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Dang JHT, Chen S, Hall S, Campbell JE, Chen MS, Doescher MP. Association Between COVID-19 and Planned and Postponed Cancer Screenings Among American Indian Adults Residing in California and Oklahoma, March-December 2020. Public Health Rep 2024:333549241254226. [PMID: 38832678 DOI: 10.1177/00333549241254226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2024] Open
Abstract
OBJECTIVE Little is known about how the COVID-19 pandemic affected cancer screenings among American Indian people residing in California and Oklahoma, 2 states with the largest American Indian populations. We assessed rates and factors associated with cancer screenings among American Indian adults during the pandemic. METHODS From October 2020 through January 2021, we surveyed 767 American Indian adults residing in California and Oklahoma. We asked participants whether they had planned to obtain screenings for breast cancer, cervical cancer, and colorectal cancer (CRC) from March through December 2020 and whether screening was postponed because of COVID-19. We calculated adjusted odds ratios (AORs) for factors associated with reasons for planned and postponed cancer screening. RESULTS Among 395 participants eligible for breast cancer screening, 234 (59.2%) planned to obtain the screening, 127 (54.3%) of whom postponed it. Among 517 participants eligible for cervical cancer screening, 357 (69.1%) planned to obtain the screening, 115 (32.2%) of whom postponed it. Among 454 participants eligible for CRC screening, 282 (62.1%) planned to obtain CRC screening, 80 of whom (28.4%) postponed it. In multivariate analyses, women who lived with a child (vs did not) had lower odds of planning to obtain a breast cancer screening (AOR = 0.6; 95% CI, 0.3-1.0). Adherence to social distancing recommendations was associated with planning to have and postponement of cervical cancer screening (AOR = 7.3; 95% CI, 0.9-58.9). Participants who received (vs did not receive) social or financial support had higher odds of planning to have CRC screening (AOR = 2.0; 95% CI, 1.1-3.9). CONCLUSION The COVID-19 pandemic impeded completion of cancer screenings among American Indian adults. Interventions are needed to increase the intent to receive evidence-based cancer screenings among eligible American Indian adults.
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Affiliation(s)
- Julie H T Dang
- Department of Public Health Sciences, Division of Health Policy and Management, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Sixia Chen
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Spencer Hall
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Moon S Chen
- Department of Internal Medicine, Division of Hematology and Oncology, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Mark P Doescher
- Stephenson Cancer Center, College of Medicine, Department of Family and Preventive Medicine, University of Oklahoma College of Health Science Center, Oklahoma City, OK, USA
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Romelus J, McLaughlin C, Ruggieri D, Morgan S. A Narrative Review of Cervical Cancer Screening Utilization Among Haitian Immigrant Women in the U.S.: Health Beliefs, Perceptions, and Societal Barriers and Facilitators. J Immigr Minor Health 2024; 26:596-603. [PMID: 38308798 DOI: 10.1007/s10903-024-01581-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/05/2024]
Abstract
Haitian immigrant women living in the U.S. have a higher rate of cervical cancer mortality than any other ethnic group, primarily due to lower rates of screening test utilization. Therefore, it is important to understand the issues affecting their pap smear screening behaviors. We conducted a narrative review of articles from PubMed, SCOPUS, Embase, CINAHL/Nursing, and Psych Info. Inclusion criteria: U.S. Haitian immigrant, screening, cervical cancer, health beliefs/perceptions. Exclusion criteria: HPV-vaccine. Primary barriers: (1) lack of knowledge of cervical cancer, HPV, and pap smears; (2) lack of culturally appropriate dissemination of information; and (3) difficulty obtaining the test. Primary facilitators: (1) provider recommendations, (2) Haitian media to disseminate health information, and (3) having health insurance. This review highlights the points for intervention by health professionals and policy makers to address this group's low pap smear utilization.
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Affiliation(s)
- Juana Romelus
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Carol McLaughlin
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dominique Ruggieri
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Sherry Morgan
- Penn Libraries, University of Pennsylvania, Philadelphia, United States of America
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Mohamed AA, Shah V, Njeru JW, Wieland ML, Rutten LJF, Prokop LJ, Murad MH. Interventions to Increase Cancer Screening Adherence Among Somali Immigrants in the US and Europe: A Systematic Review. J Immigr Minor Health 2024; 26:385-394. [PMID: 37612453 DOI: 10.1007/s10903-023-01532-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2023] [Indexed: 08/25/2023]
Abstract
Cancer screening rates among immigrant and refugee populations in high income countries is significantly lower than native born populations. The objective of this study is to systematically review the effectiveness of interventions to improve screening adherence for breast, cervical and colorectal cancer among Somali immigrants. A literature search was conducted for the years 2000-2021 and eight studies met eligibility criteria. The following intervention components were found to increase adherence to cervical cancer screening: home HPV test, educational workshop for women and education for general practitioners. A patient navigator intervention was found to increase screening for breast cancer. Educational workshops motivated or increased knowledge regarding cancer screening for breast, cervical and colorectal cancer. However, most of the studies had limitations due to methodology with potential for introduction of bias. Therefore, future studies comparing effectiveness of specific intervention components to reduce disparities in cancer screening among Somali immigrants and refugees are encouraged.
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Affiliation(s)
- Ahmed A Mohamed
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
| | - Vishal Shah
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Jane W Njeru
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Mark L Wieland
- Department of Medicine, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | | | | | - M Hassan Murad
- Mayo Clinic Evidence-Based Practice Center, Mayo Clinic, Rochester, MN, USA
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Agatsuma N, Utsumi T, Nishikawa Y, Horimatsu T, Seta T, Yamashita Y, Tanaka Y, Inoue T, Nakanishi Y, Shimizu T, Ohno M, Fukushima A, Nakayama T, Seno H. Stage at diagnosis of colorectal cancer through diagnostic route: Who should be screened? World J Gastroenterol 2024; 30:1368-1376. [PMID: 38596494 PMCID: PMC11000077 DOI: 10.3748/wjg.v30.i10.1368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 01/17/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) is a global health concern, with advanced-stage diagnoses contributing to poor prognoses. The efficacy of CRC screening has been well-established; nevertheless, a significant proportion of patients remain unscreened, with > 70% of cases diagnosed outside screening. Although identifying specific subgroups for whom CRC screening should be particularly recommended is crucial owing to limited resources, the association between the diagnostic routes and identification of these subgroups has been less appreciated. In the Japanese cancer registry, the diagnostic routes for groups discovered outside of screening are primarily categorized into those with comorbidities found during hospital visits and those with CRC-related symptoms. AIM To clarify the stage at CRC diagnosis based on diagnostic routes. METHODS We conducted a retrospective observational study using a cancer registry of patients with CRC between January 2016 and December 2019 at two hospitals. The diagnostic routes were primarily classified into three groups: Cancer screening, follow-up, and symptomatic. The early-stage was defined as Stages 0 or I. Multivariate and univariate logistic regressions were exploited to determine the odds of early-stage diagnosis in the symptomatic and cancer screening groups, referencing the follow-up group. The adjusted covariates were age, sex, and tumor location. RESULTS Of the 2083 patients, 715 (34.4%), 1064 (51.1%), and 304 (14.6%) belonged to the follow-up, symptomatic, and cancer screening groups, respectively. Among the 2083 patients, CRCs diagnosed at an early stage were 57.3% (410 of 715), 23.9% (254 of 1064), and 59.5% (181 of 304) in the follow-up, symptomatic, and cancer screening groups, respectively. The symptomatic group exhibited a lower likelihood of early-stage diagnosis than the follow-up group [P < 0.001, adjusted odds ratio (aOR), 0.23; 95% confidence interval (95%CI): 0.19-0.29]. The likelihood of diagnosis at an early stage was similar between the follow-up and cancer screening groups (P = 0.493, aOR for early-stage diagnosis in the cancer screening group vs follow-up group = 1.11; 95%CI = 0.82-1.49). CONCLUSION CRCs detected during hospital visits for comorbidities were diagnosed earlier, similar to cancer screening. CRC screening should be recommended, particularly for patients without periodical hospital visits for comorbidities.
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Affiliation(s)
- Nobukazu Agatsuma
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Takahiro Utsumi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yoshitaka Nishikawa
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan
| | - Takahiro Horimatsu
- Institute for Advancement of Clinical and Translational Science (iACT), Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Takeshi Seta
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Yukitaka Yamashita
- Department of Gastroenterology and Hepatology, Japanese Red Cross Wakayama Medical Center, Wakayama 640-8558, Japan
| | - Yukari Tanaka
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takahiro Inoue
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Yuki Nakanishi
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Takahiro Shimizu
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
| | - Mikako Ohno
- Medical Support Section, Medical Affairs Division, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Akane Fukushima
- Medical Support Section, Medical Affairs Division, Kyoto University Hospital, Kyoto 606-8507, Japan
| | - Takeo Nakayama
- Department of Health Informatics, Kyoto University School of Public Health, Kyoto 606-8501, Japan
| | - Hiroshi Seno
- Department of Gastroenterology and Hepatology, Kyoto University Graduate School of Medicine, Kyoto 606-8507, Japan
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Sun J, Frick KD, Liang H, Chow CM, Aronowitz S, Shi L. Examining cancer screening disparities by race/ethnicity and insurance groups: A comparison of 2008 and 2018 National Health Interview Survey (NHIS) data in the United States. PLoS One 2024; 19:e0290105. [PMID: 38416784 PMCID: PMC10901319 DOI: 10.1371/journal.pone.0290105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 08/01/2023] [Indexed: 03/01/2024] Open
Abstract
BACKGROUND Pervasive differences in cancer screening among race/ethnicity and insurance groups presents a challenge to achieving equitable healthcare access and health outcomes. However, the change in the magnitude of cancer screening disparities over time has not been thoroughly examined using recent public health survey data. METHODS A retrospective cross-sectional analysis of the 2008 and 2018 National Health Interview Survey (NHIS) database focused on breast, cervical, and colorectal cancer screening rates among race/ethnicity and insurance groups. Multivariable logistic regression models were used to assess the relationship between cancer screening rates, race/ethnicity, and insurance coverage, and to quantify the changes in disparities in 2008 and 2018, adjusting for potential confounders. RESULTS Colorectal cancer screening rates increased for all groups, but cervical and mammogram rates remained stagnant for specific groups. Non-Hispanic Asians continued to report consistently lower odds of receiving cervical tests (OR: 0.42, 95% CI: 0.32-0.55, p<0.001) and colorectal cancer screening (OR: 0.55, 95% CI: 0.42-0.72, p<0.001) compared to non-Hispanic Whites in 2018, despite significant improvements since 2008. Non-Hispanic Blacks continued to report higher odds of recent cervical cancer screening (OR: 1.98, 95% CI: 1.47-2.68, p<0.001) and mammograms (OR: 1.32, 95% CI: 1.02-1.71, p<0.05) than non-Hispanic Whites in 2018, consistent with higher odds observed in 2008. Hispanic individuals reported improved colorectal cancer screening over time, with no significant difference compared to non-Hispanics Whites in 2018, despite reporting lower odds in 2008. The uninsured status was associated with significantly lower odds of cancer screening than private insurance for all three cancers in 2008 and 2018. CONCLUSION Despite an overall increase in breast and colorectal cancer screening rates between 2008 and 2018, persistent racial/ethnic and insurance disparities exist among race/ethnicity and insurance groups. These findings highlight the importance of addressing underlying factors contributing to disparities among underserved populations and developing corresponding interventions.
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Affiliation(s)
- Jingjing Sun
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Kevin D Frick
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- Carey Business School, Johns Hopkins University, Baltimore, Maryland, United States of America
| | - Hailun Liang
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
- School of Administration and Policy, Renmin University of China, Beijing, China
| | - Clifton M Chow
- Department of Psychiatry, Cambridge Health Alliance, Cambridge, Massachusetts, United States of America
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, United States of America
| | - Sofia Aronowitz
- Independent Researcher, Albany, New York, United States of America
| | - Leiyu Shi
- Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, United States of America
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Karena ZV, Faldu PS. A Cross-Sectional Study on Knowledge, Attitude, and Practices Related to Cervical Cancer Screening Among the Nursing Staff in a Tertiary Care Hospital in the Western Region of India. Cureus 2024; 16:e51566. [PMID: 38313907 PMCID: PMC10835643 DOI: 10.7759/cureus.51566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/30/2023] [Indexed: 02/06/2024] Open
Abstract
Background Cervical cancer is the fourth most common cancer in women globally. It is one of the leading causes of cancer deaths in females in India. Cervical cancer has a long latent precancerous period from index human papillomavirus (HPV) infection to potential cancer development, making screening one of the most effective methods of cancer prevention. Despite the national cancer prevention programme for cancer cervix, with defined guidelines for cervical cancer screening by the auxiliary nurse midwives (ANM) and nurses, cervical cancer screening is very limited in India. In this study, we aim to assess the knowledge, attitude, and practices related to cervical cancer and screening methods among the nursing staff in a tertiary care hospital attached to a medical teaching institute. Methodology A cross-sectional study was conducted by a semi-structured questionnaire in a tertiary care hospital in Morbi, situated in the western region of India, between November and December 2023. Female nursing staff of the hospital in the age of 20 to 60 years were included as study participants. The study was approved by the Institutional Ethical Committee. Results In the study, 64.9% of participants were in the age group of 20-29 years, and 52.6% were unmarried, forming a major portion of the study group being of young age. Of the participants, 70.1% identified cancer of the cervix as a major public health problem. Only 28.8% of the participants had adequate and comprehensive knowledge of cervical cancer screening. Though 92.8% of the participants knew of Pap smear as a cervical cancer screening method, only 12.4% of participants were aware of the visual inspection with acetic acid (VIA) and 2% were aware of HPV testing as a tool for cervical cancer screening. Only 5.2% of the study participants had themselves been screened for cervical cancer. Of the participants, 87.6% had never taken a Pap smear, and 95.8% of participants had never taken VIA of any woman. A total of 32.3% of participants gave the reason of not having adequate skills to perform VIA as the reason for not ever having screened the patient with VIA. A total of 6.2% of participants had been trained in cervical screening methods formally. Conclusion The limited knowledge of the nursing staff of cervical cancer and its screening and low self-screening prevalence among healthcare professionals highlight the need to increase awareness of cervical cancer and screening to bring the impetus to training and result-driven implementation of screening programmes for cervical cancer in India.
