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Sharma N, Mehta TS, Wahab RA, Patel MM. Facilitating Culturally Competent Breast Imaging Care in South Asian Patients. JOURNAL OF BREAST IMAGING 2024; 6:529-538. [PMID: 38787594 DOI: 10.1093/jbi/wbae026] [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] [Received: 09/29/2023] [Indexed: 05/25/2024]
Abstract
South Asians are a rapidly growing subset of the Asian population in the United States. They comprise people from multiple countries with diverse beliefs, languages, and cultural identities and values. The incidence of breast cancer is rising in South Asian women in the United States, with earlier onset and predilection for HER2-enriched tumors. Despite the rising incidence of breast cancer, participation in screening remains lower than other populations. Health care inequities in South Asian women are multifactorial and may be due to traditional health beliefs and practices, language barriers, cultural differences, and lack of overall awareness. Developing a culturally sensitive environment in breast imaging clinic practice can lead to improved patient care and adherence. Given the scarcity of data specific to the South Asian population in United States, there is a need for health service researchers and practice leaders to obtain more high-quality data to understand the needs of South Asian patient populations.
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Affiliation(s)
- Nidhi Sharma
- Department of Radiology, Texas A&M University, Dallas, TX, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Miral M Patel
- University of Texas MD Anderson Cancer Center, Houston, TX, USA
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Manik R, Grady CB, Ginzberg SP, Edmonds CE, Conant EF, Hubbard RA, Fayanju OM. Racial Disparities and Strategies for Improving Equity in Diagnostic Follow-Up for Abnormal Screening Mammograms. JCO Oncol Pract 2024:OP2300782. [PMID: 38900977 DOI: 10.1200/op.23.00782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 03/13/2024] [Accepted: 04/18/2024] [Indexed: 06/22/2024] Open
Abstract
PURPOSE Black and White women undergo screening mammography at similar rates, but racial disparities in breast cancer outcomes persist. To assess potential contributors, we investigated delays in follow-up after abnormal imaging by race/ethnicity. METHODS Women who underwent screening mammography at our urban academic center from January 2015 to February 2018 and received a Breast Imaging Reporting and Data System 0 assessment were included. Kaplan-Meier estimates described distributions of time between diagnostic events from (1) screening to diagnostic imaging and (2) diagnostic imaging to biopsy. Multivariable logistic regression models estimated the associations between race/ethnicity and receipt of follow-up within 15 and 30 days. RESULTS Two thousand five hundred and fifty-four women were included (48.6% non-Hispanic [NH] Black, 38.2% NH White, 13.1% other/unknown). Median time between screening and diagnostic imaging varied by race/ethnicity (White: 7 days [IQR, 2-14]; Black: 12 days [IQR, 7-23]; other/unknown: 9 days [IQR, 5-21]). There were similar disparities in days between diagnostic imaging and biopsy (White: 12 [IQR, 7-24]; Black: 21 [IQR, 13-37]; other/unknown: 16 [IQR, 9-30]) and between screening and biopsy (White: 20 [IQR, 11-41]; Black: 35 [IQR, 22-63]; other/unknown: 27.5 [IQR, 17-42]). After adjustment, odds of diagnostic imaging follow-up within 15 days of screening were lower for Black versus White women (odds ratio, 0.59 [95% CI, 0.44 to 0.80]; P < .001). CONCLUSION In this diverse cohort, disparities in timely diagnostic follow-up after abnormal breast screening were observed, with Black women waiting 1.75 times as long as White women to obtain a tissue diagnosis. National guidelines for time to diagnostic follow-up may facilitate more timely breast cancer care and potentially affect outcomes.
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Affiliation(s)
| | - Connor B Grady
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Sara P Ginzberg
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA
- Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Christine E Edmonds
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Emily F Conant
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA
| | - Rebecca A Hubbard
- Department of Biostatistics, Epidemiology & Informatics, Perelman School of Medicine, The University of Pennsylvania, Philadelphia, PA
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
| | - Oluwadamilola M Fayanju
- Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
- Department of Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA
- Leonard Davis Institute of Health Economics (LDI), The University of Pennsylvania, Philadelphia, PA
- Penn Center for Cancer Care Innovation (PC3I), Abramson Cancer Center, The University of Pennsylvania, Philadelphia, PA
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Putnam G, Williams T, Park S, Grundman K, Goel C, Huffman K, Galiano RD. Current Trends in Breast Cancer Treatment in Chinese and Chinese American Women: The Disparity Between Mastectomy and Breast Reconstruction. Ann Plast Surg 2024; 92:463-468. [PMID: 38527354 DOI: 10.1097/sap.0000000000003826] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
BACKGROUND Breast cancer screening and surgical interventions are often underutilized in the Chinese community. For both Chinese American (CA) and native Chinese (NC) patients, screening rates are well below medical recommendations, which places these patients at risk for late diagnoses and larger tumors. There is also a notable reluctance to breast reconstruction after mastectomy. We investigated the role of sociodemographic and cultural barriers in breast treatment trends among Chinese breast cancer survivors. METHODS A literature search for full-text articles published between 2011 and 2021 was performed using PubMed, The Web of Science, and Embase. The articles that were selected contained information regarding Chinese individuals in the United States or China who had undergone breast cancer screening or diagnosis of breast cancer and received treatment with or without reconstructive surgery. RESULTS Both patient populations exhibited screening rates that were significantly lower than national recommendations. Of the CA patients, 25% reported never receiving a mammogram, whereas 450 million NCs have been left unscreened despite efforts made by the Chinese government. Misinformation, cultural beliefs, and fear significantly contributed to diminished breast health care among CA and NC women. Fear of recurrence, breast value, community influence, and limited health care resources were found to be the primary drivers of low breast reconstruction uptake. CONCLUSIONS In both NC and CA women, there is a critical need for improved breast health information dissemination and overall quality of care. The findings summarized in this review can guide such efforts.
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Affiliation(s)
- Geneviève Putnam
- From the Department of Surgery/Division of Plastic and Reconstructive Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL
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Offiah AC, Atalabi OM, Epelman M, Khanna G. Disparities in paediatric radiology research publications from low- and lower middle-income countries: a time for change. Pediatr Radiol 2024; 54:468-477. [PMID: 37773442 PMCID: PMC10902002 DOI: 10.1007/s00247-023-05762-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 08/25/2023] [Accepted: 09/03/2023] [Indexed: 10/01/2023]
Abstract
The positive impact of diversity on health research and outcomes is well-recognised and widely published. Despite this, published evidence shows that at every step of the research pathway, issues of equity, diversity and inclusion (EDI) arise. There is evidence of a lack of diversity within research teams, in the research questions asked/research participants recruited, on grant review/funding panels, amongst funded researchers and on the editorial boards and reviewer pools of the journals to which results are submitted for peer-reviewed publication. Considering the journal Pediatric Radiology, while its editorial board of 92 members has at least one member affiliated to a country in every region of the world, the majority are in North America (n=52, 57%) and Europe (n=30, 33%) and only two (2%) are affiliated to institutions in a lower middle-income country (LMIC) (India, Nigeria), with one (1%) affiliated to an institution in an upper middle-income country (UMIC) (Peru) and none in a low-income country (LIC). Pediatric Radiology is "…the official journal of the European Society of Paediatric Radiology, the Society for Pediatric Radiology, the Asian and Oceanic Society for Pediatric Radiology and the Latin American Society of Pediatric Radiology". However, of the total number of manuscripts submitted for potential publication in the four years 2019 through 2022, only 0.03% were from a LIC and only 7.9% were from a LMIC. Further, the frequency of acceptance of manuscripts from UMIC was seven times higher than that from LMIC (no manuscripts were published from LIC). Increased collaboration is required between researchers across the globe to better understand the barriers to equity in the funding, conduct and publication of research from LIC and LMIC and to identify ways in which we can overcome them together.
