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American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen “There’s Something.

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Presentation on theme: "American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen “There’s Something."— Presentation transcript:

1 American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen “There’s Something Happening Here…” A Comparative Analysis of Recent Inquiries Concerning Attitudes towards Breast Cancer Screenings by Roger E. Dahl Awareness Sub-Committee Raise the Rates Work Group Iowa Cancer Consortium

2 Background Over the past 18 months, independent inquiries were conducted by two separate local entities to better understand attitudes towards breast cancer screening and mammography Both inquiries produced findings that were quite similar and may be useful in creating methods and approaches that will improve the rate of breast cancer screenings in our state. American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

3 Investigators American Cancer Society/Iowa Cancer Consortium (ACS/ICC) Susan G. Komen for the Cure, Iowa Affiliate (Komen) American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

4 Project Titles ACS/ICC – Mammotives Interactive Social Media Campaign Komen – Qualitative Analysis; Komen Iowa Community Profile American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

5 Purpose ACS/ICC – To determine why some Iowa women do not access mammograms* Komen – To put certain “barriers” into context in order to understand the propensity to be screened American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

6 Methodologies ACS/ICC – Social media* discussions with Iowa women about screening practices as well as attitudes and beliefs about mammography, conducted in Fall, 2011 with any Iowa woman over the age of 40 welcome to participate Komen – 24 in-depth (focus group) interviews conducted in Spring, 2012 with women aged in three Iowa counties (2 rural, one urban). – Half had undergone mammography within the last two years – Half had never undergone mammography American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

7 Findings ACS/ICC – Why Women Get Screened Breast Cancer History Physician Influence Being “Pro-Active” – Barriers to Getting Screened Perceived Harmfulness and Ineffectiveness Fear Screening Guidelines Insurance and Access American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

8 Findings Komen – Three levels of barriers Fundamental – Cost – Time – Approach to Health and Wellness – Visibility in the Community Conscious Decision – Family History – Existing Conditions Conquerable – Discomfort and Anxiety – Reminders American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

9 “…what it is ain’t exactly clear… American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

10 Common Themes Discomfort, Anxiety, Pain, Fear – ACS/ICC Several women admit to having been anxious or afraid of pain before their first mammogram; one woman canceled her appointment twice before her baseline* – One woman with dense breast tissue has adopted a pessimistic view of mammography: “Mammograms seem to be a constant reminder of my sister’s death and my possible fate” – Komen The perceived level of discomfort associated with screenings varied from painful to insignificant** – For women who maintained more privacy, doctor's offices could be uncomfortable and mammograms painful and awkward. » This group included women who had weight issues or were conscious about their body American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

11 Common Themes Perceptions about Radiation – ACS/ICC Two participants report forgoing routine mammograms to avoid “unnecessary” exposure to radiation – Komen Women who took a more holistic approach to health care needs were not comfortable with screenings because they knew their bodies and were concerned about radiation* American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

12 Common Themes Cost – ACS/ICC Two insured women say their insurance companies only cover bi- annual exams Several women encourage their uninsured peers to seek care through Iowa’s Breast and Cervical Cancer Early Detection Program Another participant accessed a mammogram through “Healthy Linn Women” after she lost her insurance, and was subsequently diagnosed with breast cancer – Komen Follow up costs prevented women from seeking options because of ensuing costs associated with false positives and breast cancer treatment American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

13 Common Themes Family History – ACS/ICC Women with a personal or family history of abnormal mammograms or breast cancer are the most fervent supporters of mammography. Participants freely share personal anecdotes and medical histories, often speaking from a position of authority. Participants encourage other women to get routine mammograms; several respondents refer to mammography as a “lifesaver.” – Komen Women who had a family history of breast cancer saw screenings as very important Family history factors carried a significant influence in moving women to screenings They understood that if breast cancer ran in their family, then they were at higher risk for having it as well – They also felt this was a vice-versa rule, meaning that if breast cancer wasn't in their family, they weren't at risk for it – Women who did not have a family history of breast cancer were not as concerned about the disease – It appears that pushing “family history” messaging may have a deteriorating effect of creating over- confidence among women who do not have a history and thus lessen the importance of screening among all women American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

14 Common Themes Health Care Provider Influence/Presence – ACS/ICC Five report having been instructed by a provider to get a mammogram (for both initial screening and rescreening). – Komen In communities where breast health messaging and breast cancer isn’t visible to women outside of a current medical system, the lack of visibility can lead to an “out of sight, out of mind” mentality and stunted the growth of screening behaviors American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

15 Common Themes Geographical barriers – ACS/ICC The geographic accessibility of assistance programs can impact women’s decisions to get screened – Komen A handful of non-screened women missed their annual screenings because they forgot – In rural areas, it was common to hear women say they weren't reminded to get their mammogram – Urban women reported being reminded about annual mammograms when their insurance company and hospital sent mail reminders » Rural hospitals did not have these types of reminder programs in place* American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