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Affiliation(s)
- Zalak V Karena
- Obstetrics and Gynecology, GMERS (Gujarat Medical Education & Research Society) Medical College, Morbi, IND
| | - Payal S Faldu
- Obstetrics and Gynecology, GMERS (Gujarat Medical Education & Research Society) Medical College, Morbi, IND
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Lin E, Sleboda P, Rimel BJ, Datta GD. Inequities in colorectal and breast cancer screening: At the intersection of race/ethnicity, sexuality, and gender. SSM Popul Health 2023; 24:101540. [PMID: 37920304 PMCID: PMC10618777 DOI: 10.1016/j.ssmph.2023.101540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 10/13/2023] [Accepted: 10/16/2023] [Indexed: 11/04/2023] Open
Abstract
Objective To investigate the joint impact of sexual orientation, gender identity, and race/ethnicity on colorectal and breast cancer screening disparities in the United States. Methods Utilizing sampling weighted data from the 2016 and 2018 Behavioral Risk Factor Surveillance System, we assessed differences in two metrics via chi-square statistics: 1) lifetime uptake, and 2) up-to-date colorectal and breast cancer screening by sexual orientation and gender identity, within and across racial/ethnic classifications. Results Within specific races/ethnicities, lifetime CRC screening was higher among gay/lesbian (within NH-White, Hispanic, and Asian/Pacific Islander) and bisexual individuals (Hispanic) compared to straight individuals, and lowest overall among transgender women and transgender nonconforming populations (p < 0.05). Asian transgender women had the lowest lifetime CRC screening (13.0%; w.n. = 1,428). Lifetime breast cancer screening was lowest among the Hispanic bisexual population (86.6%; w.n. = 26,940) and Hispanic transgender nonconforming population (71.8%; w.n. = 739); within all races, SGM individuals (except NH-White, Hispanic, and Black bisexual populations, and NH-White transgender men) had greater breast cancer screening adherence compared to straight individuals. Conclusions Due to small, unweighted sample sizes, results should be interpreted with caution. Heterogeneity in screening participation by SGM status within and across racial/ethnic groups were observed, revealing the need to disaggregate data to account for intersecting identities and for studies with larger sample sizes to increase estimate reliability.
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Affiliation(s)
- Emmeline Lin
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Patrycja Sleboda
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
| | - Bobbie J. Rimel
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
| | - Geetanjali D. Datta
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, 90069, USA
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, 90048, USA
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Lachance AD, Call C, Radford Z, Stoddard H, Sturgeon C, Babikian G, Rana A, McGrory BJ. Rural-Urban Differences in Hospital and Patient-Reported Outcomes Following Total Hip Arthroplasty. Arthroplast Today 2023; 23:101190. [PMID: 37731592 PMCID: PMC10507436 DOI: 10.1016/j.artd.2023.101190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Revised: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 09/22/2023] Open
Abstract
Background Rural patients have unique health-care factors influencing outcomes of arthroplasty, hypothetically putting these patients at increased risk for complications following total joint arthroplasty. The aim of this study is to better understand differences in patient outcomes and satisfaction between rural and urban patients receiving care in an urban setting and to provide more equitable care. Methods A retrospective chart review was performed on patients undergoing primary total hip arthroplasty at a single large academic center between January 2013 and August 2020. Demographic, operative, and hospital outcomes were obtained from the institutional electronic medical record. Rurality was determined by rural-urban code (RUC) classifications by zip code with RUC codes 1-3 defined as urban and RUC 4-10 defined as rural. Results Patients from urban areas were more likely to visit the emergency department within 30 days postoperatively (P = .006) and be readmitted within 90 days (P < .001). However, unplanned (P < .001) admissions were higher in the rural group. There was no statistical difference in postoperative complications (P = .4). At 6 months, rural patients had higher patient-reported outcome measures (PROMs) including Hip Disability and Osteoarthritis Outcome Score total (P = .05), Hip Disability and Osteoarthritis Outcome Score interval (P = .05), self-reported functional improvement (P < .05), improvements in pain (P < .05), and that the surgery met expectations (P < .05). However, these values did not reach minimal clinically important difference. Conclusions There may be differences in emergency department visits, readmissions, and PROMs in rural vs urban populations undergoing total hip arthroplasty in an urban setting. Patient access to care and attitudes of rural patients toward health care may underlie these findings. Understanding differences in PROMs, satisfaction, and hospital-based outcomes based on rurality is essential to provide equitable arthroplasty care.
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Affiliation(s)
| | | | - Zachary Radford
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Henry Stoddard
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - Callahan Sturgeon
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - George Babikian
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
| | - Adam Rana
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
| | - Brian J. McGrory
- MaineHealth Institute for Research, Maine Medical Center, Portland, ME, USA
- Tufts University School of Medicine, Maine Medical Center, Portland, ME, USA
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Ganguly AP, Baker KK, Redman MW, McClintock AH, Yung RL. Racial disparities in the screening mammography continuum within a heterogeneous health care system. Cancer 2023; 129:3171-3181. [PMID: 37691529 DOI: 10.1002/cncr.34632] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 11/13/2022] [Accepted: 12/01/2022] [Indexed: 09/12/2023]
Abstract
BACKGROUND Decreased mammography drives breast cancer disparities. Black women have lower rates of mammography completion than White women, and this contributes to disparities in outcomes. Points of disparity along the continuum for screening mammography remain underresearched. METHODS The authors compared mammography referrals for Black and White women aged 40-74 years at a heterogeneous academic medical center. Completion of steps of the screening mammography continuum was compared between Black and White women within two age cohorts: 40-49 and 50-74 years. Multivariable logistic regression was used to evaluate the association between race and mammogram completion. RESULTS Among 26,476 women, 3090 (12%) were Black, and 23,386 (88%) were White. Among Black women aged 50-74 years who were due for mammography, 40% had referrals, 39% were scheduled, and 21% completed mammography; the corresponding values for White women were 42%, 41%, and 27%, respectively. Similar differences in referral outcomes were noted for women aged 40-49 years, although Black women had lower rates of provider-initiated referrals (9% vs. 13%). Adjusted analyses for those aged 40-49 and 50-74 years demonstrated an association between Black race and lower rates of mammography completion (odds ratio [OR] for 40-49 years, 0.74; 95% CI, 0.57-0.95; p = .02; OR for 50-74 years, 0.85; 95% CI, 0.74-0.98; p = .02). In multivariable analyses, noncommercial insurance and higher comorbidity were associated with lower rates of mammography. Provider-initiated referral was positively correlated to mammogram completion. CONCLUSIONS Black race was associated with 15%-26% lower mammography completion (adjusted). Both groups experienced the highest attrition after scheduling mammograms, although attrition was more precipitous for Black women. These findings have implications for future interventions, including increasing provider-initiated referrals and decreasing barriers to attending scheduled mammograms.
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Affiliation(s)
- Anisha P Ganguly
- Center for Innovation and Value, Parkland Health and Hospital System, Dallas, Texas, USA
- Division of General Internal Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Kelsey K Baker
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Mary W Redman
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Adelaide H McClintock
- Division of General Internal Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Rachel L Yung
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Division of Medical Oncology, University of Washington School of Medicine, Seattle, Washington, USA
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Jaswal G, Benipal R, Bhatty SG, Garg P, Kang MS. Comparison of Two High Dose Rate Brachytherapy Regimes. JOURNAL OF PHARMACY AND BIOALLIED SCIENCES 2023; 15:S1062-S1064. [PMID: 37694100 PMCID: PMC10485489 DOI: 10.4103/jpbs.jpbs_221_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 03/10/2023] [Accepted: 03/14/2023] [Indexed: 09/12/2023] Open
Abstract
Background Two HDR brachytherapy regimes were compared, 9.5 Gray per fraction for two fractions and 7.5 Gray per fraction for three fractions. Materials and Methods A total of 80 patients with histologically evident squamous cell carcinoma cervix were taken in the current research after randomization. Radiotherapy dose delivered was 50 Gray/25#/5 weeks with concomitant chemotherapy with weekly cisplatin 35 mg/m2. Following external chemoradiation, patients were randomized into two arms. In Arm A, 40 patients were given high dose rate (HDR) brachytherapy of weekly 7.5 Gray in three fractions over 3 weeks. In Arm B, 40 patients were given high dose rate (HDR) brachytherapy of weekly 9.5 Gray in two fractions over 2 weeks. BED and LQED had been calculated, and the evaluation of response and consequences was examined. Results In Arm A, BED to point A was 99.38 ± 0.00 and EQD2 to point A was 82.81 ± 0.00. In Arm B, BED to point A was 97.05 ± 0.00 and EQD2 to point A was 80.89 ± 0.00. With respect to rectum in Arm A, BED rectum was 108.66 ± 11.43 and EQD2 rectum was 65.07 ± 6.84. In Arm B, BED rectum was 107 ± 10.83 and EQD2 rectum was 64.21 ± 6.49. Similarly in Arm A, BED bladder was 107.86 ± 10.23 and EQD2 bladder was 64.59 ± 6.13. In arm B, BED bladder was 104.14 ± 10.79 and EQD2 bladder was 62.36 ± 6.46. Conclusion In a follow-up of 6 months, no statistical significance in terms of local control as well as complications rates in both the arms. Our research demonstrates that two fractions of HDR are comparable with three fractions of HDR.
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Affiliation(s)
- Gaurav Jaswal
- Department of Radiation Oncology, Dr. Prem Super Speciality and Cancer Hospital, Panipat, Haryana, India
| | - Raja Benipal
- Department of Radiation Oncology, Government Medical College, Patiala, Punjab, India
| | - Seema G. Bhatty
- Department of Obstetrics and Gynaecology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Pardeep Garg
- Department of Radiation Oncology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
| | - Manraj S. Kang
- Assoc Professor, Department of Radiation Oncology, Guru Gobind Singh Medical College and Hospital, Faridkot, Punjab, India
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Lee SJC, Lee J, Zhu H, Chen PM, Wahid U, Hamann HA, Bhalla S, Cardenas RC, Natchimuthu VS, Johnson DH, Santini NO, Patel HR, Gerber DE. Assessing Barriers and Facilitators to Lung Cancer Screening: Initial Findings from a Patient Navigation Intervention. Popul Health Manag 2023; 26:177-184. [PMID: 37219548 PMCID: PMC10278031 DOI: 10.1089/pop.2023.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023] Open
Abstract
Low-dose computed tomography-based lung cancer screening represents a complex clinical undertaking that could require multiple referrals, appointments, and time-intensive procedures. These steps may pose difficulties and raise concerns among patients, particularly minority, under-, and uninsured populations. The authors implemented patient navigation to identify and address these challenges. They conducted a pragmatic randomized controlled trial of telephone-based navigation for lung cancer screening in an integrated, urban safety-net health care system. Following standardized protocols, bilingual (Spanish and English) navigators educated, motivated, and empowered patients to traverse the health system. Navigators made systematic contact with patients, recording standardized call characteristics in a study-specific database. Call type, duration, and content were recorded. Univariable and multivariable multinomial logistic regression was performed to investigate associations between call characteristics and reported barriers. Among 225 patients (mean age 63 years, 46% female, 70% racial/ethnic minority) assigned navigation, a total of 559 barriers to screening were identified during 806 telephone calls. The most common barrier categories were personal (46%), provider (30%), and practical (17%). System (6%) and psychosocial (1%) barriers were described by English-speaking patients, but not by Spanish-speaking patients. Over the course of the lung cancer screening process, provider-related barriers decreased 80% (P = 0.008). The authors conclude that patients undergoing lung cancer screening frequently report personal and health care provider-related barriers to successful participation. Barrier types may differ among patient populations and over the course of the screening process. Further understanding of these concerns may increase screening uptake and adherence. Clinical Trial Registration number: (NCT02758054).