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Affiliation(s)
- Amaka C Offiah
- Division of Clinical Medicine, University of Sheffield, Sheffield Children's NHS Foundation Trust, Room 3, Damer Street Building, Western Bank, Sheffield, S10 2TH, UK.
- Department of Radiology, Sheffield Children's NHS Foundation Trust, Sheffield, UK.
| | - Omolola M Atalabi
- Department of Radiology, University College Hospital, Ibadan, Oyo State, Nigeria
| | - Monica Epelman
- Department of Radiology, Nicklaus Children's Hospital, Miami, FL, USA
| | - Geetika Khanna
- Department of Radiology & Imaging Sciences, Emory University and Children's Healthcare of Atlanta, Atlanta, GA, USA
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Huang HC, Guadamuz JS, Hoskins KF, Ko NY, Calip GS. Risk of contralateral breast cancer among Asian/Pacific Islander women in the United States. Breast Cancer Res Treat 2024; 203:533-542. [PMID: 37897647 DOI: 10.1007/s10549-023-07140-6] [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] [Received: 08/02/2023] [Accepted: 09/25/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE While breast cancer studies often aggregate Asian/Pacific Islander (API) women, as a single group or exclude them, this population is heterogeneous in terms of genetic background, environmental exposures, and health-related behaviors, potentially resulting in different cancer outcomes. Our purpose was to evaluate risks of contralateral breast cancer (CBC) among subgroups of API women with breast cancer. METHODS We conducted a retrospective cohort study of women ages 18 + years diagnosed with stage I-III breast cancer between 2000 and 2016 in the Surveillance, Epidemiology and End Results registries. API subgroups included Chinese, Japanese, Filipina, Native Hawaiian, Korean, Vietnamese, Indian/Pakistani, and other API women. Asynchronous CBC was defined as breast cancer diagnosed in the opposite breast 12 + months after first primary unilateral breast cancer. Multivariable-adjusted subdistribution hazard ratios (SHR) and 95% confidence intervals (CI) were estimated and stratified by API subgroups. RESULTS From a cohort of 44,362 API women with breast cancer, 25% were Filipina, 18% were Chinese, 14% were Japanese, and 8% were Indian/Pakistani. API women as an aggregate group had increased risk of CBC (SHR 1.15, 95% CI 1.08-1.22) compared to NHW women, among whom Chinese (SHR 1.23, 95% CI 1.08-1.40), Filipina (SHR 1.37, 95% CI 1.23-1.52), and Native Hawaiian (SHR 1.69, 95% CI 1.37-2.08) women had greater risks. CONCLUSION Aggregating or excluding API patients from breast cancer studies ignores their heterogeneous health outcomes. To advance cancer health equity among API women, future research should examine inequities within the API population to design interventions that can adequately address their unique differences.
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Affiliation(s)
- Hsiao-Ching Huang
- Department of Pharmacy Systems, Outcomes and Policy, University of Illinois Chicago, Chicago, IL, USA
| | - Jenny S Guadamuz
- School of Public Health, University of California, Berkeley, CA, USA
| | - Kent F Hoskins
- Division of Hematology and Oncology, Department of Medicine, University of Illinois Chicago, Chicago, IL, USA
| | - Naomi Y Ko
- Section of Hematology/Oncology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Gregory S Calip
- Titus Family Department of Clinical Pharmacy, Alfred E. Mann School of Pharmacy and Pharmaceutical Sciences, University of Southern California, 1985 Zonal Ave, Los Angeles, 90089, CA, USA.
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Tung WC, Chen Y. Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach. J Immigr Minor Health 2024; 26:140-147. [PMID: 37556031 DOI: 10.1007/s10903-023-01529-7] [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] [Accepted: 07/24/2023] [Indexed: 08/10/2023]
Abstract
Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.
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Affiliation(s)
- Wei-Chen Tung
- The Valley Foundation School of Nursing, San Jose State University, One Washington Square, Health Building #403, San Jose, CA, 95192, USA.
| | - Yinghan Chen
- Department of Mathematics and Statistics, University of Nevada-Reno, Reno, NV, 89557, USA
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Chen JC, Stover DG, Ballinger TJ, Bazan JG, Schneider BP, Andersen BL, Carson WE, Obeng-Gyasi S. Racial Disparities in Breast Cancer: from Detection to Treatment. Curr Oncol Rep 2024; 26:10-20. [PMID: 38100011 DOI: 10.1007/s11912-023-01472-8] [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] [Accepted: 10/15/2023] [Indexed: 02/12/2024]
Abstract
PURPOSE OF REVIEW Update on current racial disparities in the detection and treatment of breast cancer. RECENT FINDINGS Breast cancer remains the leading cause of cancer death among Black and Hispanic women. Mammography rates among Black and Hispanic women have surpassed those among White women, with studies now advocating for earlier initiation of breast cancer screening in Black women. Black, Hispanic, Asian, and American Indian and Alaskan Native women continue to experience delays in diagnosis and time to treatment. Further, racial discrepancies in receipt of guideline-concordant care, access to genetic testing and surgical reconstruction persist. Disparities in the initiation, completion, toxicity, and efficacy of chemotherapy, endocrine therapy, and targeted drug therapy remain for racially marginalized women. Efforts to evaluate the impact of race and ethnicity across the breast cancer spectrum are increasing, but knowledge gaps remain and further research is necessary to reduce the disparity gap.
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Affiliation(s)
- J C Chen
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Daniel G Stover
- Department of Internal Medicine, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Tarah J Ballinger
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | - Jose G Bazan
- Department of Radiation Oncology, City of Hope, Duarte, CA, USA
| | - Bryan P Schneider
- Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | | | - William E Carson
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA
| | - Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University Wexner Medical Center and James Cancer Hospital, Columbus, OH, USA.
- The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH, 43210, USA.
