Association between cancer screening behavior and family history among Japanese women

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<ul><li><p>aSof Hee, Oki, A</p><p>Health promotive lifestyleJapanese women</p><p>esty.al study was conducted based on baseline data from the Japan Nurses' Health Study</p><p>endometrial cancer particularly among rst-degree relatives was associ- Methods</p><p>Preventive Medicine 56 (2013) 293298</p><p>Contents lists available at SciVerse ScienceDirect</p><p>Preventive</p><p>j ourna l homepage: www.e lsated with an increased risk of developing those cancers (Beral et al.,2001; Colditz et al., 1993; Lucenteforte et al., 2009; Poole et al., 1998).In addition, public health and preventivemedicine have become focusedon the use of family history for breast cancer prevention (Audrain-McGovern et al., 2003; Yoon et al., 2002, 2003). Because a family historyof breast cancer is among the known risk factors of the disease,women atrisk due to their family history should be more motivated to participatein cancer screenings and encouraged to make changes in lifestyle habitsto promote health than thosewithout such a family history. However, lit-tle is known about whether Japanese women with a family history ofcancer utilize cancer screening opportunities, and to what extent having</p><p>Study population</p><p>We conducted a cross-sectional study based on baseline data from theJapan Nurses' Health Study (JNHS). While public awareness of women'shealth has increased, there has been little research documenting the healthstatus and behaviors of Japanese women. The JNHS is the rst large-scalecohort study aiming to acquire epidemiological data which may shed lighton the lifestyle habits, health practices, and health status of Japanese femalenurses and to examine the extent to which these health behaviors differ fromthose found in other countries (Fujita et al., 2007; Hayashi et al., 2007). Thestudy protocol was approved by the institutional review board at Gunmaa family history of cancermay inuence awompurpose of the present study was to examine l</p><p> Corresponding author at: Department of LaboratoHealth Sciences, Graduate School of Health SciencesShowa-machi, Maebashi, Gunma 371-8514, Japan. Fax</p><p>E-mail address: khayashi@health.gunma-u.ac.jp (K.</p><p>0091-7435/$ see front matter 2013 Elsevier Inc. Allhttp://dx.doi.org/10.1016/j.ypmed.2013.01.017amily history of breast orJapanese women.Many studies have reported that having a fIntroductionConclusion. Having a family history of cancer was associated with cancer screening behavior, but not healthpromotive behaviors.</p><p> 2013 Elsevier Inc. All rights reserved.</p><p>screening behavior in relation to their family history of cancer amongbetween women with and without a family history of the relevant cancer.Results. Although there were no differences in lifestyle habits with the exception of smoking status, women</p><p>with a family history of uterine cancer weremore likely to have undergone cervical cancer screenings (pb0.01).Womenwith a family history of breast cancer were alsomore likely to have undergone breast cancer screeningsregardless of their age (pb0.01), but lifestyle behaviors did not differ. Among women with a family history ofuterine cancer, those with a sister history were more likely to have undergone not only cervical (OR, 1.89;95% CIs, 1.392.58), but also breast cancer screenings (OR, 1.54; 95% CIs 1.132.09).Cervical cancer screeningBreast cancer screening</p><p>prefectures in Japan. We compared lifestyle habits and the utilization of cancer screenings (cervical and breast)Family history of cancer collected from June 2001 toMarch 2007. Participantswere 47,347 female nurses aged 3059 years residing in 47Keywords:cer among Japanese women</p><p>Methods. A cross-sectionAssociation between cancer screening behJapanese women</p><p>Hiroko Matsubara a, Kunihiko Hayashi a,, Tomotakaa Department of Laboratory Science and Environmental Health Sciences, Graduate School ob Division of Environmental Medicine and Population Sciences, Graduate School of Medicinc Department of Obstetrics and Gynecology, Hirosaki University School of Medicine, Hirosad Emeritus, Gunma University, Maebashi, Gunma 371-8511, Japan</p><p>a b s t r a c ta r t i c l e i n f o</p><p>Available online 4 February 2013 Objective. To examine lifan's health behaviors. Theifestyle habits and cancer</p><p>ry Science and Environmental, Gunma University, 3-39-15: +81 27 220 8974.Hayashi).</p><p>rights reserved.vior and family history among</p><p>bue b, Hideki Mizunuma c, Shosuke Suzuki d</p><p>alth Sciences, Gunma University, Maebashi, Gunma 371-8514, Japansaka University, Suita, Osaka 565-0871, Japanomori 036-8562, Japan</p><p>le habits and cancer screening behavior in relation to a family history of can-</p><p>Medicine</p><p>ev ie r .com/ locate /ypmedUniversity and the ethics review board at the National Institute of PublicHealth.