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Affiliation(s)
- Simon J. Craddock Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Jessica Lee
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Hong Zhu
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Patricia M. Chen
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Urooj Wahid
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Heidi A. Hamann
- Departments of Psychology and Family and Community Medicine, University of Arizona, Tucson, Arizona, USA
| | - Sheena Bhalla
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Rodrigo Catalan Cardenas
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
| | | | - David H. Johnson
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Noel O. Santini
- Department of Internal Medicine, UT Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
| | - Himani R. Patel
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
| | - David E. Gerber
- Peter O'Donnell Jr. School of Public Health, UT Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, Dallas, Texas, USA
- Parkland Health, Dallas, Texas, USA
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12
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Edmonds MC, Dahman B, Kim SJ, McGuire KP, Sheppard VB. Surveillance Mammography Behaviors in Black and White Breast Cancer Survivors: Behavioral Risk Factors and Surveillance System, 2016. BMC Womens Health 2023; 23:148. [PMID: 36997881 PMCID: PMC10061852 DOI: 10.1186/s12905-023-02246-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 02/24/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Surveillance mammography is recommended annually for early detection of disease relapse among breast cancer survivors; yet Black women have poorer national rates of surveillance mammography compared to White women. Factors that influence racial disparities in surveillance mammography rates are poorly understood. The purpose of this study is to evaluate the contribution of health care access, socioeconomic status, and perceived health status on adherence to surveillance mammography among breast cancer survivors. METHODS This is a secondary analysis of a cross-sectional survey among Black and White women ≥ 18 years, who reported a breast cancer diagnosis and completed breast surgery and adjuvant treatment from the 2016 Behavioral Risk Factor Surveillance System National Survey (BRFSS). Bivariate associations (chi-squared, t-test) for independent variables (e.g., health insurance, marital status) were analyzed with adherence to nationally recommended surveillance guidelines defined as two levels: adherent (received a mammogram in the last 12 months), vs. non- adherent ("received a mammogram in the last 2-5 years, 5 or more years or unsure). Multivariable logistic regression models were used to evaluate the relationship between study variables with adherence, while adjusting for potential confounders. RESULTS Of 963 breast cancer survivors, 91.7% were White women with an average age of 65. 71.7% reported a surveillance mammogram in the last 12 months, while 28.2% did not. Diagnosed > 5 years (p < 0.001); not having a routine checkup visit within 12 months (p = 0.045); and not seeing a doctor when needed due to cost (p = 0.026), were significantly related to survivor's non-adherence to surveillance mammography guidelines. A significant interaction was found between race and residential area (p < 0.001). Compared to White women, Black women living in metropolitan/suburban residential areas were more likely to receive surveillance guidelines (OR:3.77;95% CI: 1.32-10.81); however Black women living in non-metropolitan areas were less likely to receive a surveillance mammogram compared to White women living in non-metropolitan areas (OR: 0.04; 95% CI: 0.00-0.50). CONCLUSION Findings from our study further explain the impact of socioeconomic disparities on racial differences in the use of surveillance mammography among breast cancer survivors. Black women living in non-metropolitan counties are an important subgroup for future research and screening and navigation interventions.
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Affiliation(s)
- Megan C Edmonds
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, 17 E. 102 St, New York, NY, USA.
| | - Bassam Dahman
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
| | - Sunny Jung Kim
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
| | - Kandace P McGuire
- VCU Massey Cancer Center, Richmond, VA, USA
- Department of Surgery, VCU Massey Cancer Center, Richmond, VA, USA
| | - Vanessa B Sheppard
- Department of Health Behavior and Policy, School of Medicine, Virginia Commonwealth University, Richmond, VA, USA
- VCU Massey Cancer Center, Richmond, VA, USA
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13
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Income-related inequalities in the association of smoking with periodontitis: a cross-sectional analysis in Tokyo Metropolitan Districts. Clin Oral Investig 2023; 27:519-528. [PMID: 36241924 DOI: 10.1007/s00784-022-04747-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/02/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Socio-economic status (SES) and smoking are risk factors for periodontitis; however, their interaction has not been determined. We investigated the effect of modification of SES and smoking with periodontal conditions. MATERIALS AND METHODS Data on the social background, smoking status, and dental examination of 1033 individuals residing in the Tokyo Metropolitan District were analyzed. The outcomes were the number of remaining teeth and the proportion of teeth with probing pocket depth (PPD) ≥ 4 mm and ≥ 6 mm. Multilevel linear and Poisson regression analyses were performed after adjusting for possible confounding factors, including SES, assessed by the average income of the residential area. RESULTS The mean number of remaining teeth was 24.6 ± 4.8, and the proportion of teeth with PPD ≥ 4 mm and ≥ 6 mm was 31.2 ± 28.5% and 12.2 ± 18.1%, respectively. After adjusting for confounding factors, the lowest-income population had significantly lesser teeth (coefficient: - 0.46, 95% CI - 0.89, 0.02, p = 0.039) and a higher proportion of teeth with PPD ≥ 4 mm than the highest-income population (ratio of means: 1.22, 95% CI 1.03-1.44, p = 0.013). Significant interactions were observed; income inequalities in periodontitis were significant only among current smokers. CONCLUSION Inequality in socio-economic status is associated with oral health inequalities. The adverse effects of smoking on periodontitis might be greater in the low-income population. CLINICAL RELEVANCE The low-income population, especially current smokers, had significantly more compromised oral health than the high-income population. In addition to the emphasis on smoking cessation, the promotion of universal health coverage for dental care is necessary to reduce oral health inequalities.
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Alghamdi AA, Almutairi AH, Aldosari FS, Al-Owayed AM, AlOtaibi HK, Alghamdi TA, Aldossary AS. Knowledge, Attitude, and Practice of Colorectal Cancer Screening Among Primary Healthcare Physicians in Riyadh Second Health Cluster. Cureus 2022; 14:e32069. [DOI: 10.7759/cureus.32069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2022] [Indexed: 12/02/2022] Open
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15
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Wu Y, Saito H, Ozaki A, Tanimoto T, Jiang Y, Yang P, Li J, Zhou Z, Zhu X, Lu F, Kanemoto Y, Kurokawa T, Tsubokura M, Zhao G. Colorectal Cancer Screening Program in Songjiang district, Shanghai between 2015 and 2017: Evaluation of participation rate and the associated factor. Medicine (Baltimore) 2022; 101:e29259. [PMID: 35960121 PMCID: PMC9371502 DOI: 10.1097/md.0000000000029259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Little is known about the participation rate of newly implemented colorectal cancer (CRC) screening programs in China. Our goals were to identify factors associated with nonparticipation for CRC screening in Songjiang District, Shanghai. We analyzed individuals included in an observational cohort study from 4 towns (Xin Qiao, She Shan, Mao Gang, and Zhong Shan) in Songjiang District. The participation rate was calculated for the CRC screening program based on a fecal immunochemical test and a risk assessment questionnaire between 2015 and 2017 inclusive. Of the 27,130 individuals eligible for inclusion in this study, 20,863 (76.9%) participated in CRC screening at least once during 2015 and 2017. The factors linked with nonparticipation were; being male (odds ratio [OR] 0.87, 95% confidence interval [CI] 0.82-0.93, P < .01), unmarried (OR 0.71, 95% CI 0.64-0.80, P < .01), having a high education level (middle school, OR 0.82, 95% CI 0.74-0.90, P < .01, high school or above, OR 0.64, 95% CI 0.57-0.73, P < .01), absence of chronic disease (OR 0.90, 95% CI 0.85-0.96, P < .01), and living in 2 out of the 4 towns covered (Xin Qiao, OR 0.72, 95% CI 0.66-0.78, P < .01, Zhong Shan, OR 0.29, 95% CI 0.26-0.31, P < .01). The current study revealed several associated factors with nonparticipation for the CRC screening in Songjiang district. These findings will help identify target populations that require an individualized approach to increase the participation rate.
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Affiliation(s)
- Yiling Wu
- Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Hiroaki Saito
- Department f Gastroenterology, Sendai Kousei Hospital, Miyagi, Japan
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Akihiko Ozaki
- Department of Breast and Thyroid Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | | | - Yonggen Jiang
- Songjiang Center for Disease Control and Prevention, Shanghai, China
- * Correspondence: Yonggen Jiang, MPH, Songjiang Center for Disease Control and Prevention, Shanghai, China (e-mail: )
| | - Peng Yang
- Songjiang Center for Disease Control and Prevention, Shanghai, China
| | - Jing Li
- Department of Public Health, Zhongshan Street Community Health Service Center, Shanghai, China
| | - Zhiming Zhou
- Department of Public Health, Sheshan Community Health Service Center, Shanghai, China
| | - Xiuguo Zhu
- Department of Public Health, Maogang Community Health Service Center, Shanghai, China
| | - Fei Lu
- Department of Public Health, Xinqiao Community Health Service Center, Shanghai, China
| | - Yoshiaki Kanemoto
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Tomohiro Kurokawa
- Department of Surgery, Jyoban Hospital of Tokiwa Foundation, Fukushima, Japan
| | - Masaharu Tsubokura
- Department of Radiation Health Management, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Genming Zhao
- School of Public Hsealth, Fudan University, Shanghai, China
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16
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Grubbs A, Barber EL, Roque DR. Healthcare Disparities in Gynecologic Oncology. ADVANCES IN ONCOLOGY 2022; 2:119-128. [PMID: 35669851 PMCID: PMC9165691 DOI: 10.1016/j.yao.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Affiliation(s)
- Allison Grubbs
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
| | - Emma L Barber
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Dario R Roque
- Department of Obstetrics and Gynecology, Feinberg School of Medicine, Northwestern University, Chicago, IL 60611, USA
- Robert H Lurie Comprehensive Cancer Center, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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17
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Luo C, Li N, Lu B, Cai J, Lu M, Zhang Y, Chen H, Dai M. Global and regional trends in incidence and mortality of female breast cancer and associated factors at national level in 2000 to 2019. Chin Med J (Engl) 2022; 135:42-51. [PMID: 34593698 PMCID: PMC8850868 DOI: 10.1097/cm9.0000000000001814] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Female breast cancer (FBC) has become the most prevalent malignancy worldwide. We aimed to evaluate the global and regional burden in epidemiological trends and factors associated with the incidence and mortality of FBC. METHODS FBC incidence and mortality in 60 selected countries by cancer registry data integrity in 2020 were estimated from the GLOBOCAN database, and their association with the human development index (HDI) was further evaluated. Trends of age-standardized rates of incidence and mortality in 60 countries from 2000 through 2019 were evaluated by joinpoint regression analysis using data of Global Burden of Disease 2019. The association between potential behavioral, metabolic, and socioeconomic risk factor exposure at the nation level retrieved from the World Bank and Global Health Observatory and the incidence and mortality of FBC were evaluated by multivariate linear regression. RESULTS FBC incidence and mortality varied greatly in the 60 included countries. Higher incidence and mortality rates were typically observed in countries with higher HDIs and vice versa. During 2000 to 2019, significantly increasing trends in incidence and mortality were observed in 26 (average annual percent changes [AAPCs], 0.35-2.96) and nine countries (AAPC, 0.30-1.65), respectively, while significantly decreasing trends in both incidence and mortality were observed in 22 countries, most of which were high-HDI countries. Among the population aged ≥40 years, there were 26 and 11 countries showing significantly increased trends in incidence and mortality, respectively. Ecological analysis showed that countries with higher prevalence rates of high cholesterol and higher health expenditures were more likely to have higher FBC incidence, and countries with higher rates of obesity and poorer universal health coverage were more likely to have higher FBC mortality. CONCLUSIONS Despite decreased or stabilized FBC incidence and mortality rates were observed in some countries with high HDI over the past decades, disease burden became even severer in developing countries, especially for the population aged ≥40 years. Effective targeted preventive programs are strongly encouraged to reduce the FBC disease burden worldwide.