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Giess CS, Lynch E, Lacson R, Kapoor N, Desai S, Khorasani R. Patient and System Factors Associated With Completed Follow-Up of Probably Benign (BI-RADS 3) Breast Imaging Findings. J Am Coll Radiol 2023; 20:889-901. [PMID: 37023884 DOI: 10.1016/j.jacr.2023.02.028] [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] [Received: 11/25/2022] [Revised: 02/09/2023] [Accepted: 02/17/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Evaluate patient factors and health system test ordering and scheduling processes associated with completed BI-RADS 3 breast imaging follow-up. METHODS Retrospective review of reports from January 1, 2021, to July 31, 2021, identified BI-RADS 3 findings corresponding to unique patient encounters (index examinations). The electronic health record was queried for patient, examination, and health system ordering or scheduling data including follow-up order status (order placed, performed; order placed, scheduled, but not performed; order placed, unscheduled; no order placed); ordering provider specialty and health system affiliation (primary care versus other, internal versus external to health system); and ordering department (radiology staff versus referring physician staff). Patient home addresses were categorized by area deprivation index (University of Wisconsin's Neighborhood Atlas). Univariable and multivariable analysis identified patient, examination, and ordering or scheduling factors associated with completed follow-up imaging within 15 months of BI-RADS 3 assessment. RESULTS There were 3,104 unique BI-RADS 3 assessments, 2,561 (82.5%) with completed BI-RADS 3 follow-up within 15 months of study examination. In multivariable analysis, factors associated with incomplete follow-up included ultrasound (odds ratio [OR] 0.48; 95% confidence interval [95% CI] 0.38-0.60; P < .001) and MRI (OR 0.71; 95% CI 0.50-1.00; P = .049) versus mammogram; patients living in the highest disadvantaged neighborhoods (OR 0.70; 95% CI 0.50-0.98; P = .04); patients <40 years (OR 0.14; 95% CI 0.11-0.19; P < .001); Asian race (OR 0.55; 95% CI 0.37-0.81; P = .003); order placement >3 months (OR, 0.05; 95% CI 0.02-0.16; P < .001) after index examination or scheduling >6 months after order placement (OR, 0.35; 95% CI 0.14-0.87; P = .02); order placement by breast oncology or breast surgery departments (OR 0.35; 95% CI 0.17-0.73; P = .01) versus radiology department. DISCUSSION Incomplete BI-RADS 3 follow-up is associated with ultrasound or MRI, most socioeconomically disadvantaged patients, younger patients, Asian race, delayed order entry, and follow-up examination ordering and scheduling by non-radiology departments.
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Affiliation(s)
- Catherine S Giess
- Deputy Chair of Radiology, Center for Evidence Based Imaging, and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts.
| | - Elyse Lynch
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ronilda Lacson
- Center for Evidence Based Imaging and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Neena Kapoor
- Center for Evidence Based Imaging and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts; Associate Chair of Patient Experience, Department of Radiology, Mass General Brigham Health System, and Quality/Safety Officer for Brigham Radiology
| | - Sonali Desai
- Chief Quality Officer, Department of Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ramin Khorasani
- Vice Chair of Quality/Safety/Patient Experience for Mass General Brigham Health System, Center for Evidence Based Imaging and Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts
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Ho TQH, Bissell MCS, Lee CI, Lee JM, Sprague BL, Tosteson ANA, Wernli KJ, Henderson LM, Kerlikowske K, Miglioretti DL. Prioritizing Screening Mammograms for Immediate Interpretation and Diagnostic Evaluation on the Basis of Risk for Recall. J Am Coll Radiol 2023; 20:299-310. [PMID: 36273501 PMCID: PMC10044471 DOI: 10.1016/j.jacr.2022.09.030] [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] [Received: 06/18/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 11/11/2022]
Abstract
PURPOSE The aim of this study was to develop a prioritization strategy for scheduling immediate screening mammographic interpretation and possible diagnostic evaluation. METHODS A population-based cohort with screening mammograms performed from 2012 to 2020 at 126 radiology facilities from 7 Breast Cancer Surveillance Consortium registries was identified. Classification trees identified combinations of clinical history (age, BI-RADS® density, time since prior mammogram, history of false-positive recall or biopsy result), screening modality (digital mammography, digital breast tomosynthesis), and facility characteristics (profit status, location, screening volume, practice type, academic affiliation) that grouped screening mammograms by recall rate, with ≥12/100 considered high and ≥16/100 very high. An efficiency ratio was estimated as the percentage of recalls divided by the percentage of mammograms. RESULTS The study cohort included 2,674,051 screening mammograms in 925,777 women, with 235,569 recalls. The most important predictor of recall was time since prior mammogram, followed by age, history of false-positive recall, breast density, history of benign biopsy, and screening modality. Recall rates were very high for baseline mammograms (21.3/100; 95% confidence interval, 19.7-23.0) and high for women with ≥5 years since prior mammogram (15.1/100; 95% confidence interval, 14.3-16.1). The 9.2% of mammograms in subgroups with very high and high recall rates accounted for 19.2% of recalls, an efficiency ratio of 2.1 compared with a random approach. Adding women <50 years of age with dense breasts accounted for 20.3% of mammograms and 33.9% of recalls (efficiency ratio = 1.7). Results including facility-level characteristics were similar. CONCLUSIONS Prioritizing women with baseline mammograms or ≥5 years since prior mammogram for immediate interpretation and possible diagnostic evaluation could considerably reduce the number of women needing to return for diagnostic imaging at another visit.
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Affiliation(s)
- Thao-Quyen H Ho
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Breast Imaging Unit, Diagnostic Imaging Center, Tam Anh General Hospital, Ho Chi Minh City, Vietnam; Department of Training and Scientific Research, University Medical Center, Ho Chi Minh City, Vietnam
| | - Michael C S Bissell
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California
| | - Christoph I Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Northwest Screening and Cancer Outcomes Research Enterprise, University of Washington, Seattle, Washington; Deputy Editor, JACR
| | - Janie M Lee
- Breast Imaging, Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington; Breast Imaging, Fred Hutchinson Cancer Center, Seattle, Washington
| | - Brian L Sprague
- Department of Surgery, Office of Health Promotion Research, Larner College of Medicine at the University of Vermont and Co-Leader, Cancer Control and Population Health Sciences Program, University of Vermont Cancer Center, Burlington, Vermont
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth and Associate Director for Population Sciences, Dartmouth Cancer Center, Lebanon, New Hampshire
| | - Karen J Wernli
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington
| | - Louise M Henderson
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina; Cancer Epidemiology Program, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California; General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, San Francisco, California; Women's Health Comprehensive Clinic, and Director, Advanced Postdoctoral Fellowship in Women's Health, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, School of Medicine, Davis, California; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington; Biostatistics and Population Sciences and Health Disparities Program, University of California, Davis, Comprehensive Cancer Center, Davis, California.
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Vijayaraghavan GR, Guembou IM, Vedantham S. The Current State of Timeliness in the Breast Cancer Diagnosis Journey: Abnormal Screening to Biopsy. Semin Ultrasound CT MR 2023; 44:56-61. [PMID: 36792274 DOI: 10.1053/j.sult.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
There are several steps involved in a breast cancer diagnosis, starting from the initial abnormal screening mammogram. Each step from the additional imaging to a biopsy provokes anxiety. Timely attention to these appointments will not only help allay anxiety but also provide better care. While breast facilities routinely audit their performance, currently timeliness is not one of the audit parameters. The role of timeliness as a robust quality tool is gaining attention. In this study, we review the timeline of care at our facility over a 1-year period (October 2021- September 2022) and compare them with those reported by National Quality Measures for Breast Centers (NQMBC). Race, ethnicity, location, and type of facility affect the outcome of care and contribute to delays in providing care. In this manuscript, we outline some of the major factors. Societal guidelines outlining some metrics for timeliness may be a useful first step.
