Darrah Degnan

Measuring the use of mammography: two methods compared.

Population studies often estimate mammography use using womens self-reports. In one North Carolina county, we compared self-report surveys with a second method--counting mammograms per population--for 1987 and 1989. Estimates from self-reports (35% in 1987, 55% in 1989) were considerably higher than those from mammogram counts (20% in 1987, 36% in 1989). We then confirmed 66% of self-reports in the past year. Self-reported use is more accurate regarding whether a woman has had a mammogram than when she had it, but self-reports accurately measure change over time.

Mammography and age: are we targeting the wrong women? A community survey of women and physicians.

To determine mammography use among women with a broad range of ages, the authors surveyed women aged 30 to 74 years and physicians practicing primary care in two eastern North Carolina counties. Twenty‐five percent of women in their 30s had ever had a mammogram, and 34% intended to have one in the coming year. From 45% to 52% of women in their 40s, 50s, and 60s had ever had a mammogram, and 55% to 57% intended to have one in the next year. Thirty‐seven percent of women aged 70 to 74 years had ever had a mammogram, and 40% intended to have one in the following year. Nineteen percent of physicians reported screening nearly all women aged 30 to 39 years, and 14% screened few women aged 50 to 74 years. Younger women were more worried about breast cancer than older women and assessed their risk as higher, attitudes that were generally associated with higher mammography utilization. These community surveys suggest that mammography use may be excessive among younger women; older women continue to be underscreened.

How best to teach women breast self-examination. A randomized controlled trial

OBJECTIVE To compare three methods for teaching breast self-examination. DESIGN Randomized controlled trial with factorial design. SETTING A general medicine group practice in a university hospital. PATIENTS Continuing-care patients from 40 to 68 years of age. Of 456 eligible women, 156 refused participation, 300 were randomly assigned, 269 completed assigned interventions, and 260 completed the post-test 1 year later. INTERVENTIONS One third of patients received nurse instruction stressing tactile skills (Mammacare group) (Mammatech Corporation, Gainesville, Florida); one third, traditional nurse instruction emphasizing technique (traditional group); and one third, no nurse instruction (control group). Half of each group received physician encouragement. MEASUREMENTS AND MAIN RESULTS One year later, women in the Mammacare group found more lumps (mean, 57%; 95% CI, 54% to 60%) in manufactured breast models than did those in the traditional (mean, 47%; CI, 44% to 51%) and control (mean, 45%; CI, 42% to 48%) groups. Lump detection specificity was unaffected. Self-reported examination frequency rose in all groups, to 5.1 times per 6 months in the traditional group, 4.2 in the Mammacare group, and 3.9 in the control group. Physician encouragement did not improve sensitivity, specificity, or overall frequency. Women in the Mammacare group used more of seven examination techniques (4.9) than did those in the traditional (3.9) or control (3.2) groups (P less than 0.001). No group increased health care use or reported more overall worry about breast cancer. CONCLUSIONS Mammacare instruction resulted in more long-term improved lump detection and examination technique use than did traditional instruction or physician encouragement. Breast self-examination instruction should emphasize lump detection skills.

Comparison of respiratory symptoms among community residents near waste disposal incinerators

A previous survey found that residents near a hazardous waste incinerator reported more respiratory symptoms than residents of a nearby community. To explore the possibility that these findings might have been due to the use of a rural control site, far removed from urban pollution, we expanded the analysis to include reports of respiratory symptoms from residents of six additional communities. Residents of each of four study communities were exposed to the plumes of biomedical, municipal or hazardous waste combustors. For each study community, a comparison community was surveyed that was distant from major point sources of air pollution. Over 4200 respondents were queried by telephone about respiratory symptoms, smoking and other risk factors such as chemical exposures in the workplace and home, and provided a subjective assessment of air quality in their neighborhoods. Differences in symptom prevalence between each study community and its respective control community, as well as a combined control group, were explored, controlling for factors other than community exposure that may affect respiratory health. Results indicate a higher prevalence of all self-reported respiratory symptoms in one community near a hazardous waste incinerator compared with its control community. While this relationship persisted after controlling for perceived air quality and when compared with a combined control group, only respiratory symptoms of long duration remained significant. These results suggest that further examination of the respiratory health of residents living near this waste combustor source is warranted.