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Affiliation(s)
- Chenyu Luo
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Na Li
- Department of Cancer Prevention, Hunan Cancer Hospital, Changsha, Hunan 410006, China
| | - Bin Lu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Jie Cai
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Ming Lu
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Yuhan Zhang
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Hongda Chen
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
| | - Min Dai
- Office of Cancer Screening, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China
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18
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Kalan Farmanfarma K, Mahdavifar N, Kiasara SH, Hassanipour S, Salehiniya H. Determinants of mammography screening in Iranian women: A systematic review and meta-analysis. Breast Dis 2022; 41:279-294. [PMID: 35634841 DOI: 10.3233/bd-210037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Mammography is the most effective method for early detection of breast cancer (BC), however, it has performed in low-level. The aim of this study was to investigate the determinants of mammography in Iran. METHODS This study was a systematic review which was performed based on articles published in both Persian and English languages among Iranian patients in the period of 2000 to 2020 by using keywords of "Iran and mammography". Papers were selected from national databases including (SID, Magiran) and international database including (Scopus, PubMed and web of science), finally related articles to mammography were reviewed. RESULTS Findings indicated that 35-50% of breast cancer can be detected in the early stages by mammography, however, it is in low rate of performance among Iranian women. Age, age of menarche, occupation, family history, marital status, family support, number of pregnancies, physician recommendations, perceived sensibility and severity, self-efficacy and perceived benefits are the most important predictors of performing mammography in Iran. CONCLUSION Due to the growing trend of breast cancer cases in the country and low mammography rates in Iranian population, high risk groups such as women with BC family history, low income level, low education level, older age and people with history of breast complications were more emphasized for performing mammography through health centers. Therefore, appropriate planning to reduce the barriers of mammography could be helpful.
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Affiliation(s)
- Khadijeh Kalan Farmanfarma
- Department of Epidemiology & Biostatistics, Health Promotion Research Centre, Zahedan University of Medical Sciences, Zahedan, Iran
| | - Neda Mahdavifar
- Department of Biostatistics and Epidemiology, School of Health, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | | | - Soheil Hassanipour
- Gastrointestinal and Liver Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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19
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Nathalie H, Steele V, Miguel M, Laura M, Brigit H, Andrea B, Cohen Deborah J, DeVoe Jennifer E. Effectiveness of an insurance enrollment support tool on insurance rates and cancer prevention in community health centers: a quasi-experimental study. BMC Health Serv Res 2021; 21:1186. [PMID: 34717616 PMCID: PMC8557589 DOI: 10.1186/s12913-021-07195-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 10/19/2021] [Indexed: 11/21/2022] Open
Abstract
Background Following the ACA, millions of people gained Medicaid insurance. Most electronic health record (EHR) tools to date provide clinical-decision support and tracking of clinical biomarkers, we developed an EHR tool to support community health center (CHC) staff in assisting patients with health insurance enrollment documents and tracking insurance application steps. The objective of this study was to test the effectiveness of the health insurance support tool in (1) assisting uninsured patients gaining insurance coverage, (2) ensuring insurance continuity for patients with Medicaid insurance (preventing coverage gaps between visits); and (3) improving receipt of cancer preventive care. Methods In this quasi-experimental study, twenty-three clinics received the intervention (EHR-based insurance support tool) and were matched to 23 comparison clinics. CHCs were recruited from the OCHIN network. EHR data were linked to Medicaid enrollment data. The primary outcomes were rates of uninsured and Medicaid visits. The secondary outcomes were receipt of recommended breast, cervical, and colorectal cancer screenings. A comparative interrupted time-series using Poisson generalized estimated equation (GEE) modeling was performed to evaluate the effectiveness of the EHR-based tool on the primary and secondary outcomes. Results Immediately following implementation of the enrollment tool, the uninsured visit rate decreased by 21.0% (Adjusted Rate Ratio [RR] = 0.790, 95% CI = 0.621–1.005, p = .055) while Medicaid-insured visits increased by 4.5% (ARR = 1.045, 95% CI = 1.013–1.079) in the intervention group relative to comparison group. Cervical cancer preventive ratio increased 5.0% (ARR = 1.050, 95% CI = 1.009–1.093) immediately following implementation of the enrollment tool in the intervention group relative to comparison group. Among patients with a tool use, 81% were enrolled in Medicaid 12 months after tool use. For the 19% who were never enrolled in Medicaid following tool use, most were uninsured (44%) at the time of tool use. Conclusions A health insurance support tool embedded within the EHR can effectively support clinic staff in assisting patients in maintaining their Medicaid coverage. Such tools may also have an indirect impact on evidence-based practice interventions, such as cancer screening. Trial registration This study was retrospectively registered on February 4th, 2015 with Clinicaltrials.gov (#NCT02355262). The registry record can be found at https://www.clinicaltrials.gov/ct2/show/NCT02355262.
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Affiliation(s)
- Huguet Nathalie
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Valenzuela Steele
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Marino Miguel
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Division of Biostatistics, School of Public Health, Oregon Health & Science University - Portland State University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Moreno Laura
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Hatch Brigit
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.,Research Department, OCHIN Inc, 1881 SW Naito Pkwy, Portland, OR, 97201, USA
| | - Baron Andrea
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - J Cohen Deborah
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - E DeVoe Jennifer
- Department of Family Medicine, Oregon Health & Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
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20
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Bradley L. A most vulnerable population: Black men. Nurs Forum 2021; 57:177-181. [PMID: 34549426 DOI: 10.1111/nuf.12653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 08/16/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022]
Abstract
Black men disproportionately experience the worst health outcomes among U.S. populations. Systemic social, political, and healthcare problems are important intersecting issues of Black men's poor health outcomes. As nursing is one of the most trusted professions, it is nurses' responsibilities to include care for vulnerable populations. In this creative controversy an alternative perspective of Black men as a vulnerable population is proposed. Potential tensions and an introspective call to action for all nurses is included.
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Affiliation(s)
- Linda Bradley
- New York City College of Technology, Brooklyn, New York, USA
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21
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Johnston FM, Yeo HL, Clark C, Stewart JH. Bias Issues in Colorectal Cancer Management: A Review. Ann Surg Oncol 2021; 29:2166-2173. [PMID: 34142287 DOI: 10.1245/s10434-021-10232-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/02/2021] [Indexed: 12/11/2022]
Abstract
Based on census data, over one-third of the US population identifies as a racial or ethnic minority. This group of racial and ethnic minorities is more likely to develop cancer and die from it when compared with the general population of the USA. These disparities are most pronounced in the African American community. Despite overall CRC rates decreasing nationally and within certain racial and ethnic minorities in the USA, there continue to be disparities in incidence and mortality when compared with non-Hispanic Whites. The disparities in CRC incidence and mortality are related to systematic racism and bias inherent in healthcare systems and society. Disparities in CRC management will continue to exist until specific interventions are implemented in the context of each racial and ethnic group. This review's primary aim is to highlight the disparities in CRC among African Americans in the USA. For surgeons, understanding these disparities is formative to creating change and improving the quality of care, centering equity for all patients.
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Affiliation(s)
- Fabian M Johnston
- Division of Surgical Oncology, Department of Surgery, Johns Hopkins University, Baltimore, MD, USA.
| | - Heather L Yeo
- Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medicine, New York, NY, USA
| | - Callisia Clark
- Department of Surgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - John H Stewart
- Department of Surgery, The University of Illinois at Chicago, Chicago, IL, USA.,University of Illinois Cancer Center, Chicago, IL, USA
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22
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Lam V, Scott R, Billings P, Cabebe E, Young R. Utility of incorporating a gene-based lung cancer risk test on uptake and adherence in a community-based lung cancer screening pilot study. Prev Med Rep 2021; 23:101397. [PMID: 34040933 PMCID: PMC8142278 DOI: 10.1016/j.pmedr.2021.101397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Revised: 03/31/2021] [Accepted: 05/08/2021] [Indexed: 11/24/2022] Open
Abstract
Based on the results of randomized control trials, screening for lung cancer using computed tomography (CT) is now widely recommended. However, adherence to screening remains an issue outside the clinical trial setting. This study examines the utility of biomarker-based risk assessment on uptake and subsequent adherence in a community screening study. In a single arm pilot study, current or former smokers > 50 years old with 20 + pack year history were recruited following local advertising. One hundred and fifty seven participants volunteered to participate in the study that offered an optional gene-based lung cancer risk assessment followed by low-dose CT according to a standardised screening protocol. All 157 volunteers who attended visit 1 underwent the gene-based risk assessment comprising of a clinical questionnaire and buccal swab. Of this group, 154 subsequently attended for CT screening (98%) and were followed prospectively for a median of 2.7 years. A participant’s adherence to screening was influenced by their baseline lung cancer risk category, with overall adherence in those with a positive scan being significantly greater in the “very high” risk group compared to “moderate” and “high” risk categories (71% vs 52%, Odds ratio = 2.27, 95% confidence interval of 1.02–5.05, P = 0.047). Those in the “moderate” risk group were not different to those in the “high” risk group (52% and 52%, P > 0.05). In this proof-of-concept study, personalised gene-based lung cancer risk assessment was well accepted, associated with a 98% uptake for screening and increased adherence for those in the highest risk group.
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Affiliation(s)
- V.K. Lam
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
- El Camino Hospital, Mountain View, CA, USA
| | - R.J. Scott
- Department of Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland Hospital, New Zealand
- Corresponding author at: Medicine and Molecular Genetics, P. O. Box 26161 Epsom, Auckland 1344, New Zealand.
| | | | - E. Cabebe
- El Camino Hospital, Mountain View, CA, USA
| | - R.P. Young
- Department of Medicine, Faculty of Medical and Health Science, University of Auckland, Auckland Hospital, New Zealand
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Sandler KL, Haddad DN, Paulson AB, Osterman TJ, Scott CC, Poulos EA, Deppen SA. Women screened for breast cancer are dying from lung cancer: An opportunity to improve lung cancer screening in a mammography population. J Med Screen 2021; 28:488-493. [PMID: 33947284 DOI: 10.1177/09691413211013058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Lung cancer is the leading cancer killer in women, resulting in more deaths than breast, cervical and ovarian cancer combined. Screening for lung cancer has been shown to significantly reduce mortality, with some evidence that women may have a greater benefit. This study demonstrates that a population of women being screened for breast cancer may greatly benefit from screening for lung cancer. METHODS Data from 18,040 women who were screened for breast cancer in 2015 at two imaging facilities that also performed lung screening were reviewed. A natural language-processing algorithm followed by a manual chart review identified women eligible for lung cancer screening by U.S. Preventive Services Task Force (USPSTF) criteria. A chart review of these eligible women was performed to determine subsequent enrollment in a lung screening program (2016-2019), current screening eligibility, cancer diagnoses and cancer-related outcomes. RESULTS Natural language processing identified 685 women undergoing screening mammography who were also potentially eligible for lung screening based on age and smoking history. Manual chart review confirmed 251 were eligible under USPSTF criteria. By June 2019, 63 (25%) had enrolled in lung screening, of which three were diagnosed with screening-detected lung cancer resulting in zero deaths. Of 188 not screened, seven were diagnosed with lung cancer resulting in five deaths by study end. Four women received a diagnosis of breast cancer with no deaths. CONCLUSION Women screened for breast cancer are dying from lung cancer. We must capitalize on reducing barriers to improve screening for lung cancer among high-risk women.
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Affiliation(s)
- Kim L Sandler
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Diane N Haddad
- Division of Surgical Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Alexis B Paulson
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Travis J Osterman
- Department of Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, TN, USA.,Department of Biomedical Informatics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carolyn C Scott
- Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA
| | - Eric A Poulos
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Stephen A Deppen
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.,Nashville, Tennessee Valley Healthcare System - Veterans Affairs, Nashville, TN, USA
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Sutton MY, Anachebe NF, Lee R, Skanes H. Racial and Ethnic Disparities in Reproductive Health Services and Outcomes, 2020. Obstet Gynecol 2021; 137:225-233. [PMID: 33416284 PMCID: PMC7813444 DOI: 10.1097/aog.0000000000004224] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 10/15/2020] [Accepted: 10/29/2020] [Indexed: 11/26/2022]
Abstract
Racial and ethnic disparities in women's health have existed for decades, despite efforts to strengthen women's reproductive health access and utilization. Recent guidance by the American College of Obstetricians and Gynecologists (ACOG) underscores the often unacknowledged and unmeasured role of racial bias and systemic racial injustice in reproductive health disparities and highlights a renewed commitment to eliminating them. Reaching health equity requires an understanding of current racial-ethnic gaps in reproductive health and a concerted effort to develop and implement strategies to close gaps. We summarized national data for several reproductive health measures, such as contraceptive use, Pap tests, mammograms, maternal mortality, and unintended pregnancies, by race-ethnicity to inform health-equity strategies. Studies were retrieved by systematically searching the PubMed (2010-2020) electronic database to identify most recently published national estimates by race-ethnicity (non-Hispanic Black or African American, Hispanic or Latinx, and non-Hispanic White women). Disparities were found in each reproductive health category. We describe relevant components of the Affordable Care Act (ACA) and the Preventing Maternal Deaths Act, which can help to further strengthen reproductive health care, close gaps in services and outcomes, and decrease racial-ethnic reproductive health disparities. Owing to continued diminishment of certain components of the ACA, to optimally reach reproductive health equity, comprehensive health insurance coverage is vital. Strengthening policy-level strategies, along with ACOG's heightened commitment to eliminating racial disparities in women's health by confronting bias and racism, can strengthen actions toward reproductive health equity.
