Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women

BACKGROUND: Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics. METHODS: We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding. RESULTS: Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92). CONCLUSIONS: Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.     

Correlates of breast cancer screening among low-income, low-education Latinas.

INTRODUCTION: This paper discusses the factors associated with breast cancer screening among low-education, low-income Latinas. BACKGROUND: These data were collected as part of a breast cancer educational intervention study aimed at this population. The objective of the larger study was to evaluate multimedia methods as an appropriate medium for educating this population of Latinas about breast cancer. METHODS: The study was designed as a field experiment with a pre and posttest design. A total of 1,197 individuals participated in the study, and these were all self-identified Latinas above the age of 40 years who fit the screening criteria of low income and education levels. Of these, 583 individuals provided the baseline (pretest) data on mammogram attitudes, knowledge, and intentions analyzed in this paper. RESULTS: Our results indicate that breast cancer screening knowledge and having a regular doctor were significant factors in ever having had a mammogram and having had a recent mammogram in this sample of low-income, low-education Latinas. Age affected the odds of ever having had a mammogram, but not a recent mammogram. CONCLUSION: Attitudes toward mammography, insurance status, and demographic factors such as foreign birth were not significant predictors of mammography screening in this study.     

Barriers to cervical cancer screening among low-income HIV-positive African American women

This study elucidates the perspective of low-income HIV-positive African American women who have not received cervical cancer screening for five or more years, on the barriers they face in accessing and using reproductive health care. We focused on how women who live in a severely economically depressed and racially segregated neighborhood experience barriers to cervical cancer screening. Andersen's Behavioral Model of Health Services Use, which allows for the organization of conditions and situations that bar utilization of health services, served as the theoretical framework. Findings from individual semi-structured interviews with 35 participants revealed the importance of psychological and emotional barriers as well as the more commonly reported economic, social, and health care system barriers. We suggest how access to care for this population can be increased by including psychological and emotional components in intervention efforts.     

24099例农村妇女宫颈癌和乳腺癌筛查结果分析

目的:掌握遂昌县农村妇女宫颈癌和乳腺癌(简称"两癌")的发病率,早期发现、早期治疗,降低"两癌"的治疗成本,提高患病妇女的生存率。方法:对2009年自愿参加"两癌"免费筛查的24 099例农村妇女的资料进行统计分析。结果:24 099例妇女中,宫颈细胞学异常578例,经组织活检确诊为宫颈癌18例,患病率为74.69/10万(18/24 099);宫颈上皮内瘤变(CIN)110例,患病率为456.45/10万(110/24 099);乳腺癌2例,患病率为8.3/10万(2/24 099)。宫颈癌多见于40～64岁妇女,乳腺癌多见于50～55岁妇女。结婚和生育年龄较早是宫颈癌的高危因素;文化程度低、保健意识不强、经济条件差的农村妇女是"两癌"的高发人群,也是重点干预对象。结论:农村妇女"两癌"发病率高,应加大农村防癌普查力度,希望政府能继续执行惠民政策,切实做到早预防、早发现和早治疗。     

Barriers to breast cancer screening for low-income Mexican and Dominican women in New York City

The proportion of Mexican and Dominican women has increased rapidly in New York City and in other urban areas, and breast cancer screening rates continue to be lower for Latina women as a whole, but particularly for some nationality sub-groups. The current analysis explored the reasons why Mexican and Dominican women from medically underserved communities in New York City do not seek breast cancer screening. Data were collected through interviews with 298 Mexican and Dominican women aged 40–88 years; the interviews included an open-ended question on the barriers women face in seeking screening. The three most commonly cited barriers were not taking care of oneself (descuido) (52.3%), lack of information (49.3%), and fear (44.6%). Women who had been screened cited fear, pain, or other personal barriers more often, but women who had never had a mammogram cited cost or other logistical barriers. Responses from Dominican and Mexican women were significantly different, with Mexican women more often citing shame or embrarrassment and Dominican women more often citing fear. The dependent variable, barriers to screening, was grouped into major categories. When sociodemographic factors were controlled for, the effect of ethnicity disappeared. Multivariate logistic regression revealed that women with a source of health care were less likely to cite any logistical barriers, but significantly more likely to report only personal barriers (such as fear ordescuido). The analysis indicated that personal barriers were very prevalent in the communities studied. It may not be sufficient merely to increase access to breast cancer screening services for low-income Latinas: even when women have a source of health care, personal barriers may prevent many women from seeking screening. Outreach programs need to be tailored to the target communities as there are significant differences among groups of Latinas. Targeted outreach programs must work in tandem with programs to increase access to ensure that both personal and logistical barriers to screening are addressed.     