</p><p>During a 6-year entry period after the inception of the study in 2001, atotal of 49,927 female nurses from all 47 prefectures in Japan completedthe baseline questionnaire. We limited the current analytic data set towomen 30 to 59 years of age because at that time, cervical and breast can-cer screenings in population-based programs targeted women at leastaged 30 years for initial screenings (Hamashima et al., 2010; Hisamichi,2001; MHLW, 2004; Morimoto, 2009). The total of 47,347 female nurses</p></li><li><p>cluded the participants' mothers, sisters, and their maternal and paternalgrandmothers. We dened women with a family history of uterine or breast</p><p>relatives and 2) women with and without a family history of cancer amongrst-degree relativeswere determined by chi-square tests for variables</p><p>294 H. Matsubara et al. / Preventive Medicine 56 (2013) 293298with two categories and by two-sidedWilcoxon's rank sum tests for variableswith more than two levels. Next, odds ratios (OR) and 95% condence inter-vals (CIs) were calculated to estimate the magnitude of the association be-tween cancer screening practice and a family history of cancer for eachfemale relative. In multivariate logistic regression analyses, covariates simul-taneously adjusted for in the model included body mass index (BMI; b18.5,18.5b25, 25b30, or 30 kg/m2), physical activity (active or inactive),breakfast intake (every day, sometimes, or never), smoking status (never,former, or current), alcohol consumption (never, b3 days/week, or 3 days/week), family history of cancer in interest among other family members (yesor no), and age at taking the questionnaire (years). The level of signicancewas set at p=0.05. All analyses were performed using the SAS 9.2.statisticalcancer as those who had any female family members with a previous diag-nosis of each cancer, regardless of the age at which female relatives werediagnosed.</p><p>Participants were asked to provide the total time spent engaging in threelevels of physical activity outside of work. Those who engaged in light or mod-erate activity for 150 min or more per week, or vigorous activity for 60 min ormore per week were considered to be physically active individuals. Theserecommended time estimates were used based on the criteria for reducingthe risk of cancers established by the National Cancer Institute in the UnitedStates (NCI, 2009). Breakfast consumption habits were derived from the follow-ing response options: Never, Once a week, 23 days per week, 45 daysper week, and Daily. The responses were categorized into three groups:Never, Sometimes, and Every day. Smoking history was ascertainedthrough the question: Have you ever smoked more than 20 packs of ciga-rettes? with the following response options: No, Yes: smoked in the past,but quit, and Yes: currently smoke. Responses were coded as: Never, For-mer, and Current smokers. Additionally, the frequency of alcohol consump-tion was categorized into three groups: Non-drinker, Drinker (b3 days perweek), and Drinker (3 days per week).</p><p>Participants were asked to report on the utilization of cervical cancerscreening (Pap smear) and breast cancer screening (mammography or ul-trasound examination), regardless of the screening programs they hadattended, along with a summary question: During the past 5 years, didyou undergo each cancer screening? The responses were coded as binary(yes, no) variables.</p><p>Statistical analysis</p><p>All analyses were conducted without substituting missing values. First,health behavioral characteristics of participants in relation to a family historyof cancer were descriptively summarized using frequencies. The differencesin lifestyle habits and cancer screening behavior between family historygroups1) women with and without a family history of cancer among femaleincluded in the primary analyses comprised 21,350 (45.1%) of the womenaged 3039 years, 17,832 (37.7%) of those aged 4049 years, and 8165(17.2%) of those aged 5059 years. The mean age was 41.37.54 (SD)years, 82.0% were registered nurses, and 68.6% were married.</p><p>To note, when examining the association of uterine cancer family historywith lifestyle habits and cervical cancer screening practice, we excluded 2008women who had reported a previous diagnosis of uterine (endometrial orcervical) cancer and/or a hysterectomy, leaving a total of 45,339 women eli-gible for the analyses. Similarly, after excluding 362 women who had devel-oped breast cancer, we analyzed 46,985 women to estimate the association ofbreast cancer family history with lifestyle habits and breast cancer screeningpractice.