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Affiliation(s)
- Madeline Y Sutton
- Department of Obstetrics and Gynecology, Morehouse School of Medicine, Atlanta Georgia
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Sabatino SA, Thompson TD, White MC, Shapiro JA, de Moor J, Doria-Rose VP, Clarke T, Richardson LC. Cancer Screening Test Receipt - United States, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2021; 70:29-35. [PMID: 33444294 PMCID: PMC7808714 DOI: 10.15585/mmwr.mm7002a1] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abdalla E, Troy R, Fall S, Elhussin I, Egiebor-Aiwan O, Nganwa D. Racial differences in 5-year relative survival rates of cervical cancer by stage at diagnosis, between African American (black) and white women, living in the state of Alabama, USA. BMC Cancer 2020; 20:830. [PMID: 32873252 PMCID: PMC7465406 DOI: 10.1186/s12885-020-07338-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/25/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Our objective was to assess racial differences in the 5-year relative survival rates (RSRs) of Cervical Cancer (CerCancer) by stage at diagnosis, between Black and White women, living in Alabama, USA. METHODS Data for 3484 Blacks and 21,059 Whites diagnosed with CerCancer were extracted from the 2004 to 2013 Surveillance, Epidemiology, and End Results (SEER) database. We incorporated age groups, CerCancer stages, county, and year of diagnosis to compare the RSR between Blacks and Whites, using SEER*Stat software. RESULTS In urban, Black Belt (BB) and other rural counties, Whites diagnosed with localized stage of CerCancer always had better chances of survival because their RSRs were always more than 77%, compared to Blacks. Only exception was in Blacks living in other rural counties, who had a significantly higher RSR of 83.8% (95% Cl, 74.2-90.1). Which was the same as in Whites (83.8% (95% CI 74.5-89.9) living in BBC. Although, in other rural counties, Whites had a slightly lower RSR of 83.7% (95% CI 79.9-86.8%), their RSR was better compared to Blacks and Whites living in BB and other rural counties who had slightly higher RSRs of 83.8%. This was due to statistical precision, which depended on their larger sample size and a lower variability therefore, more reliability resulting in a tighter confidence interval with a smaller margin of error. In all the three county groups, Whites 15-44 years old diagnosed with localized stage of CerCancer had a higher RSR of 93.6% (95% CI 91.4-95.2%) for those living in urban and BB counties, and 94.6% (95% CI 93.6-95.4) for those living in other rural counties. The only exception was in Blacks 65-74 years old living in other rural counties who had the highest RSR of 96.9% (95% Cl, 82.9-99.5). However, Whites were considered to have a better RSR. This was also due to the statistical precision as mentioned above. CONCLUSION There were significant racial differences in the RSRs of CerCancer. Overall, Black women experienced the worst RSRs compared to their White counterparts.
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Affiliation(s)
- Ehsan Abdalla
- Department of Graduate Public Health (College of Veterinary Medicine), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Roberta Troy
- Biology Department (College of Arts and Sciences), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Souleymane Fall
- Department of Agriculture and Environmental Sciences (College of Agriculture, Environment and Nutrition Sciences), Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Isra Elhussin
- Integrative Biosciences PhD program, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
| | - Oyoyo Egiebor-Aiwan
- Southern Illinois School of Medicine, 2711 Covered Wagon, Trail Springfield, IL 62711 USA
| | - David Nganwa
- Department of Pathobiology/Department of Graduate Public Health, Tuskegee University, 1200 W Montgomery Rd, Tuskegee, AL 36088 USA
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Li Y, Zhu MX, Zhang B. The impact of insurance status on the survival outcomes of patients with renal cell carcinoma. Transl Androl Urol 2020; 9:1678-1690. [PMID: 32944529 PMCID: PMC7475676 DOI: 10.21037/tau-20-1045] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background The impact of insurance status on renal cell carcinoma (RCC) patient survival is unclear. In this study, we investigated the effects of insurance status on the survival outcomes of RCC patients in the United States of America. Methods Data of patients diagnosed with RCC between 2007 and 2014 were obtained from the Surveillance, Epidemiology and End Results (SEER) database, a large national database including statistics on cancer patients. The Kaplan-Meier method and Cox regression analysis were used to determine the influence of insurance status on cancer-specific survival (CSS). Results A total of 30,951 eligible RCC patients were identified. Of these patients, 25,493 (82.37%) were insured, 3,959 (12.79%) had any Medicaid coverage, and 1,499 (4.84%) were uninsured. Kaplan-Meier analysis revealed that insurance status was associated with better CCS (P<0.001). The 5-year CSS rates of patients with insurance, any Medicaid, and no insurance were 88.3%, 82.6%, and 82.7%, respectively. Multivariate Cox regression analysis showed that patients with any Medicaid had poorer CSS than insured patients [hazard ratio (HR), 1.222; 95% confidence interval (CI), 1.100–1.357]. Stratified analysis revealed that at localized tumor stage and at regional tumor stage or among white patients, any Medicaid insurance was an independent predictor of an unfavorable survival outcome. Conclusions Among the RCC patients in this study, individuals with insurance experienced improved CSS while individuals with any Medicaid tended to suffer worse survival outcomes.
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Affiliation(s)
- Yan Li
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Ming-Xi Zhu
- Department of Anatomy, School of Basic Medicine and Life Science, Hainan Medical University, Haikou, China
| | - Bing Zhang
- Department of Anesthesiology, the Fourth Affiliated Hospital of Harbin Medical University, Harbin, China
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Wenzel M, Humke C, Wicker S, Mani J, Engl T, Hintereder G, Vogl TJ, Wild P, Köllermann J, Rödel C, Asgharie S, Theissen L, Welte M, Kluth LA, Mandel P, Chun FKH, Preisser F, Becker A. [Movember health care initiative 2019: prostate cancer screening at the University Hospital Frankfurt]. Urologe A 2020; 59:1237-1245. [PMID: 32617622 PMCID: PMC7547026 DOI: 10.1007/s00120-020-01265-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund Männer in Deutschland sterben früher als Frauen und nehmen weniger häufig Krebsvorsorgeuntersuchungen wahr. Fragestellung Ziel war die prospektive Evaluation einer „Movember-Gesundheitsinitiative“ am Universitätsklinikum Frankfurt (UKF) im November 2019. Methoden Im Rahmen der „Movember-Gesundheitsinitiative“ wurde allen männlichen Mitarbeitern des UKF ab dem 45. Lebensjahr und bei erstgradiger familiärer Vorbelastung eines Prostatakarzinoms ab dem 40. Lebensjahr im November 2019 gemäß S3-Leitlinien der Deutschen Gesellschaft für Urologie (DGU) eine Prostatakarzinom-Vorsorgeuntersuchung angeboten. Ergebnisse Insgesamt nahmen 14,4 % der Mitarbeiter teil. Eine familiäre Vorbelastung gaben insgesamt 14,0 % Teilnehmer an. Das mediane Alter betrug 54 Jahre. Der mediane PSA(prostataspezifisches Antigen)-Wert lag bei 0,9 ng/ml, der mediane PSA-Quotient bei 30 %. Bei 5 % (n = 6) zeigte sich ein suspekter Tastbefund in der DRU (digital-rektale Untersuchung). Nach Altersstratifizierung (≤ 50 vs. > 50 Lebensjahre) zeigten sich signifikante Unterschiede im medianen PSA-Wert (0,7 ng/ml vs. 1,0 ng/ml, p < 0,01) und der bereits zuvor durchgeführten urologischen Vorsorge (12,1 vs. 42,0 %, p < 0,01). Vier Teilnehmer (3,3 %) zeigten erhöhte Gesamt-PSA-Werte. Bei 32,2 % der Teilnehmer zeigte sich mindestens ein kontrollbedürftiger Befund. Insgesamt wurden 6 Prostatabiopsien durchgeführt. Hierbei zeigte sich in einem Fall ein intermediate-risk Prostatakarzinom (Gleason 3 + 4, pT3a, pPn1, pNx, R0). Schlussfolgerungung Im Rahmen der UKF-Movember-Gesundheitsinitiative 2019 konnten durch ein Vorsorgeangebot 121 Männer für eine Prostatakrebs-Vorsorge inklusive PSA-Testung gewonnen werden. Auffällige/kontrollbedürftige Befunde zeigten sich bei 32,2 %. Bei einem Mitarbeiter wurde ein therapiebedürftiges Prostatakarzinom entdeckt und therapiert.
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Affiliation(s)
- M Wenzel
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - C Humke
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - S Wicker
- Betriebsärztlicher Dienst, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - J Mani
- Urogate Praxis, Frankfurt, Deutschland
| | - T Engl
- Urogate Praxis, Frankfurt, Deutschland
| | - G Hintereder
- Zentrallabor, Zentrum der Inneren Medizin, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - T J Vogl
- Zentrum für diagnostische und interventionelle Radiologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - P Wild
- Dr. Senkenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - J Köllermann
- Dr. Senkenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - C Rödel
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum Frankfurt, Frankfurt, Deutschland
| | - S Asgharie
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - L Theissen
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - M Welte
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - L A Kluth
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - P Mandel
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - F K H Chun
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
| | - F Preisser
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| | - A Becker
- Klinik für Urologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland
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Lal N, Singh HK, Majeed A, Pawa N. The impact of socioeconomic deprivation on the uptake of colorectal cancer screening in London. J Med Screen 2020; 28:114-121. [PMID: 32295488 DOI: 10.1177/0969141320916206] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Screening programmes based on the faecal occult blood test (FOBT) can reduce mortality from colorectal cancer (CRC). However, a significant variation exists in uptake of the test within the UK. Disproportionate uptake risks increasing inequity during staging at diagnosis and survival from CRC. This study aims to evaluate the impact of socioeconomic deprivation on the uptake of CRC screening (FOBT) in London. METHODS A retrospective review of the "Vanguard RM Informatics" database was performed to identify eligible individuals for CRC screening across all general practices across London over 30 months (2014-2017). The postcodes of the general practices were used to obtain the deprivation data via the "Indices of Deprivation" database. A Spearman's rho correlation was performed to quantify the impact of the deprivation variables on FOBT uptake. RESULTS Overall, 697,402 individuals were eligible for screening across 1359 London general practices, within 5 Clinical Commissioning Groups (CCGs); 48.4% (range: 13%-74%) participated in CRC screening with the lowest participation rates in North West (46%) and North East (47%) London CCGs. All indices of deprivation had a significant correlation with the uptake of FOBT (p < 0.01). CONCLUSION This is the largest study across London to date demonstrating a significant positive correlation between deprivation indices and FOBT uptake, highlighting areas of particular risk. Further studies are imperative to quantify the impact of deprivation on CRC morbidity and mortality, together with focused strategies to reduce socioeconomic inequalities in screening in these high risk areas.
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Affiliation(s)
- Nikhil Lal
- Sheffield Teaching Hospital NHS Foundation Trust, Sheffield, UK
| | - Harpreet Ksi Singh
- Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
| | - Azeem Majeed
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Nikhil Pawa
- Colorectal Surgical Department, West Middlesex University Hospital, Chelsea and Westminster NHS Foundation Trust, Isleworth, UK
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Atti del 52° Congresso Nazionale: Società Italiana di Igiene, Medicina Preventiva e Sanità Pubblica (SItI). JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2019; 60:E1-E384. [PMID: 31777763 PMCID: PMC6865078 DOI: 10.15167/2421-4248/jpmh2019.60.3s1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Miles RC, Narayan AK, Lopez DB, Lehman CD, Harvey HB, Mishra V, Glover M, Flores EJ. Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence. J Womens Health (Larchmt) 2019; 28:1378-1383. [DOI: 10.1089/jwh.2018.7315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Randy C. Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K. Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B. Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - H. Benjamin Harvey
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J. Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Tanjasiri SP, Mouttapa M, Sablan-Santos L, Weiss JW, Chavarria A, Lacsamana JD, May VT, Quitugua L, Tupua M, Schmidt-Vaivao D. Design and Outcomes of a Community Trial to Increase Pap Testing in Pacific Islander Women. Cancer Epidemiol Biomarkers Prev 2019; 28:1435-1442. [PMID: 31186260 DOI: 10.1158/1055-9965.epi-18-1306] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 02/08/2019] [Accepted: 06/05/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pap tests remain an essential cervical cancer detection method in the United States, yet they are underutilized among Pacific Islanders (PI) who experience elevated cervical cancer incidence and mortality. This study describes the design, methods, participants, and outcomes of a multiyear (2010-2016), community-based randomized intervention trial in southern California. Based upon strong collectivistic norms, the trial tested the efficacy of a unique social support intervention targeting Chamorro, Samoan, and Tongan women and their male husbands/partners. METHODS A single-session educational intervention was designed and tailored for ethnic- and gender-specific groups to increase men's social support for their female wives/partners to receive a Pap test, and for women to receive a Pap test. The comparison group received preexisting brochures on Pap testing (for women) or general men's health (for men). Pretest and 6-month follow-up data were analyzed. RESULTS Intervention and comparison groups were mostly equivalent on pretest demographics and outcome variables. Intervention women who were not compliant with Pap screening recommendations at pretest were significantly more likely to have scheduled and received a Pap test at 6-month follow-up. However, 6-month follow-up results indicated no intervention effect on changes in women's Pap testing knowledge, fatalistic attitudes, or perceived social support from their male partner. CONCLUSIONS Ethnic- and gender-tailored community interventions can successfully increase Pap test behaviors for PI women, although more research is needed on the specific pathways leading to behavior change. IMPACT Collaborative community-based interventions lead to increases in women's cancer prevention and early detection for Pacific Islander and other collectivistic communities.