台州市30余万农村妇女宫颈癌和乳腺癌筛查结果分析

目的:了解台州市农村妇女宫颈癌和乳腺癌的筛查情况,为“两癌”的防治提供依据,降低“两癌”治疗成本,提高患病妇女的生存率.方法:分析2012年5月-2013年12月“两癌”免费筛查农村妇女的资料.结果:该市筛查315 290例农村妇女宫颈癌,检查出宫颈癌前病变1 706例,宫颈癌144例,患病率为45.67/10万;筛查298 247例农村妇女乳腺癌,检查出乳腺癌147例,患病率为49.29/10万.结论:农村妇女“两癌”发病率高,“两癌”普查意义重大,应加大普查力度,切实做到早预防、早发现和早治疗,降低宫颈癌和乳腺癌的发病率和死亡率,保障妇女的生殖健康.     

Effectiveness of interventions to improve follow-up after abnormal cervical cancer screening

OBJECTIVE: The purpose of this study was to determine the effectiveness of interventions designed to improve follow-up after an abnormal Pap smear. METHODS: We performed a qualitative meta-analysis of interventions designed to improve follow-up after an abnormal Pap smear and included studies that met the following criteria: randomized or concurrently controlled study design, defined outcomes, and data available for abstraction. Interventions were classified as behavioral, cognitive, sociologic, or combined strategies (e.g., behavioral and cognitive). Abnormal Pap smears were defined as any test result requiring additional follow-up. Effectiveness was measured by the rate of compliance with recommended follow-up. RESULTS: Twenty-two interventions in 10 studies met the inclusion criteria. Cognitive interventions utilizing interactive telephone counseling were the most effective, improving compliance by 24 to 31%. Behavioral interventions, such as patient reminders, were also effective, increasing follow-up by up to 18%. Not all of these results achieved statistical significance. The single sociologic intervention we identified used video-taped peer discussions to provide a message about abnormal Pap smears and appropriate follow-up. This intervention was not associated with increased follow-up after an abnormal test. The effectiveness of interventions using multiple types of strategies to improve follow-up was inconsistent. CONCLUSIONS: Cognitive strategies led to the greatest improvement in compliance with follow-up of abnormal Pap smear screening tests. Extension of similar interventions to follow-up of abnormal breast and colon cancer screening, development of physician- and system-targeted interventions, and evaluation of the cost-effectiveness of these strategies are important priorities for future research.     

Implementation issues and costs associated with a proven strategy for increasing breast and cervical cancer screening among low-income women.

Results from a randomized controlled trial demonstrated that a physician reminder letter combined with telephone counseling from a health educator significantly increased women's use of both mammograms and Pap tests in a low-income population in a managed care setting. This article presents results from a process evaluation and cost analysis of the intervention. An average of 35 minutes was spent preparing each of 304 intervention letters for mailing, including the time needed to secure signatures from 110 physicians. The results of an economic analysis suggested that this intervention cost $11.44 per recipient and $28.93 per screening test received above expected. However, intervention costs can be reduced significantly if one physician signs all letters (rather than each woman's own primary care physician) and if the health educator labor costs are diminished (e.g., by using student interns). Overall, the women under study reported that they are comfortable with both mailed and telephone reminders when they are post due for a clinical preventive service.     

