肥胖女性較少完成乳房攝影


【24drs.com】根據女性健康期刊上一項回溯性世代研究結果,肥胖女性比較少完成乳房攝影且較常表示接受檢查是疼痛的。
  
  波蘭奧勒岡凱薩醫療機構健康研究中心的資深研究者Adrianne C. Feldstein醫師表示,這是很重要的發現,即使我們知道乳房攝影可以拯救生命,仍有許多女性不願意接受檢查;我們的研究發現,雖然婦女們有接受健康照護的管道,但她們接受這些重要檢查時仍有障礙,我們必須進一步了解並且協助她們克服這些障礙。
  
  研究人員使用電子病歷資料以及分組調查評估病患特徵,並且報告在一提示計畫後與完成乳房攝影有關的障礙。
  
  受試者分為兩階段接受研究,第一階段,包括標的族群,透過電子病歷評估女性特徵,研究與乳房攝影完成率有關的因子。在第一階段的6,934位女性中,總共有4,708位納入研究分析,這些女性被納入凱薩醫療機構西北健康維持組織中,年齡介於50到69歲間,在20個月前完成上一次乳房攝影(標的日期),並接受一項提醒介入,這項介入包括在完成上一次乳房攝影後20個月寄發「乳房攝影即將到期」的明信片,接著是最多2通的自動語音電話,如果沒有回應的話,還有1通真人電話通知。
  
  研究第二階段包括667位接受郵件調查的女性,其中340位(50.2%)完成調查;主要的試驗終點是標的日期後10個月乳房攝影完成率。
  
  相較於非肥胖女性,肥胖女性比較可能表示乳房攝影過於疼痛(31.3%相較於18.8%;P<0.01);疼痛調控肥胖與乳房攝影完成率之間的關係(間接效應-0.111;P=0.008)。
  
  Feldstein醫師指出,我們並不知道為什麼肥胖女性接受乳房攝影比較容易表示疼痛;過去一項研究顯示肥胖可能與較低的疼痛閾值有關。在我們的研究中,將近一半的女性是肥胖的,而肥胖女性比較可能罹患乳癌,因此我們需要找出更好的方法確保這些女性接受篩檢。
  
  與乳房攝影完成率較低有關的因素,包括肥胖(勝算比[OR]為0.67;P<0.0001),年齡60歲以下(OR為0.69;P<0.0001),健康計畫會員未滿5年(OR為0.81;P=0.019),還有家庭收入每年少於4萬美金(OR為0.77;P=0.018);至於年紀較輕的女性,則比較可能表示她們太忙了(19.1%比上6.4%;P<0.001),以及對乳房攝影的準確性有較多擔憂(5分指標中2.5分比上2.3分;P<0.05)。
  
  這項研究限制包括缺乏其他族群的應用性、個別族群的資料不完整、在闡釋調查族群結果時需要小心、因為樣本數目有限,無法根據種族評估肥胖亞群,以及只有50%患者回應調查,可能有回應誤差。
  
  研究作者們的結論是,即使在有效的提醒系統下,乳房攝影仍然存在著重要的患者障礙。我們的研究發現指出,剩下的患者障礙比較無法以更多提醒以及臨床醫師的介入克服,因此,使用在這方面的資源很可能會浪費掉,具體來說,因為標的族群中,高比例肥胖女性需要接受乳房攝影,了解並找出為什麼肥胖是完成乳房攝影一個顯著障礙,應是研究的首當其要目標。
  
  國家癌症機構贊助這項研究。試驗作者表示沒有相關資金上的往來。期刊文章內容僅代表作者們的立場,不代表國家癌症機構或國家衛生研究院的官方觀點。

Obese Women May Be Less Likely to Complete Mammography

By Laurie Barclay, MD
Medscape Medical News

February 9, 2011 — Obese women may be less likely to complete mammography and more likely to find it painful, according to the results of a retrospective cohort study reported online January 31 in the Journal of Women's Health.

"These are important findings because, even though we know that mammograms can save lives, many women put them off," said lead author Adrianne C. Feldstein, MD, MS, a senior investigator with the Kaiser Permanente Center for Health Research, in Portland, Oregon, in a news release. "Our study found that, even when women have access to health care, there are still barriers to getting this important screening test. We need to do more to understand these barriers and help women overcome them."

Using data from electronic records and a subgroup survey, the investigators assessed patient characteristics and reported barriers for their association with completing mammography after a reminder program. The study cohort was divided into 2 phases.

Phase 1, which consisted of the target group cohort, evaluated characteristics of women through the electronic medical record for their association with mammogram completion rates. Of 6934 women in phase 1, a total of 4708 were analyzed for the study. These women were enrolled in a Kaiser Permanente Northwest health maintenance organization, were aged 50 to 69 years, were 20 months past their last mammogram (index date), and had received a reminder intervention. This intervention consisted of sending a "mammogram due soon" postcard 20 months after the last mammogram, followed by up to 2 automated phone calls and 1 live call for nonresponders.

Phase 2 of the study consisted of a subgroup of 667 women who received a mailed survey, of whom 340 (50.2%) completed it. The primary study endpoint was mammogram completion at 10 months after the index date.

Compared with nonobese women, obese women were more likely to report "too much pain" from mammograms (31.3% vs 18.8%; P < .01). Pain mediated the association between obesity and rates of mammogram completion (indirect effect, ?.111; P = .008).

"We don't know why obese women report more pain with mammograms," said Dr. Feldstein. "One previous study suggests that obesity might be associated with a lower pain threshold. Nearly half of the women in our study were obese and obese women are more likely to get breast cancer, so we need to find better ways to ensure that these women are screened."

Factors linked to lower rates of mammogram completion were obesity (odds ratio [OR], 0.67; P < .0001), age younger than 60 years (OR, 0.69; P < .0001), health plan membership of less than 5 years (OR, 0.81; P = .019), and family income of less than $40,000 per year (OR, 0.77; P = .018). Younger women were more likely to report that they were "too busy" (19.1% vs 6.4%; P < .001) and had greater concerns regarding accuracy of the mammogram (2.5 vs 2.3 on a 5-point scale; P < .05).

Limitations of this study include lack of generalizability to other populations, incomplete data for individual race, need for caution in interpreting the survey group results, inability to assess obesity subgroups by race in either phase of the study because of limited sample size, and possible response bias because only 50% of patients responded to the survey.

"Even in the context of an effective mammogram reminder system, important patient barriers to mammography remain," the study authors conclude. "Our findings indicate that remaining patient barriers are not likely to be overcome through more reminders and interventions with clinicians; therefore, resources spent addressing the problem from this angle are likely to be wasted.... Specifically, given the large percentage of obese women in the target age groups for mammograms, understanding and addressing why obesity appears to be a significant hurdle to mammogram completion should be a research priority."

The National Cancer Institute supported this study. The study authors have disclosed no relevant financial relationships. The content of the journal article is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

J Women's Health. Published January 31, 2011.

    
相關報導
回顧發現:肥胖基因對減重無影響
2016/9/30 下午 04:58:33
兒科醫師提供的肥胖介入方法難以減少BMI
2016/9/26 下午 03:57:35
大麻衍生製劑可能有助於第二型糖尿病
2016/9/21 下午 03:39:06

上一頁
   1   2   3   4   5   6   7   8   9   10  




回上一頁