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Affiliation(s)
- Gopal R Vijayaraghavan
- Department of Radiology, University of Massachusetts Chan School of Medicine, UMass Memorial Healthcare, Worcester, MA.
| | - Isabelle M Guembou
- CITC (Center for Innovation and Transformational Change), UMass Memorial Healthcare, Worcester, MA
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Khoong EC, Rivadeneira NA, Pacca L, Schillinger D, Lown D, Babaria P, Gupta N, Pramanik R, Tran H, Whitezell T, Somsouk M, Sarkar U. Extent of Follow-Up on Abnormal Cancer Screening in Multiple California Public Hospital Systems: A Retrospective Review. J Gen Intern Med 2023; 38:21-29. [PMID: 35641722 PMCID: PMC9849534 DOI: 10.1007/s11606-022-07657-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 05/03/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND Inequitable follow-up of abnormal cancer screening tests may contribute to racial/ethnic disparities in colon and breast cancer outcomes. However, few multi-site studies have examined follow-up of abnormal cancer screening tests and it is unknown if racial/ethnic disparities exist. OBJECTIVE This report describes patterns of performance on follow-up of abnormal colon and breast cancer screening tests and explores the extent to which racial/ethnic disparities exist in public hospital systems. DESIGN We conducted a retrospective cohort study using data from five California public hospital systems. We used multivariable robust Poisson regression analyses to examine whether patient-level factors or site predicted receipt of follow-up test. MAIN MEASURES Using data from five public hospital systems between July 2015 and June 2017, we assessed follow-up of two screening results: (1) colonoscopy after positive fecal immunochemical tests (FIT) and (2) tissue biopsy within 21 days after a BIRADS 4/5 mammogram. KEY RESULTS Of 4132 abnormal FITs, 1736 (42%) received a follow-up colonoscopy. Older age, Medicaid insurance, lack of insurance, English language, and site were negatively associated with follow-up colonoscopy, while Hispanic ethnicity and Asian race were positively associated with follow-up colonoscopy. Of 1702 BIRADS 4/5 mammograms, 1082 (64%) received a timely biopsy; only site was associated with timely follow-up biopsy. CONCLUSION Despite the vulnerabilities of public-hospital-system patients, follow-up of abnormal cancer screening tests occurs at rates similar to that of patients in other healthcare settings, with colon cancer screening test follow-up occurring at lower rates than follow-up of breast cancer screening tests. Site-level factors have larger, more consistent impact on follow-up rates than patient sociodemographic traits. Resources are needed to identify health system-level factors, such as test follow-up processes or data infrastructure, that improve abnormal cancer screening test follow-up so that effective health system-level interventions can be evaluated and disseminated.
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA. .,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.
| | - Natalie A Rivadeneira
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Lucia Pacca
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - Dean Schillinger
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
| | - David Lown
- California Health Care Safety Net Institute, Oakland, CA, USA
| | - Palav Babaria
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,Alameda Health System, Oakland, CA, USA
| | | | - Rajiv Pramanik
- Office of Informatics & Technology and Department of Emergency Medicine, Contra Costa Health Services, Martinez, CA, USA
| | - Helen Tran
- Department of Family Medicine, Charles R. Drew University College of Medicine, Los Angeles, CA, USA.,Department of Health Services at Los Angeles County, Los Angeles, CA, USA
| | | | - Ma Somsouk
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA.,Division of Gastroenterology, Department of Medicine, UCSF, San Francisco, CA, USA
| | - Urmimala Sarkar
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, USA.,UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital, San Francisco, CA, USA
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12
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Disparities Associated With Patient Adherence to BI-RADS 3 Assessment Follow-up Recommendations for Mammography and Ultrasound. J Am Coll Radiol 2022; 19:1302-1309. [PMID: 36182098 DOI: 10.1016/j.jacr.2022.08.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/09/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To assess the relationship between sociodemographic factors and adherence rates in patients with a BI-RADS 3 assessment. METHODS This retrospective cohort study reviewed data from all patients with a BI-RADS 3 assessment on mammography and ultrasound examinations at a single, multisite academic institution, which serves a diverse urban-suburban population, from January 1, 2015, to December 13, 2017. Appropriate follow-up was defined as returning for the first follow-up examination 3 to 9 months after the index examination. Associations between BI-RADS 3 adherence rates and patient sociodemographic characteristics were evaluated using logistic regression. RESULTS There were 4,038 patients in our study period; 2,437 patients (60%) had appropriate follow-up, 765 (19%) patients had delayed follow-up, and 836 patients (21%) were lost to follow-up. The overall malignancy rate was 1.4% (46 of 3,202). Older age, retired employment status, and Medicare insurance status were associated with increased adherence to BI-RADS 3 follow-up recommendations. Black race, single relationship status, Medicaid and self-pay insurance status, and living in a top 15% disadvantaged zip code were associated with decreased adherence. On multivariate analysis, older age remained associated with increased adherence and Medicaid insurance status with decreased adherence. Time between index examination and cancer diagnosis was shorter in patients who had timely follow-up (202 days [interquartile range 183-358] versus 392 days [interquartile range 365-563], P ≤ .001), although there was not a significant difference in stage at diagnosis (P = .46). DISCUSSION Multiple sociodemographic factors are associated with low adherence to BI-RADS 3 follow-up recommendations suggesting that more frequent and targeted interventions are needed to close disparity gaps.
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13
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Nguyen DL, Ambinder EB, Myers KS, Oluyemi E. Addressing Disparities Related to Access of Multimodality Breast Imaging Services Before and During the COVID-19 Pandemic. Acad Radiol 2022; 29:1852-1860. [PMID: 35562265 PMCID: PMC8947962 DOI: 10.1016/j.acra.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/26/2023]
Abstract
Despite technological advancements focused on reducing breast cancer mortality through early detection, there have been reported disparities in the access to these imaging services with underserved patient populations (including racial minority groups and patients of low socioeconomic status) showing underutilization compared to other patient groups. These underserved populations tend to have more advanced breast cancer presentations, in part due to delays in diagnosis resulting in later stage of disease presentation. To make matters worse, the COVID-19 pandemic declared in March 2020 has resulted in significant healthcare disruptions leading to extensive delays in breast imaging services which are expected to negatively impact breast cancer mortality long-term. Given the worsening disparity in breast cancer mortality among racial/ethnic minorities and financially disadvantaged groups, it is vital to address these disparity gaps with the goal of reducing the barriers to timely breast cancer diagnosis and addressing breast cancer mortality differences among breast cancer patients. Therefore, this review aims to provide a discussion highlighting the disparities related to breast imaging access, the effects of the COVID-19 pandemic on these disparities, current targeted interventions implemented in breast imaging practices to reduce these disparities, and future directions on the journey to reducing disparity gaps for breast imaging patients. Tackling the root cause factors of the persistent breast cancer-related disparities is critical to meeting the needs of patients who are disadvantaged and can lead to continued improvement in the quality of individualized care for patients who have higher breast cancer morbidity and mortality risks.