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Affiliation(s)
| | - Michele Mouttapa
- Department of Public Health, California State University, Fullerton
| | | | - Jie W Weiss
- Department of Public Health, California State University, Fullerton
| | | | | | - Vanessa Tuiòne May
- Tongan Community Service Center/Special Service for Groups, Inc., Los Angeles, California
| | | | - Marina Tupua
- Samoan National Nurses Association, Long Beach, California
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Tchounga B, Boni SP, Koffi JJ, Horo AG, Tanon A, Messou E, Koulé SO, Adoubi I, Ekouevi DK, Jaquet A. Cervical cancer screening uptake and correlates among HIV-infected women: a cross-sectional survey in Côte d'Ivoire, West Africa. BMJ Open 2019; 9:e029882. [PMID: 31473620 PMCID: PMC6720463 DOI: 10.1136/bmjopen-2019-029882] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVES Despite the increasing number of interventions aiming to integrate cervical cancer screening into HIV clinics in sub-Saharan Africa, Women living with HIV (WLHIV) still have a high risk of developing cervical cancer. The aim of this study was to estimate the coverage of cervical cancer screening and associated factors among WLHIV in Abidjan, Côte d'Ivoire. DESIGN Cross-sectional survey conducted from May to August 2017. SETTINGS Outpatient setting in the four highest volume urban HIV clinics of government's or non-governmental organisation's sector in Côte d'Ivoire. PARTICIPANTS All WLHIV, aged 25-55 years, followed since at least 1 year, selected through a systematic sampling procedure. INTERVENTION A standardised questionnaire administered to each participant by trained healthcare workers. OUTCOME Cervical cancer screening uptake. RESULTS A total of 1991 WLHIV were included in the study, aged in median 42 years (IQR 37-47), and a median CD4 count (last known) of 563 (378-773) cells/mm3. Among the participants, 1913 (96.1%) had ever heard about cervical cancer, 1444 (72.5%) had been offered cervical cancer screening, mainly in the HIV clinic for 1284 (88.9%), and 1188 reported a personal history of cervical cancer screening for an overall coverage of 59.7% (95% CI 57.6 to 62.0). In multivariable analysis, university level (adjusted OR (aOR) 2.1; 95% CI 1.4 to 3.1, p<0.001), being informed on cervical cancer at the HIV clinic (aOR 1.5; 95% CI 1.1 to 2.0, p=0.017), receiving information self-perceived as 'clear and understood' on cervical cancer (aOR 1.7; 95% CI 1.4 to 2.2, p<0.001), identifying HIV as a risk factor for cervical cancer (aOR 1.4; 95% CI 1.1 to 1.8, p=0.002) and being proposed cervical cancer screening in the HIV clinic (aOR 10.1; 95% CI 7.6 to 13.5, p<0.001), were associated with cervical cancer screening uptake. CONCLUSION Initiatives to support cervical cancer screening in HIV care programmes resulted in effective access to more than half of the WLHIV in Abidjan. Efforts are still needed to provide universal access to cervical cancer screening, especially among socioeconomically disadvantaged WLHIV.
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Affiliation(s)
- Boris Tchounga
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
- Public Health Evaluation and Research, Elizabeth Glaser Pediatric AIDS Foundation, Yaounde, Center, Cameroon
| | - Simon Pierre Boni
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
- Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d'Ivoire
| | - Jean Jacques Koffi
- Operations Research IeDEA, Programme PACCI, Site ANRS, Abidjan, Lagune, Côte d'Ivoire
| | - Apollinaire G Horo
- Service de Gynécologie obstétrique, CHU de Yopougon, Abidjan, Lagune, Côte d'Ivoire
| | - Aristophane Tanon
- Service des Maladies Infectieuses et Tropicales, CHU de Treichville, Abidjan, Côte d'Ivoire
| | - Eugène Messou
- Centre de Prise en Charge de Recherche et de Formation CEPREF, Abidjan, Côte d'Ivoire
| | - Serge-Olivier Koulé
- Unité de soins ambulatoires et de conseils d'Abidjan, USAC, Abdjan, Côte d'Ivoire
| | - Innocent Adoubi
- Research, Programme National de Lutte contre le Cancer, Abidjan, Lagune, Côte d'Ivoire
- Service de cancérologie CHU de Treichville, Abidjan, Lagune, Côte d'Ivoire
| | - Didier K Ekouevi
- Département des Sciences Fondamentales et Santé Publique, Université de Lomé, Lome, Togo
- Centre Inserm 1219 and Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, Girond, France
| | - Antoine Jaquet
- Centre Inserm 1219 and Institut de Santé Publique d'épidémiologie et de développement, Université de Bordeaux, Bordeaux, Girond, France
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Awuor L, Melles S. The influence of environmental and health indicators on premature mortality: An empirical analysis of the City of Toronto's 140 neighborhoods. Health Place 2019; 58:102155. [DOI: 10.1016/j.healthplace.2019.102155] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 05/28/2019] [Accepted: 06/14/2019] [Indexed: 10/26/2022]
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Peisl S, Zimmermann S, Camey B, Betticher D, Bouchardy C. Comparison between opportunistic and organised breast cancer mammography screening in the Swiss canton of Fribourg. BMC Cancer 2019; 19:469. [PMID: 31101028 PMCID: PMC6525418 DOI: 10.1186/s12885-019-5706-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 05/13/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Breast cancer screening mammography is widespread in industrialised countries within the framework of public health program or opportunist form. Only few data exist on the comparison of effectiveness between organised and opportunistic screening. The aim of this study is to compare organised and opportunistic screening using population-based data from the Fribourg cancer registry, Switzerland. METHODS We included all first primary breast adenocarcinoma diagnosed between 2006 and 2014 in women aged 50-69 years resident in the canton of Fribourg. We considered only breast cancer discovered by mammography screening. We compared patients, tumour characteristics and treatment modalities between breast cancer detected by the organised screening program versus opportunistic screening using logistic regression. RESULTS Out of 989 patients diagnosed with breast cancer, 402 (40.6%) were diagnosed by organised and 205 (20.7%) by opportunistic screening. Women with breast cancer detected within the screening program were more likely to be from rural areas (P = 0.035) and lived less frequently in high favoured regions (P = 0.020). They presented more frequently in situ than invasive cancer (P = 0.022). For patients with invasive breast cancer, those detected by the program were less likely to undergo mastectomy (P = 0.06) and consequently, they were more likely to undergo radiation therapy (P = 0.003). Adjustment for area of residence and financial context of the region did not modify the results presented. CONCLUSIONS The present study reports an increased rate of detection of carcinoma in situ in organised screening program as compared to opportunistic screening mammographies, an indirect evidence of a higher radiologic sensitivity. Furthermore, the results show a trend towards more mastectomies among patients with breast cancer discovered after opportunistic than after organized mammography screening, reflecting lower treatment burden. Those results were independent of socio-economic factors which differed across screening groups.
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Affiliation(s)
- Sarah Peisl
- Department of Oncology, HFR Fribourg Hopital cantonal, CH-1708 Fribourg, Switzerland
| | - Stefan Zimmermann
- Department of Oncology, HFR Fribourg Hopital cantonal, CH-1708 Fribourg, Switzerland
| | - Bertrand Camey
- Cancer Registry of Fribourg, Rte St-Nicolas-de-Flüe 2, CH-1701 Fribourg, Switzerland
| | - Daniel Betticher
- Department of Oncology, HFR Fribourg Hopital cantonal, CH-1708 Fribourg, Switzerland
| | - Christine Bouchardy
- Geneva Cancer Registry, IGH – University of Geneva, CH-1211 Geneva 4, Switzerland
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Han HR, Kim K, Cudjoe J, Kim MT. Familiarity, Navigation, and Comprehension: Key Dimensions of Health Literacy in Pap Test Use among Korean American Women. JOURNAL OF HEALTH COMMUNICATION 2019; 24:585-591. [PMID: 31046641 PMCID: PMC6803056 DOI: 10.1080/10810730.2019.1607955] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Health literacy consists of multiple dimensions such as print and oral literacy or numeracy. Different dimensions of health literacy may have more salient impact on certain health behaviors and outcomes. Yet, evidence is limited regarding which dimensions particularly affect cervical cancer screening. The objective of this study was to examine the role of different dimensions of health literacy in cervical cancer screening among Korean American women. We used baseline data obtained from 560 Korean American women in a community-based health literacy-focused intervention study. Backward stepwise logistic regression analysis revealed that familiarity (adjusted odds ratio [AOR] = 1.20, 95% confidence interval [CI] = 1.11-1.31) and navigational health literacy (AOR = 1.10, 95% CI = 1.04-1.16) were associated with lifetime Pap test use and comprehension (AOR = 1.08, 95% CI = 1.02-1.14) with triennial Pap test screening. Prior exposure to healthcare settings and knowing how to navigate the healthcare system were more important than other health literacy dimensions for lifetime Pap test use. Understanding cancer screening-related words was most relevant to triennial Pap test use. In addition to addressing system factors such as insurance and physicians' recommendations, interventions to increase Pap test screening targeted at Korean American women are needed to address certain dimensions of health literacy such as familiarity, navigation, and comprehension.
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Affiliation(s)
- Hae-Ra Han
- School of Nursing, Johns Hopkins University, Baltimore, MD
| | - Kyounghae Kim
- School of Nursing, University of Connecticut, Storrs, CT
| | | | - Miyong T. Kim
- School of Nursing, University of Texas at Austin, Austin, TX
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Testing a Religiously Tailored Intervention with Somali American Muslim Women and Somali American Imams to Increase Participation in Breast and Cervical Cancer Screening. J Immigr Minor Health 2019; 22:87-95. [DOI: 10.1007/s10903-019-00881-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hughes AE, Tiro JA, Balasubramanian BA, Skinner CS, Pruitt SL. Social Disadvantage, Healthcare Utilization, and Colorectal Cancer Screening: Leveraging Longitudinal Patient Address and Health Records Data. Cancer Epidemiol Biomarkers Prev 2018; 27:1424-1432. [PMID: 30135072 PMCID: PMC6279539 DOI: 10.1158/1055-9965.epi-18-0446] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/11/2018] [Accepted: 08/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Social disadvantage predicts colorectal cancer outcomes across the cancer care continuum for many populations and places. For medically underserved populations, social disadvantage is likely intersectional-affecting individuals at multiple levels and through membership in multiple disadvantaged groups. However, most measures of social disadvantage are cross-sectional and limited to race, ethnicity, and income. Linkages between electronic health records (EHR) and external datasets offer rich, multilevel measures that may be more informative. METHODS We identified urban safety-net patients eligible and due for colorectal cancer screening from the Parkland-UT Southwestern PROSPR cohort. We assessed one-time screening receipt (via colonoscopy or fecal immunochemical test) in the 18 months following cohort entry via the EHR. We linked EHR data to housing and Census data to generate measures of social disadvantage at the parcel- and block-group level. We evaluated the association of these measures with screening using multilevel logistic regression models controlling for sociodemographics, comorbidity, and healthcare utilization. RESULTS Among 32,965 patients, 45.1% received screening. In adjusted models, residential mobility, residence type, and neighborhood majority race were associated with colorectal cancer screening. Nearly all measures of patient-level social disadvantage and healthcare utilization were significant. CONCLUSIONS Address-based linkage of EHRs to external datasets may have the potential to expand meaningful measurement of multilevel social disadvantage. Researchers should strive to use granular, specific data in investigations of social disadvantage. IMPACT Generating multilevel measures of social disadvantage through address-based linkages efficiently uses existing EHR data for applied, population-level research.