16 Common Themes Personal Involvement in Health Management – ACS/ICC Women value autonomy in health-care decision-making Several women cite getting mammograms as a way to be “proactive about their health” – For some participants, “being proactive” is synonymous with making the decision to take aggressive, preventive measures, such as getting a mammogram as early as possible, and undergoing mastectomy after receiving an abnormal mammogram and biopsy – For other participants, “being proactive” means questioning conventional medical authority, expressed by eschewing mammography in favor of breast self-exams* – Komen Reactionary approach Women with existing health conditions were not likely to be proactive in their own breast health and wellness management Reactive women were not the type who would engage in preventative health care such as annual screenings – It was common for them to wait for health problems before choosing to address them – These women placed less importance on staying healthy

17 Unique Findings Skepticism and Uncertainty – A CS/ICC Screening Guidelines – One participant says that official screening guidelines are “not consistent” because her sister was falsely diagnosed with breast cancer after receiving a mammogram. – Several participants have specific questions about screening guidelines, including: » When daughters of breast cancer patients should start getting mammograms » Whether women undergoing treatment for Multiple Myeloma need annual mammograms » Which screening guidelines, apply to breastfeeding women American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

18 Everybody look - what's going down? American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

19 Thoughts for Future Study and Action Health Care Provider Influence – Findings from both investigators indicate the importance women attach to the recommendations of their health care providers For this reason, ongoing education to health care providers regarding mammography screening guidelines may be helpful in encouraging a higher rate of mammography among state residents – For those women with other severe medical conditions, many are in constant contact with hospitals and reported strong relationships with their primary health care providers This also identifies a potential opportunity to cross-educate individuals in different hospital wings and departments – While hospitals play a critical role in communicating proactive breast health care to women, opportunities to connect these care messages to a larger community through communication channels and opportunities beyond the hospital may be significant in increasing the overall visibility of breast health issues Geographic accessibility and availability of support systems such as reminder programs and mobile mammography could be helpful in making screening services more convenient, especially in rural communities – Annual reminders could have significant impact on addressing screening lapses » Appropriate avenues for reminders include hospitals, clinics and insurance companies American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

20 Thoughts for Future Study and Action Health Care Provider Influence “Improving the frequency and scope of mammography recommendation by primary care providers is the single most important direct contribution the medical community can make toward increasing mammography use.”* – *Factors Associated with Mammography Utilization: A Systematic Quantitative Review of the Literature » Kristin M. Schueler, Philip W. Chu, and Rebecca Smith- Bindman Journal of Women's Health. November 2008, Vol. 17, No. 9: American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

21 Thoughts for Future Study and Action Discomfort, Anxiety, Pain, Fear – ACS/ICC reported that several women replied that their fears about pain and discomfort were unfounded and that getting screened gives them “peace of mind” – Komen found that among both screened and non-screened women, the perceived pain and discomfort of having a mammogram was described as insignificant compared to the physical and emotional pain they would experience if they were to be diagnosed with breast cancer – These findings suggest that ways to leverage peer to peer support, testimonials, and other forms of communications among women who have undergone screenings may alleviate some of these concerns Much more granularity needs to be considered when looking at ways to alleviate discomfort, anxiety, pain and fear American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

22 Thoughts for Future Study and Action Perceptions about Radiation – Information about risks of radiation from mammography may be dealt with via a risk management approach Comparisons and analogies with other, more routine exposures to radiation may help put this risk into perspective in a way that might encourage more regular mammography Models from public and private sector health care agencies may be useful in helping to define a more comforting “risk-reward message” Comparisons could also be drawn between other routine medical procedures and the relative “risk” associated with mammography American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

23 Thoughts for Future Study and Action Family History – Peer influence from women with a personal or family history of breast cancer could be leveraged to encourage more regular and routine mammography As reported by ACS/ICC these women “are the most fervent supporters of mammography” and spoke via Mammotives from a position of authority – Family history messaging should also consider the fact that Komen found confusion about the need for mammography among respondents with no family history of breast cancer American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

24 Thoughts for Future Study and Action Personal Involvement in Health Management – The type of proactive involvement identified by ACS/ICC should be encouraged through peer support that may help women “take aggressive, preventive measures, such as getting a mammogram as early as possible…” and taking an active role during screening to”…make sure the process is thorough.” – There are evident challenges for women when doing self exams Additional education could help improve self exam techniques and restore women’s confidence in their efforts and need to continue preventative care American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

25 Thoughts for Future Study and Action Time – There may be an opportunity to shine light on the time it takes to get a mammogram versus the time that breast cancer can steal from life American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

26 Summary and Conclusions Stratified barriers to screening Women outside of a regular medical care path struggle with fundamental barriers to mammography including costs and an overall approach to health care While women believe that resources exist, these perceptions must be considered within the context of the stratified barriers they face – There is a significant difference between recognizing that resources exist within the community and believing that these resources are accessible to them » Must consider perceptions of services being cost prohibitive, etc. American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

27 Summary and Conclusions Geographical barriers – Geography has a contributing factor but a more encompassing view includes: Woman’s approach to health care – Proactive or reactive – Technical or Traditional Environmental factors – Visibility of health care issues Personal beliefs – Anxieties, Skepticisms, etc Established relationships – With health care providers – With survivors – With family members American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen

28 “…I’VE GOT TO BEWARE…” This presentation is designed to suggest that further investigation regarding these findings may be helpful in increasing the rates of regular mammography screening in Iowa American Cancer Society | Iowa Cancer Consortium | Iowa Department of Public Health Susan G. Komen for the Cure Iowa Affiliate | Telligen


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