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14
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Gao Y, Heller SL. Health Disparity and Breast Cancer Outcomes in Asian Women. Radiographics 2022; 42:1912-1924. [PMID: 36053846 DOI: 10.1148/rg.220074] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Health disparities in Asian women are complex and multifactorial. Screening attendance is low among Asian women, regardless of nativity or acculturation, and breast cancer detection has decreased by more than half in this population during the COVID-19 pandemic. The follow-up rate after abnormal screening results is similarly poor among Asian women compared with that among other groups, often resulting in a delay of cancer diagnosis. Yet the incidence of breast cancer in Asian women is increasing in the United States, with no such increase observed in other racial and ethnic groups in recent years. The age distribution of breast cancer in Asian women is distinct and peaks in younger women, underscoring the importance of early screening. The predilection for human epidermal growth factor receptor 2 (HER2)-enriched tumors may reflect the unique biologic characteristics of breast cancer among Asian subgroups, which are not well understood. Known biomarkers for breast cancer risk such as body mass index and mammographic density do not perform the same way in Asian women, as compared with other groups, owing to a lack of Asian population-specific data. Within that limitation, the association between body mass index and breast cancer is strongest in older Asian women, and the association between breast density and breast cancer is strongest in younger Asian women. There is an unmet need to improve breast cancer care in Asian women, a heterogeneous and growing population that is facing an increasing burden of breast cancer. An invited commentary by Leung is available online. ©RSNA, 2022.
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Affiliation(s)
- Yiming Gao
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
| | - Samantha L Heller
- From the Department of Radiology, New York University School of Medicine, 160 E 34th St, New York, NY 10016
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15
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Thai CL, Ong G, Tran T, Le Y. Assessing the Impact of a Patient Navigator Intervention Program for Vietnamese-American Women with Abnormal Mammograms. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:621-630. [PMID: 32880868 DOI: 10.1007/s13187-020-01856-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Breast cancer incidence among Asian Americans increased at a rate of 1.8% per year from 2014 to 2018, while the general population's incidence rate remained stable. Vietnamese-American women have been found to have the longest follow-up time after an abnormal mammogram. This study assesses the impact of a patient navigator program for Vietnamese-American women who received abnormal mammograms. Ninety-six Vietnamese-American participants with abnormal mammograms were assigned a Vietnamese patient navigator to provide emotional support, education, translation, and assistance with medical bills and doctor's appointments. Data collected from pre-test, post-test (1 year after initial enrollment in program), and 3-month follow-up surveys measured psychosocial outcomes and participant satisfaction. All 96 participants attended follow-up appointments for their abnormal mammograms. Psychosocial outcomes worsened from pre- to post-test, though these results were not statistically significant. Feeling in control of situations in one's life improved and was significant for participants who did not receive a breast cancer diagnosis (4.31, 5.04, p = .039). A majority of the participants reported satisfaction with their patient navigators. Vietnamese-American women have been found to be the least adherent to appropriate follow-up after an abnormal mammogram; in this study, all 96 participants attended a follow-up appointment within 90 days. Findings did not show improvements in psychosocial outcomes. Past research suggests that sociocultural factors may be at play: the initial abnormal mammogram may have triggered fatalistic thoughts affecting the reactions of the participants, even though the abnormal mammogram did not result in a breast cancer diagnosis.
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Affiliation(s)
- Chan L Thai
- Department of Communication, Santa Clara University, 500 El Camino Real, Santa Clara, CA, 95053, USA.
| | - Giannina Ong
- Women and Gender Studies Institute, University of Toronto, Toronto, ON, Canada
| | | | - Yen Le
- Boat People SOS, Inc., Falls Church, VA, USA
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16
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Vang SS, Dunn A, Margolies LR, Jandorf L. Delays in Follow-up Care for Abnormal Mammograms in Mobile Mammography Versus Fixed-Clinic Patients. J Gen Intern Med 2022; 37:1619-1625. [PMID: 35212876 PMCID: PMC9130416 DOI: 10.1007/s11606-021-07189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics. OBJECTIVES To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics. DESIGN Electronic medical record review of abnormal screening mammograms. SUBJECTS Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337). MAIN MEASURES Our outcome was delay in follow-up of an abnormal mammogram of 60 days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors. KEY RESULTS Only 45% of MM patients had obtained recommended follow-up within 60 days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively. CONCLUSIONS A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.
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Affiliation(s)
- Suzanne S Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Alexandra Dunn
- MD/MPH Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, and The Dubin Breast Center, Mount Sinai Hospital, New York, NY, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
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17
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Hiatt RA, Sibley A, Venkatesh B, Cheng J, Dixit N, Fox R, Ling P, Nguyen T, Oh D, Palmer NR, Pasick RJ, Potter MB, Somsouk M, Vargas RA, Vijayaraghavan M, Ashworth A. From Cancer Epidemiology to Policy and Practice: the Role of a Comprehensive Cancer Center. CURR EPIDEMIOL REP 2022; 9:10-21. [PMID: 35342686 PMCID: PMC8935108 DOI: 10.1007/s40471-021-00280-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 11/24/2022]
Abstract
Purpose of Review Cancer incidence and mortality are decreasing, but inequities in outcomes persist. This paper describes the San Francisco Cancer Initiative (SF CAN) as a model for the systematic application of epidemiological evidence to reduce the cancer burden and associated inequities. Recent Findings SF CAN is a multi-institutional implementation of existing evidence on the prevention and early detection of five common cancers (i.e., breast, prostate, colorectal, liver, and lung/tobacco-related cancers) accounting for 50% of cancer deaths in San Francisco. Five Task Forces follow individual logic models designating inputs, outputs, and outcomes. We describe the progress made and the challenges faced by each Task Force after 5 years of activity. Summary SF CAN is a model for how the nation’s Comprehensive Cancer Centers are ideally positioned to leverage cancer epidemiology for evidence-based initiatives that, along with genuine community engagement and multiple stakeholders, can reduce the population burden of cancer.