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Affiliation(s)
- Amy E Hughes
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Jasmin A Tiro
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Bijal A Balasubramanian
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
- Department of Epidemiology, Human Genetics, and Environmental Sciences UTHealth in Dallas, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
| | - Sandi L Pruitt
- Department of Clinical Sciences, The University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas
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Ojikutu BO, Bogart LM, Higgins-Biddle M, Dale SK, Allen W, Dominique T, Mayer KH. Facilitators and Barriers to Pre-Exposure Prophylaxis (PrEP) Use Among Black Individuals in the United States: Results from the National Survey on HIV in the Black Community (NSHBC). AIDS Behav 2018; 22:3576-3587. [PMID: 29468493 PMCID: PMC6103919 DOI: 10.1007/s10461-018-2067-8] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
This study explores willingness to use PrEP among Black individuals in the US. From February to April 2016, an online survey was administered to a nationally representative sample of Black individuals. 855 individuals who were HIV negative by self-report participated [mean age: 33.6 (SD 9.2); 45.5% male]. Among all respondents, 14.5% were aware of, and 26.0% would be willing to use PrEP. Among high-risk individuals (N = 327), 19.8% knew about and 35.1% would be willing to use PrEP. The most common reason for lack of willingness among high-risk individuals was low self-perceived risk (65.1%). In multivariate analysis, individuals reporting single marital status [OR 1.8 (1.2, 2.5), p = 0.002], depressive symptoms [OR 1.6 (1.2, 2.2), p = 0.0054], arrest history [OR 1.7(1.2, 2.4), p = 0.0003], PrEP knowledge [OR 1.5 (1.0, 2.3), p = 0.0247] and belief in HIV conspiracies [OR 1.3 (1.1, 1.5), p = 0.0075] were more willing to use PrEP. Participants who saw a health care provider less frequently were less willing to use PrEP [OR 0.5 (0.4, 0.8), p = 0.0044]. Among a nationally representative sample of Black individuals, few high risk individuals were willing to use PrEP. Interventions to increase risk awareness, PrEP knowledge and access to care are necessary to improve PrEP uptake.
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Affiliation(s)
- Bisola O Ojikutu
- Brigham and Women's Hospital, Boston, 75 Francis Street, MA, 02115, USA.
- Massachusetts General Hospital, Boston, MA, USA.
| | | | | | - Sannisha K Dale
- Massachusetts General Hospital, Boston, MA, USA
- University of Miami, Coral Gables, USA
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Llanos AAM, Tsui J, Rotter D, Toler L, Stroup AM. Factors associated with high-risk human papillomavirus test utilization and infection: a population-based study of uninsured and underinsured women. BMC WOMENS HEALTH 2018; 18:162. [PMID: 30285820 PMCID: PMC6171187 DOI: 10.1186/s12905-018-0656-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/26/2018] [Indexed: 02/02/2023]
Abstract
Background Current cervical cancer screening guidelines recommend a Pap test every 3 years for women age 21–65 years, or for women 30–65 years who want to lengthen the screening interval, a combination of Pap test and high-risk human papilloma virus testing (co-testing) every 5 years. Little population-based data are available on human papilloma virus test utilization and human papilloma virus infection rates. The objective of this study was to examine the patient-level, cervical cancer screening, and area-level factors associated with human papilloma virus testing and infection among a diverse sample of uninsured and underinsured women enrolled in the New Jersey Cancer Early Education and Detection (NJCEED) Program. Methods We used data for a sample of 50,510 uninsured/underinsured women, age ≥ 29 years, who screened for cervical cancer through NJCEED between January 1, 2009 and December 31, 2015. Multivariable logistic regression models were used to estimate associations between ever having a human papilloma virus test or a positive test result, and individual- (age, race/ethnicity, birthplace) and area-level covariates (% below federal poverty level, % minority, % uninsured), and number of screening visits. Results Only 26.6% (13,440) of the sample had at least one human papilloma virus test. Among women who underwent testing, 13.3% (1792) tested positive for human papilloma virus. Most women who were positive for human papilloma virus (99.4%) had their first test as a co-test. Human papilloma virus test utilization and infection were significantly associated with age, race/ethnicity, birthplace (country), and residential area-level poverty. Rates of human papilloma virus testing and infection also differed significantly across counties in the state of New Jersey. Conclusions These findings suggest that despite access to no-cost cervical cancer screening for eligible women, human papilloma virus test utilization was relatively low among diverse, uninsured and underinsured women in New Jersey, and test utilization and infection were associated with individual-level and area-level factors.
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Affiliation(s)
- Adana A M Llanos
- Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, USA. .,Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.
| | - Jennifer Tsui
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - David Rotter
- Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA
| | - Lindsey Toler
- Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, Piscataway, NJ, USA
| | - Antoinette M Stroup
- Department of Epidemiology, Rutgers School of Public Health, 683 Hoes Lane West, Room 211, Piscataway, NJ, 08854, USA.,Division of Population Science, Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, USA.,New Jersey State Cancer Registry, New Jersey Department of Health, Trenton, NJ, USA
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Pearlstein KA, Basak R, Chen RC. Cardiovascular Care Among Cancer Survivors in the United States. JNCI Cancer Spectr 2018; 2:pky049. [PMID: 31360872 PMCID: PMC6649739 DOI: 10.1093/jncics/pky049] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Revised: 08/05/2018] [Accepted: 08/10/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Cardiovascular disease (CVD) is a leading cause of mortality among cancer survivors, but whether survivors receive routine cardiovascular monitoring and preventive care has not been well studied. This study uses a population-based dataset to examine this question. METHODS Data from the National Health Interview Survey were used to identify 13 266 cancer survivors who completed surveys from 2011 to 2015. Prevalence of CVD and associated risk factors, patterns of doctor visitation, and receipt of CVD preventive care were examined. We used multivariable logistic regression analysis to examine factors associated with the receipt of preventive care for survivors with and without CVD risk factors. RESULTS CVD risk factors were prevalent in older cancer survivors 65 years and older (56.9% with hyperlipidemia, 66.8% with hypertension) and younger survivors younger than 50 years (35.4% obese, 30.3% current smokers). Rates of blood pressure, cholesterol, and glucose monitoring were high, but rates of lifestyle modification were lower (54.8% moderate exercise, 47.1% smoking cessation attempts among smokers). Although 71.5% of survivors at 2 years or less from diagnosis saw both general and specialist doctors, only 51.6% of survivors at 5 or more years saw both, and 43.5% saw only a general doctor. On multivariable analysis, receipt of CVD preventive care was strongly associated with general doctor visitation for those with and without CVD risk factors. CONCLUSIONS CVD and associated risk factors are prevalent among both older and younger cancer survivors across the United States. This study identifies areas for improvement related to lifestyle modification in survivors, and also highlights the importance of care transition to the primary care provider for long-term survivors.
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Affiliation(s)
| | | | - Ronald C Chen
- Department of Radiation Oncology
- Lineberger Comprehensive Cancer Center
- Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC
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Sabatino SA, Thompson TD, Miller JW, Breen N, White MC, Breslau E, Shoemaker ML. Prevalence of Out-Of-Pocket Payments for Mammography Screening Among Recently Screened Women. J Womens Health (Larchmt) 2018; 28:910-918. [PMID: 30265611 DOI: 10.1089/jwh.2018.6973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Because cost may be a barrier to receiving mammography screening, cost sharing for "in-network" screening mammograms was eliminated in many insurance plans with implementation of the Affordable Care Act. We examined prevalence of out-of-pocket payments for screening mammography after elimination in many plans. Materials and Methods: Using 2015 National Health Interview Survey data, we examined whether women aged 50-74 years who had screening mammography within the previous year (n = 3,278) reported paying any cost for mammograms. Logistic regression models stratified by age (50-64 and 65-74 years) examined out-of-pocket payment by demographics and insurance (ages 50-64 years: private, Medicaid, other, and uninsured; ages 65-74 years: private ± Medicare, Medicare+Medicaid, Medicare Advantage, Medicare only, and other). Results: Of women aged 50-64 years, 23.5% reported payment, including 39.1% of uninsured women. Compared with that of privately insured women, payment was less likely for women with Medicaid (adjusted OR 0.17 [95% CI 0.07-0.41]) or other insurance (0.49 [0.25-0.96]) and more likely for uninsured women (1.99 [0.99-4.02]) (p < 0.001 across groups). For women aged 65-74 years, 11.9% reported payment, including 22.5% of Medicare-only beneficiaries. Compared with private ± Medicare beneficiaries, payment was less likely for Medicare+Medicaid beneficiaries (adjusted OR 0.21 [95% CI 0.06-0.73]) and more likely for Medicare-only beneficiaries (1.83 [1.01-3.32]) (p = 0.005 across groups). Conclusions: Although most women reported no payment for their most recent screening mammogram in 2015, some payment was reported by >20% of women aged 50-64 years or aged 65-74 years with Medicare only, and by almost 40% of uninsured women aged 50-64 years. Efforts are needed to understand why many women in some groups report paying out of pocket for mammograms and whether this impacts screening use.
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Affiliation(s)
- Susan A Sabatino
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Trevor D Thompson
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline W Miller
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Nancy Breen
- 2National Institute on Minority Health and Health Disparities, Bethesda, Maryland
| | - Mary C White
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erica Breslau
- 3Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland
| | - Meredith L Shoemaker
- 1Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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Kelly C, Pericleous M, Hendy J, de Lusignan S, Ahmed A, Vandrevala T, Ala A. Interventions to improve the uptake of screening across a range of conditions in Ethnic Minority Groups: a systematic review. Int J Clin Pract 2018; 72:e13202. [PMID: 29920875 DOI: 10.1111/ijcp.13202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 04/15/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Screening programmes are well established in cancer, and are now being implemented in other conditions. An effective screening programme leads to early disease detection and improved outcomes but its impact is dependent on the quality of the test and the proportion of the target population participating. A further consideration is that uptake of screening by minority groups is low. PURPOSE To determine which interventions have successfully increased screening uptake amongst minorities. DATA SOURCES Medline, Cochrane database and the grey literature were searched from 1990 to 1st March 2016. STUDY SELECTION Fifty-five English language studies that assessed uptake of screening in any minority population in the country of study aged over 18 years and that included a comparison arm. DATA EXTRACTION Independent data extraction was undertaken by two researchers (CK and MP), using a predesigned data extraction form (DEF) which assisted retrieval of the core contents of each study and the organisation of material. DATA SYNTHESIS Evidence was organised by screening test and type of intervention. Two authors (CK and MP) extracted data into evidence tables to enable comparison of study characteristics and findings. The heterogeneity of methods precluded a meta-analysis thus results are descriptive. Evidence was also assessed, using the Cochrane Collaboration risk of bias tables. RESULTS This systematic review appraises data from international studies on a variety of minority groups, interventions and screening programmes providing a narrative review of their success and limitations.
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Affiliation(s)
- Claire Kelly
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Marinos Pericleous
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Jane Hendy
- Brunel Business School, Brunel University, London, UK
| | - Simon de Lusignan
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
| | - Ayesha Ahmed
- Brunel Business School, Brunel University, London, UK
| | | | - Aftab Ala
- Department of Gastroenterology and Hepatology, Royal Surrey County Hospital, Guildford, Surrey, UK
- Department of Clinical and Experimental Medicine, FHMS, University of Surrey, Guildford, Surrey, UK
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Akinlotan M, Bolin JN, Helduser J, Ojinnaka C, Lichorad A, McClellan D. Cervical Cancer Screening Barriers and Risk Factor Knowledge Among Uninsured Women. J Community Health 2018; 42:770-778. [PMID: 28155005 PMCID: PMC5494033 DOI: 10.1007/s10900-017-0316-9] [Citation(s) in RCA: 109] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A steady decline in cervical cancer incidence and mortality in the United States has been attributed to increased uptake of cervical cancer screening tests such as Papanicolau (Pap) tests. However, disparities in Pap test compliance exist, and may be due in part to perceived barriers or lack of knowledge about risk factors for cervical cancer. This study aimed to assess correlates of cervical cancer risk factor knowledge and examine socio-demographic predictors of self-reported barriers to screening among a group of low-income uninsured women. Survey and procedure data from 433 women, who received grant-funded cervical cancer screenings over a span of 33 months, were examined for this project. Data included demographics, knowledge of risk factors, and agreement on potential barriers to screening. Descriptive analysis showed significant correlation between educational attainment and knowledge of risk factors (r = 0.1381, P < 0.01). Multivariate analyses revealed that compared to Whites, Hispanics had increased odds of identifying fear of finding cancer (OR 1.56, 95% CI 1.00–2.43), language barriers (OR 4.72, 95% CI 2.62–8.50), and male physicians (OR 2.16, 95% CI 1.32–3.55) as barriers. Hispanics (OR 1.99, 95% CI 1.16–3.44) and Blacks (OR 2.06, 95% CI 1.15–3.68) had a two-fold increase in odds of agreeing that lack of knowledge was a barrier. Identified barriers varied with age, marital status and previous screening. Programs aimed at conducting free or subsidized screenings for medically underserved women should include culturally relevant education and patient care in order to reduce barriers and improve screening compliance for safety-net populations.
