the maintenance stage, and 8.2% were in the relapse stage. The distribution of stages was associated with attitude, subjective norms and self-efficacy (p for trend<0.01). To investigate the overall relationship between the variables, we conducted a linear structural equation model analysis based on the theory of planned behavior. The subjective norms and self-efficacy influenced the stage of the women's screening behavior. CONCLUSIONS: We should target on self-efficacy about the screening behavior of women by performing timely, thoughtful interventions. The support from family members, friends and other people is crucial for women to undergo breast cancer screening and to improve the breast cancer screening rate.

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Original Article

Socioeconomic Disparities in Breast Cancer Screening among US Women: Trends from 2000 to 2005.: Jaeyoung Kim, Soong Nang Jang; J Prev Med Public Health. 2008;41(3):186-194.; DOI: https://doi.org/10.3961/jpmph.2008.41.3.186

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Abstract PDF

OBJECTIVES
This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS: Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS: Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS: These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. ontinued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.

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English Abstract

Ten Year Trend of Cancer Incidence in Seoul, Korea: 1993-2002.: Myung Hee Shin, Hyun Kyung Oh, Yoon Ok Ahn; J Prev Med Public Health. 2008;41(2):92-99.; DOI: https://doi.org/10.3961/jpmph.2008.41.2.92

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Abstract PDF

OBJECTIVES
Effective cancer prevention and control measures can only be done when dependable data on the cancer incidence is available. The Seoul Cancer Registry (SCR) was founded to provide valid, comparable and representative cancer incidence data for Koreans. We aimed to compare the cancer incidence in the first (1993-1997) and second term (1998-2002) of the SCR, and we analyzed the annual incidence trend during that 10 years. METHODS: The SCR detects potential cancer cases through the Korean Central Cancer Registry (KCCR) data, the health insurance claims, the individual hospital's discharge records and the death certificates. About 87% of the SCR data is registered through the KCCR. The rest of the data is registered by SCR registrars who visit about 70~80 mid-sized hospitals in Seoul to review and abstract the medical records of the potential cancer patients. RESULTS: The total number of new cancer cases was higher in 1998~2002 than in 1993~1997 by 20.6% for men and 18.4% for women, respectively. The age-standardized rate (ASR) of total cancer per 100,000 increased 1% (from 295.4 to 298.3) for men and 5.1% (from 181.5 to 190.7) for women, between the two periods. The commonest cancer sites during 1998-2002 for men were stomach, liver, bronchus/lung, colorectum, bladder and prostate, and the commonest cancer sites for women were breast, stomach, colorectum, cervix uteri, thyroid and bronchus/lung. Compared with the ASRs in 1993, the ASRs in 2002 increased for colorectum (58.4% for men, 27.1% for women), prostate (81.5%), breast (58.3% for women), thyroid (141% for women), and bronchus/lung (15.4% for women). The ASRs for stomach (-18.7% for men, -20.7% for women) and uterine cervix cancer (-39.7%) had decreased. CONCLUSIONS: The cancer incidence is increasing in Seoul, Korea, especially for the colorectum and prostate for men, and for the breast, colorectum, bronchus/lung and thyroid for women.

Summary

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Original Articles

Analysis of Cancer Screening Recommendations by Physicians for Various Types of Cancer.: Yong Mun Park, Won Chul Lee, Keun Sang Yum, Jung Wan Koo, Hyeon Woo Yim, Kang Sook Lee, Hoon Kyo Kim; Korean J Prev Med. 2000;33(1):99-108.

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Abstract PDF: OBJECTIVES
The purpose of this study was to examine the present status of cancer screening recommendations(beginning age, interval, recommended screening methods, etc.) by physicians and analyze the association between physician's characteristics and the content of their recommendations. METHODS: Data were collected from March 1 to April 30 of 1997, and 373 physicians who were from different hospital settings all over Korea were interviewed by telephone about their screening recommendations for stomach, cervical and breast cancer for those who provided cancer screening services. RESULTS: For stomach cancer screening, respondents recommended that cancer screening begin at 40 years of age(57.8%), with a 1 year interval(77.2%), and by gastrofibroscopy (86.2%). For cervical cancer screening, respondents recommended that cancer screening begin at 25 years of age(42.0%), with a 1 year interval(67.8%), and by using a Pap smear(100.0%). For breast cancer screening, respondents recommended that cancer screening begin at 35 years of age(38.7%), with a 1 year interval(57.3%), and by mammography (97.3%). CONCLUSIONS: To establish appropriate cancer screening recommendations for Korea, it may be useful to consider the above results concerning medical care providers.; Summary

The Knowledge and Practice of the Breast Self-examination in Women who got health check up.: Soo Jin Jeong, Soon Seok Choi, Jun Han Park, Sang Hwa Urm, Kui Won Jeong, Chae Un Lee, Ki Taek Pae; Korean J Prev Med. 1998;31(4):740-750.