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Affiliation(s)
- Robert A Hiatt
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA.,Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Mission Hall UCSF, 550 16th Street, 2nd Floor, San Francisco, CA 94158 USA
| | - Amanda Sibley
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Brinda Venkatesh
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
| | - Joyce Cheng
- Chinese Community Health Resource Center, San Francisco, USA
| | - Niharika Dixit
- Division of Hematology/Oncology, UCSF at Zuckerberg San Francisco General Hospital, San Francisco, USA
| | - Rena Fox
- Department of Medicine, UCSF, San Francisco, USA
| | - Pamela Ling
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA.,Center for Tobacco Control Research and Education, UCSF, San Francisco, USA
| | - Tung Nguyen
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA.,Department of Medicine, UCSF, San Francisco, USA
| | - Debora Oh
- Department of Epidemiology and Biostatistics, UCSF, San Francisco, USA
| | | | | | - Michael B Potter
- Department of Family and Community Medicine, UCSF, San Francisco, USA
| | - Ma Somsouk
- Division of Gastroenterology, UCSF, San Francisco, USA
| | - Roberto Ariel Vargas
- Center for Community Engagement, UCSF, San Francisco, USA.,Clinical and Translational Science Institute, UCSF, San Francisco, USA
| | | | - Alan Ashworth
- Helen Diller Family Comprehensive Cancer Center, UCSF, San Francisco, USA
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18
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Xie H, Li Y, Theodoropoulos N, Wang Q. Mammography Screening Disparities in Asian American Women: Findings From the California Health Interview Survey 2015-2016. Am J Health Promot 2021; 36:248-258. [PMID: 34814756 DOI: 10.1177/08901171211048136] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To identify mammography screening prevalence and predictors in Asian American women, focusing on the potential disparities in race and its influence on screening behaviors. DESIGN A secondary analysis utilized the California Health Interview Survey (CHIS) 2015-2016. SETTING California, U.S. SAMPLE Cisgender women who were non-Hispanic (NH) White, Chinese, Filipino, Vietnamese, Japanese, Korean, or "other Asian", aged 40 or above (unweighted N=13 451). MEASURES Socioeconomics, chronic health conditions, and preventive care utilization were mesuared as potential risk factors, where up-to-date mammography screening as the outcome variable. ANALYSIS Multivariable adjusted logistic regressions were generalized to identify the up-to-date mammography screening behaviors in relation to potential factors, stratified by race and ethnicity. RESULTS The prevalence for up-to-date mammography screening in NH-White and Asian American women were 68.06% and 65.97%, respectively. In NH-White women, receiving an up-to-date mammogram was associated with age, birthplace, smoking status, diabetes, hypertension, health insurance coverage, and a preventive care visit in the past 12 months, whereas only age and a preventive care visit were significant predictors in Asian women. CONCLUSIONS The findings indicate that utilization disparities exist in mammogram in relation to socioeconomics, chronic health conditions, preventive care utilization, when comparing between race and ethnicity. Asian American women with borderline hypertension and no preventive care visits may require more public health outreach and cancer education.
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Affiliation(s)
- Hui Xie
- Joseph J. Zilber School of Public Health, 14751University of Wisconsin-Milwaukee Milwaukee, WI, USA
| | - Yannan Li
- Dapartment of Medicine, 5925Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Nickolas Theodoropoulos
- Dapartment of Medicine, 5925Icahn School of Medicine at Mount Sinai Morningside and West, New York, NY, USA
| | - Qian Wang
- Division of Hematology and Medical Oncology, Department of Medicine, 5925Icahn School of Medicine at Mount Sinai, New York, NY, USA
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19
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Trentham-Dietz A, Chapman CH, Bird J, Gangnon RE. Recent Changes in the Patterns of Breast Cancer as a Proportion of All Deaths According to Race and Ethnicity. Epidemiology 2021; 32:904-913. [PMID: 34172689 PMCID: PMC8478795 DOI: 10.1097/ede.0000000000001394] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent reports suggest that racial differences in breast cancer incidence rates have decreased. We examined whether these findings apply to breast cancer mortality while considering age, period, and cohort influences on both absolute and relative measures of breast cancer mortality. METHODS Using publicly available datasets (CDC WONDER, Human Mortality Database), we developed an age-period-cohort model of breast cancer mortality and breast cancer deaths as a proportion of all deaths during 1968-2019 among all women and by 5 race/ethnicity groups with sufficient numbers for estimation: Hispanic (all races), American Indian/Alaska Native and Asian/Pacific Islanders (regardless of ethnicity), non-Hispanic Black, and non-Hispanic White. RESULTS Initially increasing after 1968, age-adjusted breast cancer mortality rates have decreased among all racial/ethnic groups since 1988. The age-adjusted percent of all deaths due to breast cancer also has been declining for non-Hispanic White women since about 1990 while increasing or holding steady for other race/ethnic groups. In 2019, the age-adjusted percent of deaths due to breast cancer for women was highest for Asian/Pacific Islanders (5.6%) followed by non-Hispanic Black (4.5%), Hispanic (4.4%), non-Hispanic White (4.1%), and American Indian/Alaska Native women (2.6%). CONCLUSIONS Breast cancer mortality disparities are now greater on both relative and absolute scales for non-Hispanic Black women, and using the relative scale for Asian/Pacific Islander and Hispanic women, compared with non-Hispanic White women for the first time in 50 years.
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Affiliation(s)
- Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | | | - Jennifer Bird
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Ronald E. Gangnon
- Department of Population Health Sciences and Carbone Cancer Center, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Department of Biostatistics and Medical Informatics, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
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20
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Sohn YJ, Chang CY, Miles RC. Current Gaps in Breast Cancer Screening Among Asian and Asian American Women in the United States. J Am Coll Radiol 2021; 18:1376-1383. [PMID: 34174207 DOI: 10.1016/j.jacr.2021.06.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/07/2021] [Accepted: 06/07/2021] [Indexed: 11/15/2022]
Abstract
Over the past two decades, the US Asian population has increased 72%, representing the fastest growth rate of any major racial group. Currently, there are over 20 million Asian and Asian American women in the United States, who identify with at least 1 of 19 different origin groups. Although women of Asian ancestry have traditionally been considered low risk for experiencing adverse breast cancer-specific outcomes, aggregated data may mask health disparities seen among subgroups. In the United States, recent data demonstrate that the burden of breast cancer among Asian women has increased each year over the past decade. We aim to characterize challenges faced by Asian and Asian American women in the United States related to cultural stigma, socioeconomic status, and overall access to breast cancer care. An increased understanding of barriers to breast cancer prevention and treatment efforts is needed to develop more effective strategies aimed at reducing disparities in care among segments of this heterogenous population.
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Affiliation(s)
| | - Connie Y Chang
- Associate Professor of Radiology, Department of Radiology, Boston, Massachusetts; Radiology Wellbeing Officer, Department of Radiology, Boston, Massachusetts
| | - Randy C Miles
- Clinical Service Chief, Division of Breast Imaging, Department of Radiology, Boston, Massachusetts.
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21
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Oviedo AD. Mammogram Adherence Among Filipino American Women. J Immigr Minor Health 2021; 24:639-644. [PMID: 34089445 DOI: 10.1007/s10903-021-01223-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2021] [Indexed: 11/27/2022]
Abstract
Filipino American women experience breast cancer disparities including being diagnosed with breast cancer at a younger age and at a later stage. More Filipino women have breast cancer tumors that are ER-negative or overexpress Her2-neu. These disparities could be effectively minimized with screening mammograms. This study aims to determine factors that influence mammogram adherence in Filipino American women using Andersen's Behavioral Health Model of Services for Vulnerable Populations as the conceptual framework. Logistic regression models determined the influence of predisposing, enabling and need variables with mammogram adherence. Among all variables-breast cancer literacy, mammogram reminder, sociocultural deterrents, cultural beliefs, and years of residence in the United States-only a mammogram reminder from a healthcare provider was significantly associated with mammogram adherence. Convenience and snowballing sampling generated a group of women who were highly-educated Filipinas limiting the generalizability of the study's findings.
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Affiliation(s)
- Astrid D Oviedo
- Department of Nursing, University of North Carolina Pembroke, Room 329, Weinstein Health Sciences Building, 001 University Drive, Pembroke, NC, 28372, USA.