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Affiliation(s)
- Marvellous Akinlotan
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA.
| | - Jane N Bolin
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA
| | - Janet Helduser
- Department of Health Policy & Management, Texas A&M School of Public Health, TAMU 1266, College Station, TX, 77843-1266, USA
| | - Chinedum Ojinnaka
- Department of Health Sciences, University of Missouri, Columbia, MO, 65211, USA
| | - Anna Lichorad
- Department of Clinical Translational Medicine, College of Medicine, Texas A&M Health Science Center, 2900 E. 29th Street, Bryan, TX, 77802, USA
| | - David McClellan
- Department of Clinical Translational Medicine, College of Medicine, Texas A&M Health Science Center, 2900 E. 29th Street, Bryan, TX, 77802, USA
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Leal IM, Kao LS, Karanjawala B, Escamilla RJ, Ko TC, Millas SG. Understanding Patients' Experiences of Diagnosis and Treatment of Advanced Colorectal Cancer in a Safety-Net Hospital System: A Qualitative Study. Dis Colon Rectum 2018. [PMID: 29521833 DOI: 10.1097/dcr.0000000000000967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Greater understanding of barriers to screening of colorectal cancer among lower socioeconomic, particularly Hispanic, patients is needed to improve disparities in care. OBJECTIVE This study aimed to explore patients' perceptions and experiences of care seeking for colorectal cancer to identify barriers to early diagnosis and treatment. DESIGN This explorative qualitative study was conducted as a focused ethnography of patients diagnosed with advanced-stage colorectal cancer. SETTINGS This study was conducted at an urban safety-net hospital. PARTICIPANTS Thirty lower-income, primarily minority, patients diagnosed with stage III and IV colorectal cancer without prior colorectal cancer screening were selected. MAIN OUTCOME MEASURES The primary outcomes measured were participants' perceptions and experiences of colorectal cancer and barriers they faced in seeking diagnosis and treatment RESULTS:: Data analysis yielded 4 themes consistently influencing participants' decisions to seek diagnosis and treatment: 1) limited resources for accessing care (structural barriers, including economic, health care and health educational resources); 2) (mis)understanding of symptoms by patients; misdiagnosis of symptoms, by physicians; 3) beliefs about illness and health, such as relying on faith, or self-care when symptoms developed; and 4) reactions to illness, including maintenance of masculinity, confusing interactions with physicians, embarrassment, and fear. These 4 themes describe factors on the structural, health care system, provider and patient level, that interact to make engaging in prevention foreign among this population, thus limiting early detection and treatment of colorectal cancer. LIMITATIONS This study was limited by selection bias and the lack of generalizability. CONCLUSION Improving screening rates among lower-income populations requires addressing barriers across the multiple levels, structural, personal, health care system, that patients encounter in seeking care for colorectal cancer. Acknowledging the complex, multilevel influences impacting patient health care choices and behaviors allows for the development of culturally tailored interventions, and educational, financial, and community resources to decrease disparities in cancer screening and care and improve outcomes for these at-risk patients. See Video Abstract at http://links.lww.com/DCR/A473.
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Affiliation(s)
- Isabel M Leal
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas.,Department of Psychological, Health and Learning Sciences, University of Houston, Houston, Texas
| | - Lillian S Kao
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas.,Center for Surgical Trials and Evidence-based Practice, The University of Texas Health Science Center, Houston, Texas
| | - Burzeen Karanjawala
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Richard J Escamilla
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Tien C Ko
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
| | - Stefanos G Millas
- Department of General Surgery, The University of Texas Health Science Center, Houston, Texas
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Adekeye OA, Adesuyi BF, Takon JG. Barriers to Healthcare among African Immigrants in Georgia, USA. J Immigr Minor Health 2018; 20:188-193. [PMID: 28213691 DOI: 10.1007/s10903-017-0549-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
African-born immigrants are among the fastest growing immigrant groups in the US, yet they are underrepresented in healthcare research, particularly, cancer research and tend to be categorized as African American or Black, obscuring any cultural nuances that exist. A survey designed to provide insight on the barriers to healthcare, knowledge of common cancers, and cancer risks was utilized during a health fair. Data analyses included descriptive statistics to examine participant demographics and other study variables of interest. Most of the participants reported African origin (approximately 97%), were males (59%), were aged 18-40 years (49%), had a minimum of some college education (78%), a household income of >$50,000 (35%) and were mostly uninsured (45%). The cost of medical treatment 19 (45.2%) was reported as a major barrier to healthcare access. The Health Fair presented the opportunity to provide free health screenings, education/awareness, and referral to follow-up resources. The findings are evidence of the importance and impact of health fairs in communities of greatest need.
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Affiliation(s)
- Oluwatoyosi A Adekeye
- Department of Community Health and Preventive Medicine, Satcher Health Leadership Institute, NCPC A-216C, Morehouse School of Medicine, 720 Westview Drive S.W., Atlanta, GA, 30310, USA.
| | - Bola F Adesuyi
- Redeemer's Medical Center, 5875 Peachtree Industrial Blvd #370, Norcross, GA, 30092, USA
| | - Joseph G Takon
- Redeemer's Medical Center, 5875 Peachtree Industrial Blvd #370, Norcross, GA, 30092, USA
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Jewett PI, Gangnon RE, Elkin E, Hampton JM, Jacobs EA, Malecki K, LaGro J, Newcomb PA, Trentham-Dietz A. Geographic access to mammography facilities and frequency of mammography screening. Ann Epidemiol 2018; 28:65-71.e2. [PMID: 29439783 PMCID: PMC5819606 DOI: 10.1016/j.annepidem.2017.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the association between geographic access to mammography facilities and women's mammography utilization frequency. METHODS Using data from the population-based 1995-2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50-74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups. RESULTS We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09-1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer. CONCLUSIONS Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.
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Affiliation(s)
- Patricia I Jewett
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison.
| | - Ronald E Gangnon
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | - Elena Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - John M Hampton
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
| | - Elizabeth A Jacobs
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison
| | - Kristen Malecki
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
| | - James LaGro
- Department of Urban and Regional Planning, University of Wisconsin, Madison
| | - Polly A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, WA; University of Washington School of Public Health, Seattle
| | - Amy Trentham-Dietz
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
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Molina Y, Pichardo CM, Patrick DL, Ramsey SD, Bishop S, Beresford SAA, Coronado GD. Estimating the costs and cost-effectiveness of promoting mammography screening among US-based Latinas. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 12:10. [PMID: 34414017 PMCID: PMC8373201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
PURPOSE We characterize the costs and cost-effectiveness of a community health worker (CHW)-based intervention to promote screening mammography among US-based non-adherent Latinas. METHODS The parent study was a randomized controlled trial for 536 Latinas aged 42-74 years old who had sought care within a safety net health center in Western Washington. Participants were block-randomized within clinic to the control arm (usual care) or intervention arm (CHW-led motivational interviewing intervention). We used the perspective of the organization implementing promotional activities to characterize costs and cost-effectiveness. Cost data were categorized as program set-up and maintenance (initial training, booster/annual training) program implementation (administrative activities, intervention delivery); and, overhead/miscellaneous expenses. Cost-effectiveness was calculated as the incremental cost of screening for each additional woman screened between the intervention and control arms. RESULTS The respective costs per participant for standard care and the intervention arm were $69.96 and $300.99. There were no study arm differences in 1-year QALYs were small among women who completed a 12-month follow-up survey (intervention= 0.8827, standard care = 0.8841). Most costs pertained to program implementation and administrative activities specifically. The incremental cost per additional woman screened was $2,595.32. CONCLUSIONS Our findings are within the ranges of costs and cost-effectiveness for other CHW programs to promote screening mammography among underserved populations. Our strong study design and focus on non-adherent women provides important strengths to this body of work, especially give implementation and dissemination science efforts regarding CHW-based health promotion for health disparity populations.
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Affiliation(s)
| | | | - Donald L Patrick
- University of Washington and the Fred Hutchinson Cancer Research Center
| | - Scott D Ramsey
- University of Washington and the Fred Hutchinson Cancer Research
| | - Sonia Bishop
- University of Washington and the Fred Hutchinson Cancer Research
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Bayık Temel A, Dağhan Ş, Kaymakçı Ş, Öztürk Dönmez R, Arabacı Z. Effect of structured training programme on the knowledge and behaviors of breast and cervical cancer screening among the female teachers in Turkey. BMC WOMENS HEALTH 2017; 17:123. [PMID: 29216918 PMCID: PMC5721587 DOI: 10.1186/s12905-017-0478-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 11/23/2017] [Indexed: 11/10/2022]
Abstract
Background Breast cancer and cervical cancer are the most common cancers among women in the world. Many studies on the early detection of cancer have been conducted among women worldwide, but few studies have been performed in the world on female teachers regarding breast self-examination (BSE), mammography (MMG) and Pap smear test (PST). As teachers interact with students, this could play an important role in health education and in developing healthy behavior such as cancer screening. The main objective of this study was to evaluate the effect of a structured teaching program on breast and cervical cancer screening on the knowledge and practice of teachers. The other objective was to encourage teachers to transfer this knowledge to the women who attended their courses. Methods Semi –experimental designs with pre-intervention, post-intervention and six month follow-up tests were used in this study. The data were collected from 37 volunteer teachers and their 64 volunteer students with a sociodemographic form, a questionnaire form for breast and cervical cancer, and a Transtheoretical Model of behavior change for BSE, MMG and PST. Behavior of the teachers related to BSE, MMG, PST was evaluated in pre-training and in the first, third and sixth months post-training, and the behavior of the students was evaluated with point follow-up in the sixth month. Results In post-training, it was determined that the teachers’ knowledge of breast cancer increased from 11.70 ± 2.80 to 14.81 ± 3.22 and their knowledge of cervical cancer increased from 7.75 ± 5.60 to 17.68 ± 3.79. For BSE behavior, 47.8% of teachers were in the action and maintenance stage in pre-training, but this ratio was 81.1% in the sixth month post-training. For MMG behavior, all of the teachers were in the precontemplation stage in pre-training, and 38.9% of them were in the action and maintenance stage in the sixth month post-training. For PST, while 24.3% were in the action and maintenance stage in pre-training, this ratio was 45.9% in the sixth month post-training. Conclusion It was determined that the behavior change for BSE, MMG, PST was positive. Similarly, knowledge transfer from teachers to students was also effective. Electronic supplementary material The online version of this article (10.1186/s12905-017-0478-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayla Bayık Temel
- Department of Public Health Nursing, Ege University Nursing Faculty, 35100, İzmir, Turkey
| | - Şafak Dağhan
- Department of Public Health Nursing, Ege University Nursing Faculty, 35100, İzmir, Turkey.
| | - Şenay Kaymakçı
- Department of Nursing, Near East University, Lefkoşa, Turkish Republic of Northern Cyprus
| | - Renginar Öztürk Dönmez
- Department of Public Health Nursing, Ege University Nursing Faculty, 35100, İzmir, Turkey
| | - Zeynep Arabacı
- Department of Nursing, Kastamonu Universiy, Tosya Vocational School, Kastamonu, Turkey
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Vines AI, Carpenter WR, Chen RC, Cherry MW, Long DG, Amos KD, Godley PA. Responding to a Community's Concern: A Comparison of Breast Cancer Characteristics and Initial Treatment in Three Selected North Carolina Counties. N C Med J 2017; 78:357-365. [PMID: 29203594 DOI: 10.18043/ncm.78.6.357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND A 2007 national report identified North Carolina's Edgecombe County as having among the highest breast cancer incidence and mortality rates nationally, motivating the initiation of a task force and other local efforts to address the problem. The goal of this study is to examine county breast cancer characteristics before and after the report, including whether geographic variation may mask racial disparities in this majority African American community.METHOD With guidance from community partners, breast cancer cases from 2000 to 2012 in Edgecombe, Nash, and Orange Counties (N = 2,641) were obtained from the North Carolina Central Cancer Registry. Bivariate and trend analyses of tumor and treatment characteristics were examined by county and race.RESULTS Women in Edgecombe and Nash Counties were diagnosed with more advanced stage, higher grade tumors. African Americans in Edgecombe and Nash Counties were diagnosed with advanced disease more often than African Americans in Orange County. Average time-to-treatment was well within guideline recommendations. Incidence and mortality rates appear to have declined, with variation in measures of racial differences over time.LIMITATIONS Changes in coding standards across the observation period required reliance on coarse measures that may partially mute useful findings.CONCLUSIONS Racial disparities remain a concern in North Carolina; however, they appear to be less profound than in the 2007 national report. The portentous statistics in the report represent an all-time high, after which some, but not all, measures reflect positive change amidst ongoing local efforts to improve breast cancer knowledge and care.
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Affiliation(s)
- Anissa I Vines
- research assistant professor, Department of Epidemiology, Gillings School of Global Health; fellow, UNC Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - William R Carpenter
- adjunct associate professor, Department of Health Policy and Management, Gillings School of Global Health; member, UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ronald C Chen
- associate professor, Department of Radiation Oncology, UNC School of Medicine; member, UNC Lineberger Comprehensive Cancer Center; senior fellow, UNC Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michele W Cherry
- manager, Grants and Special Projects, Vidant Edgecombe Hospital, Tarboro, North Carolina
| | - Debra G Long
- nutritionist and director, Crossworks LLC, Rocky Mount, North Carolina
| | - Keith D Amos
- (in Memoriam) member, UNC Lineberger Comprehensive Cancer Center; assistant professor, Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Paul A Godley
- vice dean, Diversity and Inclusion; Rush S. Dickson distinguished professor, Division of Hematology/Oncology, UNC School of Medicine; member, UNC Lineberger Comprehensive Cancer Center; senior fellow, UNC Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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