</p><p>Measures and assessments</p><p>We obtained information on family histories of cancers, selected life-style habits, and the utilization of cancer screenings from the self-administered questionnaires. The family cancer histories examined in thepresent study included breast and uterine cancers (endometrial or cervicalcancer was not specied), and the family members we inquired about in-software.Results</p><p>Table 1 presents the comparisons of lifestyle habits and cervicalcancer screening behavior between women with and without a fam-ily history of uterine cancer. Among 45,339 women who did not havea diagnosis of uterine (endometrial or cervical) cancer and/or a hys-terectomy, 2681 women had reported having a family history of uter-ine cancer. Although there were no differences between the groupswith regard to physical activity, breakfast intake, and alcohol con-sumption, women without a family history of uterine cancer wereless likely to be current smokers than those with such a family history(17.2% versus 19.0%, pb0.01). Also, women with a family history ofuterine cancer were more likely to have undergone cervical cancerscreenings than those without such a family history (60.6% versus53.6%, pb0.01). In analyses stratied by age group, women in allage groups with a family history of uterine cancer were more likelyto have undergone cervical cancer screenings (52.0% versus 45.3% ofthe women aged 3039 years, pb0.01, 67.0% versus 60.0% of thoseaged 4049 years, pb0.01, and 68.3% versus 63.3% of those aged5059 years, p=0.03). These associations did not differ appreciablywhen we compared women with and without a family history ofuterine cancer among their rst-degree relatives.</p><p>The comparisons of lifestyle habits and breast cancer screeningbehavior between women with and without a family history of breastcancer are presented in Table 2. Among 46,985 women who did nothave a diagnosis of breast cancer, 2217 women had reported havinga family history of breast cancer. Lifestyle behaviors includingsmoking status did not differ between the groups. However, womenwere more likely to have undergone breast cancer screenings if theyhad a family history of the disease (23.0% versus 16.6%, pb0.01).When the data were analyzed using age-stratication, women witha family history of breast cancer were more likely to have undergonebreast cancer screenings regardless of their age (13.8% versus 8.4% ofthe women aged 3039 years, pb0.01, 27.6% versus 21.9% of thoseaged 4049 years, pb0.01, and 35.6% versus 26.9% of those aged5059 years, pb0.01). The results remained unchanged when wecompared women with and without a family history of breast canceramong their rst-degree relatives.</p><p>Table 3 presents the association of cancer screening practice witha family history of uterine cancer for each female relative. Womenwith a family history of uterine cancer were more likely to have un-dergone cervical cancer screenings than those without a family histo-ry of the disease, regardless of a degree of relationship. Of those,women who had sisters with a diagnosis of uterine cancer had thehighest odds of having undergone cervical cancer screenings (OR,1.89; 95% CIs, 1.39 to 2.58). They were also found to have undergonebreast cancer screenings (OR, 1.54; 95% CIs, 1.13 to 2.09).</p><p>Table 4 presents the association of cancer screening practice witha family history of breast cancer. For each family member, womenwith a family history of breast cancer were more likely to have under-gone breast cancer screenings than those without such a family histo-ry. Of those, women with a maternal history had as high odds ofhaving undergone breast cancer screenings as those with a sister his-tory (OR, 1.47; 95% CIs, 1.23 to1.78, OR, 1.43; 95% CIs, 1.13 to 1.80, re-spectively). When stratied by age group, women both aged 3039 years and 4049 years with a sister history were more likely tohave undergone breast cancer screenings than those with a maternalhistory (Table 5). Having a family history of breast cancer was not as-sociated with cervical cancer screening practice.</p><p>Discussion</p><p>Overall, 54.0% (45.7% of the women aged 3039 years, 60.4% ofthose aged 4049 years, and 63.6% of those aged 5059 years) ofJapanese women who participated in the present study had under-</p><p>gone cervical cancer screenings and 16.9% (8.7%, 22.1%, and 27.3%,</p></li><li><p>een</p><p>on</p><p>2,65</p><p>7.7)2.3)</p><p>2.2)6.5).4)</p><p>9.9)1.5)7.2)</p><p>9.3)1.8)2.7)</p><p>3.6)6.4)</p><p>295H. Matsubara et al. / Preventive Medicine 56 (2013) 293298Table 1Association of uterine cancer family history with lifestyle habits and cervical cancer scr</p><p>Family history of uterine cancer am</p><p>Yes (n=2,681) No (n=4</p><p>n (%) n (%)</p><p>Physical activityActive 728 (27.2) 11,802 (2Inactive 1953 (72.8) 30,856 (7</p><p>Breakfast intakeEvery day 1684 (62.8) 26,522 (6Sometimes 426 (15.9) 7058 (1Never 223 (8.3) 3570 (8</p><p>Smoking statusNever 1806 (67.4) 29,799 (6Former 333 (12.4) 4913 (1Current 509 (19.0) 7349 (1</p><p>Alcohol consumptionNon-drinker 789 (29.4) 12,480 (2Drinker (b3 days/week) 1111 (41.4) 17,837 (4Drinker (3 days/week) 638 (23.8) 9686 (2</p><p>Cervical cancer screeningYes 1625 (60.6) 22,870 (5No 1056 (39.4) 19,788 (4respectively) of those had undergone breast cancer screenings. Datafrom a national survey collected in 2004 showed that the rate of can-cer screening, both cervical cancer screening among women aged20 years or older and breast cancer screening among women aged40 years or older was about 20% (NCC, 2012). Thus the rate of breastcancer screening among our participants was at about the same levelas the general population.</p><p>Consistent with the previous studies, Japanese women weremore likely to have undergone cancer screenings if they had a familyhistory of the disease (Antill et al., 2006; Cook et al., 2009; Gierischet al., 2009; Madlensky et al., 2005; Oran et al., 2008)....</p></li></ul>