Travel distance to screening facilities and completion of abnormal mammographic follow-up among disadvantaged women

PurposeAlthough many studies have examined factors in predicting incomplete and delay in abnormal mammogram follow-up, few have used geospatial methods to examine these factors. Consequently, the purpose of this study was to examine the relationship between travel distance to health facilities and completion of abnormal mammogram follow-up among disadvantaged women in South Carolina.MethodsWomen participating in South Carolina's Best Chance Network between 1996 and 2009 with abnormal mammogram were included in the study. Kaplan–Meier survival was used to describe the probability of work-up completion after abnormal mammogram among different distance categories, and Cox proportional hazards model was used to further assess the relationship between work-up completion and travel distance to the screening provider and mammography facility.ResultsAmong 1,073 women, there was significant difference in time to completion of abnormal mammogram work-up by race; African American women had longer time to completion compared to European American women. Accounting for race, age, previous mammograms, income, and insurance status, women who lived closest to their diagnosing mammography facility were more likely to complete their work-up compared to those who lived the farthest (HR = 1.41; 95% CI = 1.00–1.80).ConclusionsDistance to the diagnosing mammography facility may play a role on the completion of abnormal mammogram work-up.     

Breast cancer screening among relatives of women with breast cancer.

BACKGROUND. National surveys indicate that only 15% to 30% of all women in the general population 50 years of age or older have an annual mammogram. METHODS. We studied first-degree female relatives of women with breast cancer, who are at elevated risk of disease, to describe the breast cancer screening practices of these relatives and to improve their practices through a program of intensive education. We report here the screening behaviors of 2471 relatives of women with breast cancer. RESULTS. Self-reported behaviors were as follows: 49% performed monthly breast self-examination and 70% had annual breast examinations by a medical professional. Of 983 women 50 years of age or older, 49% had had a mammogram, but only 14% have a mammogram annually. Of women 50 years of age or older who had never had a mammogram, 92% reported never having had one recommended by a medical professional. CONCLUSIONS. Our findings indicate that screening behaviors in relatives of breast cancer patients are not substantially different from those of women in the general population. Enhanced efforts both to educate medical professionals and to encourage women to demand screening mammography are necessary to reduce breast cancer mortality.     

肥西县宫颈癌普查结果分析

目的掌握肥西县妇女宫颈癌流行病学情况,为宫颈癌防治决策提供科学依据。方法 2011年4月6日至10月30日,对肥西县5 316名妇女进行了宫颈癌筛查。采用宫颈刮片筛查(改良式),异常情况进一步进行阴道镜检查和活组织病理学检查。结果宫颈刮片异常2.92%(155/5 316),宫颈癌检出率(病理诊断为≥CINⅢ)150.48/10万(8/5 316),HPV检出率0.06%(3/5 316);文化程度高的农村妇女宫颈刮片异常检出率较低,40岁年龄组和50岁年龄组农村妇女TCT检出率较高。结论对文化程度低的农村妇女和35岁以上农村妇女,应重点加强健康教育和定期普查,以有效预防和控制宫颈癌的危害。     

Factors influencing duration of breast feeding among low-income women

Forty low-income breast feeding primiparous women were interviewed to determine whether family member and peer attitudes toward breast feeding and available postpartum support were associated with continued or early termination of breast feeding. Mean breast feeding duration equalled 20.5 weeks (range, 1 to 52 weeks). When an outside source of assistance (a doula) was available during the first 2 weeks postpartum, mean duration was 23.4 weeks compared with 12.3 weeks when a doula was unavailable (p less than .05). Breast feeding duration was independent of the doula's attitude regarding breast feeding. Duration of breast feeding was significantly longer for breast feeding women who participated in the USDA Special Supplemental Program for Women, Infants, and Children (WIC) than for those who did not participate. All of the women claimed to like breast feeding; 93% of the husbands or boyfriends, 83% of the women's mothers, and 81% of the women's best friends had positive attitudes toward breast feeding. The more breast feeding friends the woman had, the longer she breast fed (r = .32, p less than .05). Termination of breast feeding was not due to perceived negative attitudes of family members and peers regarding breast feeding.