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22
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Park S, Chen J, Ma GX, Ortega AN. Inequities in Access to Care and Health Care Spending for Asian Americans With Cancer. Med Care 2021; 59:528-536. [PMID: 33782249 PMCID: PMC8119364 DOI: 10.1097/mlr.0000000000001538] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Asian Americans have lower cancer screening rates than non-Latino "Whites," suggesting inequities in cancer prevention among Asian Americans. Little is known about inequities in cancer treatment between Whites and Asian Americans with cancer. METHODS Using the 2002-2017 Medical Expenditure Panel Survey, we examined inequities in access to care and health care spending between Whites and Asian Americans with and without cancer. Our outcomes included 3 measures of access to care and 3 measures of health care spending. We used multivariable regressions while adjusting for predisposing, enabling, and need factors and estimated the mean adjusted values of the outcomes for each group. We then examined the differences in these adjusted mean outcomes among Asian Americans relative to Whites. RESULTS We observed evidence of inequities that Asian Americans without cancer experienced limited access to care due to a lack of a usual source of care. The likelihood of having a usual source of care was lower among Asian Americans without cancer than Whites without cancer. Inequities were not observed among Asian Americans with cancer. Compared with Whites with cancer, Asian Americans with cancer had similar or better levels of access to care. No or marginal differences in health care spending were detected between Whites and Asian Americans with cancer. These findings were consistent in both nonelderly and elderly groups. CONCLUSION While Asian Americans without cancer have unmet medical needs due to limited access to care, access to care and spending are relatively equitable between Whites and Asian Americans with cancer.
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Affiliation(s)
- Sungchul Park
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
| | - Jie Chen
- Department of Health Policy and Management, School of Public Health, University of Maryland, College Park, MD
| | - Grace X Ma
- Department of Clinical Sciences and Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA
| | - Alexander N Ortega
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, PA
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Reece JC, Neal EFG, Nguyen P, McIntosh JG, Emery JD. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review. BMC Cancer 2021; 21:373. [PMID: 33827476 PMCID: PMC8028768 DOI: 10.1186/s12885-021-08100-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/23/2021] [Indexed: 01/07/2023] Open
Abstract
Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08100-3.
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Affiliation(s)
- Jeanette C Reece
- Colorectal Cancer Unit, Centre for Epidemiology and Biostatistics and Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 207 Bouverie Street, Parkville, VIC, 3010, Australia. .,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Eleanor F G Neal
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Peter Nguyen
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer G McIntosh
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Software Systems and Cybersecurity, Faculty of Information Technology, Monash University, VIC, Clayton, Australia
| | - Jon D Emery
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
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24
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Mach JC, Omar A, Abujudeh H. Public Health Foundations for Radiology Resident Education: Healthcare Disparities in Radiology. Curr Probl Diagn Radiol 2021; 51:403-407. [PMID: 33838972 DOI: 10.1067/j.cpradiol.2021.03.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 02/04/2021] [Accepted: 03/04/2021] [Indexed: 11/22/2022]
Abstract
Increasing recognition within the medical literature and by the Accreditation Council for Graduate Medical Education has been attributed to the need for enhanced resident education on concepts related to public health and health equity. Despite increasing documentation of pervasive inequalities within the scope of radiology, dedicated curricula designed to improve cultural competency and understanding of healthcare disparities among radiology trainees remains sparse. With relatively fewer patient interactions, radiology trainees are particularly susceptible to insufficient contextual awareness of how socioeconomic factors influence patient health and behaviors, physician recommendations, and ultimately clinical outcomes. The purpose of this article is to provide a high-yield background of foundational health equity and disparity concepts for radiology trainees, from which additional educational curricula may be derived. Specifically, this article will discuss the fundamental socioeconomic factors known to contribute to discrepant access and use of imaging services, followed by areas in radiology with well-documented disparities of which trainees should be aware. Lastly, previous and current strategies for addressing disparities in radiology will be discussed with the ultimate goal of stimulating trainee participation and the development of novel approaches.
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Affiliation(s)
- John C Mach
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI..
| | - Abdillahi Omar
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
| | - Hani Abujudeh
- Department of Radiology, Detroit Medical Center, Wayne State University, Detroit, MI
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25
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Guo XM, Tom L, Leung I, O'Brian C, Zumpf K, Simon M. Associations between Fatalistic Cancer Beliefs and Cancer-Screening Behaviors in Chinese American Immigrant Women. J Immigr Minor Health 2021; 23:699-706. [PMID: 33515161 DOI: 10.1007/s10903-021-01144-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2021] [Indexed: 11/25/2022]
Abstract
Chinese Americans have among the lowest rates of up-to-date cancer screening in the United States. Fatalistic health beliefs are also common in this population and can lead to decreased healthcare utilization. We sought to understand how these fatalistic beliefs are associated with cancer screening behaviors in this underserved population. A cross-sectional survey was conducted with 732 Chinese women from the greater Chinatown area of Chicago, Illinois. Surveyed questions included sociodemographic information, self-reported healthcare utilization and cancer screening behaviors. The majority of respondents were older than 50, spoke Chinese, had less than a college education, public or no medical insurance, and an annual income < $20,000. Approximately 20% had never received Papanicolaou or mammogram screening. Fatalistic beliefs were common and associated with increased health-seeking behaviors and appropriate Pap and mammogram screening. In this cohort of Chinese American immigrant women in an urban Chinatown community, fatalistic cancer beliefs were prevalent and associated with increased health-seeking and positive cancer screening behaviors. This previously unreported relationship could be leveraged in improving health outcomes of an underserved population.
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Affiliation(s)
- Xiaoyue Mona Guo
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA. .,, 2020 Zonal Ave, IRD, Room 220, Los Angeles, CA, 90033, USA.
| | - Laura Tom
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ivy Leung
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Catherine O'Brian
- Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katelyn Zumpf
- Biostatistics Collaboration Center, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Melissa Simon
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 250 E. Superior St., Suite 5-2177, Chicago, IL, 60611, USA.,Center for Health Equity Transformation, Institute for Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.,Department of General/Preventive Medicine and Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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26
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Kenny JD, Karliner LS, Kerlikowske K, Kaplan CP, Fernandez-Lamothe A, Burke NJ. Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems. J Gen Intern Med 2020; 35:3000-3006. [PMID: 32601926 PMCID: PMC7573092 DOI: 10.1007/s11606-020-05972-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 06/05/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND Regular mammogram screening for eligible average risk women has been associated with early detection and reduction of cancer morbidity and mortality. Delayed follow-up and resolution of abnormal mammograms limit early detection efforts and can cause psychological distress and anxiety. OBJECTIVE The goal of this study was to gain insight from women's narratives into how organizational factors related to communication and coordination of care facilitate or hinder timely follow-up for abnormal mammogram results. DESIGN We conducted 61 qualitative in-person interviews with women from four race-ethnic groups (African American, Chinese, Latina, and White) in three different healthcare settings (academic, community, and safety-net). PARTICIPANTS Eligible participants had an abnormal mammogram result requiring breast biopsy documented in the San Francisco Mammography Registry in the previous year. APPROACH Interview narratives included reflections on experience and suggested improvements to communication and follow-up processes. A grounded theory approach was used to identify themes across interviews. KEY RESULTS Participants' experiences of follow-up and diagnosis depended largely on communication processes. Twenty-one participants experienced a follow-up delay (> 30 days between index mammogram and biopsy). Organizational factors, which varied across different institutions, played key roles in effective communication which included (a) direct verbal communication with the ability to ask questions, (b) explanation of medical processes and terminology avoiding jargon, and (c) use of interpretation services for women with limited English proficiency. CONCLUSION Health organizations varied in their processes for abnormal results communication and availability of support staff and interpretation services. Women who received care from institutions with more robust support staff, such as bilingual navigators, more often than not reported understanding their results and timely abnormal mammogram follow-up. These reports were consistent across women from diverse ethnic groups and suggest the value of organizational support services between an abnormal mammogram and resolution for improving follow-up times and minimizing patient distress.