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Abstract PDF: The methods for the early diagnoses of breast cancer are mammography, physical examination, breast self-examination(BSE). This study was conducted to investigate the knowledge and practice of BSE by structured questionnaire which included questions on general characteristics, performance of mammography, physical examination of breast, knowledge and practice of BSE. The subjects in this study were 412 females between 20 and 69 years old who visit to the Health Care Center of College of medicine of Inje University from December 1997 to February 1998. The results were as follows: 1. Women who have gotten the regular mammography are 8.19% of these subjects and women who have gotten the regular physical examination by doctors are 4.19% of these subjects. 2. Regarding BSE, 77.4% of these subjects said that they knew BSE and 3.88% of these subjects said that they practiced BSE regularly. It was that women who knew BSE were more younger, better-educated and higher economic status(p=0.001) and lived a normal life with her husband(p=0.033). And women who practiced BSE regularly were more younger, and married(p=0.001). 3. The most common barrier to doing BSE is 'Do not see the needs/Worry unnecessarily', and the most common reasons for doing BSE is 'Early detection'. 4. The overall frequency and percentage distribution of recommended BSE step in Korea is lower than U.S.A.; Summary

A Case-control Study for Assessment of Risk Factors of Breast Cancer by the p53 Mutation .: Heon Kim, Se Hyun Ahn, Moo Song Lee; Korean J Prev Med. 1998;31(1):15-26.

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Abstract PDF: p53 is the most frequently mutated gene in female breast cancer tissues and the prognosis of breast cancer could be changed by mutation of the gene. This study was performed to examine risk factors for breast cancer subtypes classified by p53 mutation and to investigate the roles of p53 gene mutation in carcinogenesis of breast cancer. The study subjects were 81 breast cancer patients and 121 controls who were matched to cases 1:1 or 1:2 by age, residence, education level and menopausal status. All the subjects were interviewed by a well-trained nurse with standardized questionnaire on reproductive factors, and were asked to fill the self-administrative food frequency and 24 hour recall questionnaires. p53 gene mutation in the cancer tissue was screened using polymerase chain reaction (PCR)-single strand conformational polymorphism (SSCP) method. Mutation type was identified by direct sequencing of the exon of which mobility shift was observed in SSCP analysis. Mutations were detected in p53 gene of 25 breast cancer tissues. By direct sequencing, base substitutions were found in 20 cancer tissues (10 transition and 10 transversion), and frame shift mutations in 5 (4 insertions and 1 deletion). For the whole cases and controls, risk of breast cancer incidence decreased when the parity increased, and increased when intake amount of total calory, fat, or protein increased. Fat and protein were statistically significant risk factors for breast cancer with p53 mutation. For breast cancer without p53 mutation, protein intake was the only significant dietary factor. These results suggests that causes of p53 positive breast cancer would be different from those of p53 negative cancer, and that dietary factors or related hormonal factors induce mutation of p53, which may be the first step of breast cancer development or a promoter following some unidentified genetic mutations.; Summary

English Abstract

A Study on Scheduling Periodic Examinations for the Early Detection of Breast Cancer in Korea.: Seong Hwa Jeong, Dae Ryong Kang, Nam Wook Hur, Jinheum Kim, Soon Young Lee, Sang Hyuk Jung, Chung Mo Nam; J Prev Med Public Health. 2006;39(4):346-352.

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Abstract PDF: OBJECTIVES
The purposes of this study were to propose a screening schedule for the early detection of breast cancer among Korean women, as based on the statistical model, and to compare the efficacy of the proposed screening schedule with the current recommendations. METHODS: The development of the screening schedule for breast cancer closely followed the work of Lee and Zelen (1998). We calculated the age-specific breast cancer incidence rate from the Korea Central Cancer Registry (2003), and then we estimated the scheduling of periodic examinations for the early detection of breast cancer, using mammography, and based on the threshold method. The efficacy of the derived screening schedule was evaluated by the schedule sensitivity. RESULTS: For estimating the screening schedule threshold method, we set the threshold value as the probability of being in the preclinical stage at age 35, the sensitivity of mammography as 0.9 and the mean sojourn time in the preclinical stage as 4 years. This method generated 14 examinations within the age interval [40, 69] of 40.0, 41.3, 42.7, 44.1, 45.4, 46.7, 48.0, 49.3, 51.0, 53.2, 55.3, 57.1, 59.0 and 63.6 years, and the schedule sensitivity was 75.4%. The proposed screening schedule detected 85.2% (74.5/87.4) of the cases that could have been detected by annual screening, but it required only about 48.7% (14.0/30.0) of the total number of examinations. We also examined the threshold screening schedules for a range of sensitivities of mammography and the mean sojourn time in the preclinical stage. CONCLUSIONS: The proposed screening schedule for breast cancer with using the threshold method will be helpful to provide guidelines for a public health program for choosing an effective screening schedule for breast cancer among Korean women.; Summary

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