婦女接受乳房攝影之相關因素調查

Research On Factors Affecting Acceptance of Mammography By Female Patients

廖敏娟(Min-Chuan Liao)

指導教授 ： 楊俊毓

高雄醫學大學/健康科學院/公共衛生學研究所碩士在職專班/碩士(2003年)

摘要

研究目的：瞭解一般門診婦女接受乳房X光攝影檢查之相關因素，如人口學特質、觸發接受檢查之重要因素，及各相關因素與檢查結果間之相關，並瞭解其決定接受檢查至前來檢查之時間間距。
研究方法：研究對象為自92年2月至4月之間於南部某區域教學醫院一般門診接受乳房攝影檢查之個案為研究樣本，並排除自費身體檢查和國民健康局所推動之二階段高危險婦女乳癌篩檢個案。以自行設計之半結構式問卷訪談前來放射科接受乳房X光攝影之個案，個案數共207位，所得資料以SAS統計軟體進行分析。
研究結果：接受乳房攝影的個案與其檢查結果，不會因人口學特質的不同而有差異；平常乳房自我檢查頻率、以前有無做過乳房篩檢、是否曾因乳房疾病就醫都與檢查結果沒有相關。受檢重要因素為乳房自我檢查(或配偶)發現異常者為最多，佔36.7%。單變項分析預測影響乳房自我檢查與否的各項因子，年齡≧50歲乳房自我檢查的機率是<50歲者的0.52倍，教育程度在專科以上者，乳房自我檢查的機率是高中職以下的5.28倍，有職業的是無業者的2.15倍，做過乳癌篩檢是沒做過者的3.86倍，曾因乳房疾病就醫者是不曾因乳房疾病就醫者的4.19倍。多變項分析中，以年齡、教育程度、有無子女、曾做乳癌篩檢等四項因子具統計學上顯著的差異。乳房攝影時間與決定受檢時間間距，由1天至365天不等，平均為74天。所有個案有54.4%在一週內實踐受檢行動，在一個月內者則有76.7%。
討論：研究對象中，個案的人口學特性，與影響受檢的重要因素分佈及決定接受檢查到實際受檢的時間間距，及乳房自我檢查執行率的高低，是否會因個案所處地理位置不同而有城鄉差異，尚待研究。檢查結果與人口學基本資料交叉分析都不具統計學上之顯著性差異，是否代表婦女得乳癌機率與各種人口學特性沒有相關，尚須進一步驗證。
建議：建立40歲以上婦女定期並正確乳房自我檢查機制；對乳房攝影個案，以個案管理方式追蹤有問題者，提高早期乳癌的發現比例，降低乳癌死亡率。
關鍵詞：乳房自我檢查；乳房X光攝影術；乳癌高危險婦女

關鍵字

乳房自我檢查 ； 乳房X光攝影 ； 乳癌高危險婦女

並列摘要

Aims: To study factors that affecting acceptance of the mammogram by female patients of out patient status. These factors include characteristics of the population; causes affecting acceptance of mammogram examination; the co-relation between these factors and the results of examinations. The time lag between the time patients make up their decision and time when they come for examination was also studied.
Patients and Methods: Patients included were all female patients visited the OPD in a hospital, Southern part of Taiwan from February to April of 2003, and accepted mammogram examination. Self-payment patients and patients under the National Health Department program for second stage; high risks breast cancer screening were excluded. There were a total of 207 patients coming to the radiologist department for X-ray of the breast according to our own design semi-structure questionnaire. The collected data were analyzed with SAS.
Results: The number of patients accepting the mammogram examination and its subsequence results were not related to the population characteristic. Factors such as 1) frequency of self-breast examination;2) whether there is or no breast cancer screening before and 3)history of medical consultation due to previous breast disease were all not related to the results of mammogram examination. Important factors causing the acceptance of mammogram are discovering abnormal finding from breast self-examination (or by partner) which is about 36.7%. Breast self-examination rate of the above 50 years old is 0.52 time those below 50 years old. Individual factors analysis showed that those having education level at college or above is 5.25 time higher incidence of breast self-examination then those with only high school education level or below. Those employed are 2.15 time more than the unemployed group. Those having breast cancer screening are 3.86 time more than those without screening. Those who were admitted due to breast disease were 4.19 time more than those without such history. Multiple factor analysis showed that four factors: that is education level age, with or without children and having or not previous breast cancer screening showed statistical significant. The time lag between making up their mind and time of mammogram were between 1 to 365 days, an average of 74 days. 54.4% done that within one weak while 76.7% done that within one month.
Discussions: Patients factors such as characteristic of the population; causes affecting the acceptance of mammogram examination; the time lag between the time patient make up their decision and time when they come for examination; frequency of self breast examination and geographical district differences, need further study to evaluate. Patients basic information cross analysis and the results of examination showed no statistical significant. It does not showed whether the incidence of having breast cancer having any relation with the population characteristics.
Suggestions: (1) Set up a standard breast self-examination procedure for female above 40 years old at a specific date each month according to a set technique (2)highlight case management and follow up the suspected cases (3)raise the ratio of early breast cancer diagnosis and (4) decrease the mortality rate of breast cancer.
Key Words: Breast Self-examination; Breast Mammography; High risk Breast cancer female

並列關鍵字

Breast Self-examination ； X-ray Mammography ； High risk Breast cancer female

參考文獻

英文部份：

Abood D.A., Coster D.C., Mullis A.K., et al.: Evaluation of a “loss-framed” minimal intervention to increase mammography utilization among un- and under-insured women. Cancer Detection and Prevention 26(5): 394-400, 2002

Aiken L.S., West S.G., Woodward C.K., et al.: Health beliefs and compliance with mammography-screening recommendations in asymptomatic women. Health Psychology .13(2):122-129, 1994

Alagna S.W., Morokoff P.J., Bevett J.M., et al.: Performance of breast examination by women at high risk for breast cancer. Women and Health 12:29-46, 1987

Allen J.R.: Relationship of perceived barriers to breast self-examination in women of varying ages and levels of education. American Journal of Operating Room Nursing 63(4)：795-796, 1996