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Affiliation(s)
- Jazmine D Kenny
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California , Merced, CA, USA
| | - Leah S Karliner
- Division of General Internal Medicine, Department of Medicine at the University of California San Francisco, San Francisco, CA, USA
| | - Karla Kerlikowske
- Department of Medicine and Epidemiology/Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Celia P Kaplan
- Division of General Internal Medicine, Department of Medicine at the University of California San Francisco, San Francisco, CA, USA
| | - Ana Fernandez-Lamothe
- Division of General Internal Medicine, Department of Medicine at the University of California San Francisco, San Francisco, CA, USA
| | - Nancy J Burke
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California , Merced, CA, USA.
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27
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Nguyen DL, Oluyemi E, Myers KS, Harvey SC, Mullen LA, Ambinder EB. Impact of Telephone Communication on Patient Adherence With Follow-Up Recommendations After an Abnormal Screening Mammogram. J Am Coll Radiol 2020; 17:1139-1148. [DOI: 10.1016/j.jacr.2020.03.030] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 03/24/2020] [Accepted: 03/26/2020] [Indexed: 12/19/2022]
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28
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Quality Improvement and Reimbursements: An Opportunity to Address Health Disparities in Radiology. J Am Coll Radiol 2019; 16:635-637. [DOI: 10.1016/j.jacr.2018.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/19/2018] [Indexed: 01/03/2023]
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29
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Karliner LS, Kaplan C, Livaudais-Toman J, Kerlikowske K. Mammography facilities serving vulnerable women have longer follow-up times. Health Serv Res 2018; 54 Suppl 1:226-233. [PMID: 30394526 PMCID: PMC6341204 DOI: 10.1111/1475-6773.13083] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objective To investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis. Data Sources Prospectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012. Study Design We examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group. Data Extraction Methods Merged SFMR, Cancer Registry and facility survey data. Principal Findings Facilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91). Conclusions Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.
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Affiliation(s)
- Leah S Karliner
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Celia Kaplan
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Jennifer Livaudais-Toman
- Department of Medicine, Division of General Internal Medicine, University of California San Francisco, San Francisco, California.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, California
| | - Karla Kerlikowske
- General Internal Medicine Section, San Francisco Veteran Affairs Medical Center, San Francisco, California.,Departments of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
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30
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Roberts MC, Ferrer RA, Rendle KA, Kobrin SC, Taplin SH, Hesse BW, Klein WMP. Lay Beliefs About the Accuracy and Value of Cancer Screening. Am J Prev Med 2018; 54:699-703. [PMID: 29551327 PMCID: PMC5911403 DOI: 10.1016/j.amepre.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 02/01/2018] [Accepted: 02/01/2018] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Appreciating the accuracy and value of cancer screening is essential to informed decision making about screening. This study's objectives were to (1) examine people's beliefs about the accuracy and value of cancer screening, and (2) determine whether sociodemographics, cancer beliefs, and shared decision making are associated with these beliefs. METHODS Data from the National Cancer Institute's Health Information National Trends Survey (cycle 4, August-November 2014) were used. Respondents were non-institutionalized adults (aged ≥18 years, n=3,677). Weighted generalized linear modeling was used to examine bivariate and multivariate associations between key covariates and beliefs about cancer screening (assessed by four-item scale and independently). Secondary analyses examined whether these beliefs were associated with self-reported cancer screening. Data were analyzed between 2016 and 2017. RESULTS Only 5.6% (n=189) of respondents answered all four cancer screening items correctly. Men, racial/ethnic minorities, and those with lower education and higher cancer fatalism were less likely to have accurate beliefs about cancer screening. However, those who reported shared decision making for colorectal cancer screening were more likely to know that "when a test finds something abnormal, more tests are needed to know if it is cancer" and "when a test finds something abnormal, it is [not] very likely to be cancer" (adjusted risk ratio=1.13, p<0.01, adjusted risk ratio=1.25, p<0.01). Beliefs were not associated with likelihood of past mammography or Pap testing. CONCLUSIONS Educators, researchers, and clinicians should consider opportunities (e.g., through shared decision making) to improve the accuracy of individuals' beliefs about cancer screening.
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Hiatt RA, Sibley A, Fejerman L, Glantz S, Nguyen T, Pasick R, Palmer N, Perkins A, Potter MB, Somsouk M, Vargas RA, van ’t Veer LJ, Ashworth A. The San Francisco Cancer Initiative: A Community Effort To Reduce The Population Burden Of Cancer. Health Aff (Millwood) 2018; 37:54-61. [DOI: 10.1377/hlthaff.2017.1260] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Robert A. Hiatt
- Robert A. Hiatt is chair of and a professor in the Department of Epidemiology and Biostatistics, director of population sciences, and associate director of the Helen Diller Family Comprehensive Cancer Center, all at the University of California, San Francisco (UCSF)
| | - Amanda Sibley
- Amanda Sibley is initiatives program director at the Helen Diller Family Comprehensive Cancer Center, UCSF
| | - Laura Fejerman
- Laura Fejerman is an associate professor in the Department of Medicine, UCSF
| | - Stanton Glantz
- Stanton Glantz is a professor of medicine in the Department of Medicine and director of the Center for Tobacco Control Research and Education, UCSF
| | - Tung Nguyen
- Tung Nguyen is a professor of medicine in the Department of Medicine, UCSF
| | - Rena Pasick
- Rena Pasick is a professor of medicine in the Department of Medicine and director of community engagement at the Helen Diller Family Comprehensive Cancer Center, UCSF
| | - Nynikka Palmer
- Nynikka Palmer is an assistant professor of medicine in the Department of Medicine at UCSF
| | - Arnold Perkins
- Arnold Perkins is chair of the Community Advisory Board, Helen Diller Family Comprehensive Cancer Center, UCSF
| | - Michael B. Potter
- Michael B. Potter is a professor in the Department of Family and Community Medicine, UCSF
| | - Ma Somsouk
- Ma Somsouk is an associate professor in the Department of Medicine, UCSF
| | - Roberto A. Vargas
- Roberto A. Vargas is a navigator at the Clinical and Translational Science Institute, UCSF
| | - Laura J. van ’t Veer
- Laura J. van ’t Veer is a leader in the Breast Oncology Program, director of Applied Genomics, and the Angela and Shu Kai Chan Endowed Chair in Cancer Research, all at the UCSF Helen Diller Family Comprehensive Cancer Center
| | - Alan Ashworth
- Alan Ashworth is president of the Helen Diller Family Comprehensive Cancer Center and senior vice president for cancer services at UCSF Health
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