Rationale and Objectives
The specific aim of the study was to determine which of several cost-effective interventions is best able to improve the breast cancer knowledge of women who present for screening mammography.
Materials and Methods
A total of 198 English-speaking women, with no personal or family history of breast cancer, were recruited and randomized to four groups when they presented to the clinic for a screening mammogram. All women filled in a demographic data form and answered a questionnaire containing nine questions about breast cancer, risk, and screening to assess their knowledge and perception. Three educational interventions were tested in this study. The first consisted of a brochure, which provided answers to the questionnaire items and addressed the issues in more depth. The second intervention was an educational conversation with a specially trained mammography technologist. She reviewed the subject’s answers to the questionnaire items correcting and/or clarifying them. The third intervention consisted of the brochure together with the conversation with a trained technologist. There was also a control group that just filled in the study questionnaire but did not receive an educational intervention. The same questionnaire was administered by telephone 4 to 6 weeks after the screening experience to all study subjects. Changes in their knowledge and perceptions of breast cancer were measured and compared.
Results
A statistically significant increase in knowledge was found in all of the three investigated groups compared to the control group. There were no statistically significant differences in the amount of increase between women who underwent different interventions.
Conclusions
All three interventions resulted in increased knowledge about breast cancer and screening. No differences in the amount of knowledge increase were found between three interventions tested. The educational brochure seems to represent the most convenient and least costly method to increase knowledge about breast cancer and screening among women who present for screening mammography.
Breast cancer is the most common nonskin malignancy among women in the United States and second only to lung cancer as a cause of cancer-related death. In 2005, an estimated 211,240 new cases of invasive and 58,490 cases of in situ breast cancer were diagnosed in American women, while an estimated 40,410 women died of the disease ( ).
Screening mammography has been shown to significantly reduce breast cancer mortality in multiple trials ( ). Despite government and public agency recommendations that women participate in screening mammography on a regular basis, as of 2002 about 38.5% of American women aged 40 years or older have not received a mammogram in the past year ( ) and, as of 2000, about 45% have not received mammography and clinical breast examination ( ).
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Materials and methods
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Results
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Table 1
Participants’ distribution
Group No. of Subjects Intervention A: Control 50 None B: First intervention 50 Brochure C: Second intervention 50 Conversation/clarification D: Third intervention 48 Dual (brochure + conversation/clarification)
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Table 2
Participants’ characteristics
Characteristics Group A Group B Group C Group D_P_ -value Age (y) Mean 58.6 56.1 56.6 54.2 (SD) (9.3) (10.7) (10.7) (11.0) .22 Race White 44 40 40 38 Black 5 9 8 8 Other 1 1 2 2 .88 Education Low 0 3 0 2 Middle 21 15 13 18 High 29 32 37 28 .26 Family history Yes 25 22 19 16 No 25 28 31 32 .36 Recommendation Yes 47 47 42 44 No 3 3 8 4 .30 Previous mammogram Yes 49 47 45 45 No 1 3 5 3 .44
Education: low, less than high school; middle, high school graduate and some college/vocational training; high, college graduate and postgraduate; family history: family history of beast cancer (mother, sister, aunt, daughter); recommendation: told by physician or nurse to undergo routine screening mammogram.
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Table 3
Questionnaire scores and score improvements
Group A (control) Group B (brochure) Group C (clarification) Group D (dual intervention) total 1 (SD) 4.29 (1.26) 4.44 (1.28) 4.46 (1.16) 4.08 (1.25) total 2 (SD) 4.52 (1.19) 5.28 (1.54) 5.27 (1.40) 4.88 (1.43) Change (SD) +0.23 (1.09) +0.84 (1.25) +0.81 (1.17) +0.79 (1.20)
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Table 4
Comparison of four interventions
Comparison_P_ -value B to A (brochure to no intervention) 0.0052 C to A (conversation to no intervention) 0.0074 D to B (dual intervention to brochure) 0.58 D to C (dual intervention to conversation) 0.53
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Discussion
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Conclusion
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