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Fairman CM, Kava CM, Beima-Sofie K, Sakhuja M, Masud M, Dias E, Sheng J, Gorzelitz J, Morshed A, Green BB, Skiba MB, Madhivanan P, Parthasarathy N, Hirschey R, Vander Weg MW, Hebert J. Addressing differences in cancer: a framework for synergistic programming in cancer prevention and control. RESEARCH SQUARE 2024:rs.3.rs-4046415. [PMID: 38562683 PMCID: PMC10984020 DOI: 10.21203/rs.3.rs-4046415/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Abstract
Background Cancer remains a leading cause of death worldwide and continues to disproportionately impact certain populations. Several frameworks have been developed that illustrate the multiple determinants of cancer. Expanding upon the work of others, we present an applied framework for cancer prevention and control designed to help clinicians, as well as public health practitioners and researchers, better address differences in cancer outcomes. Methods The framework was developed by the Cancer Prevention and Control Research Network's Health Behaviors Workgroup. An initial framework draft was developed based on workgroup discussion, public health theory, and rapid literature review on the determinants of cancer. The framework was refined through interviews and focus groups with Federally Qualified Health Center providers (n=2) and cancer patients (n=2); participants were asked to provide feedback on the framework's causal pathways, completeness, and applicability to their work and personal life. Results The framework provides an overview of the relationships between sociodemographic inequalities, social and structural determinants, and key risk factors associated with cancer diagnosis, survivorship, and cancer morbidity and mortality across the lifespan. The framework emphasizes how health-risk behaviors like cigarette smoking interact with psychological, psychosocial, biological, and psychosocial risk factors, as well as healthcare-related behavior and other chronic diseases. Importantly, the framework emphasizes addressing social and structural determinants that influence health behaviors to reduce the burden of cancer and improve health equity. Aligned with previous theory, our framework underscores the importance of addressing co-occurring risk factors and disease states, understanding the complex relationships between factors that influence cancer, and assessing how multiple forms of inequality or disadvantage intersect to increase cancer risk across the lifespan. Conclusions This paper presents an applied framework for cancer prevention and control to address cancer differences. Because the framework highlights determinants and factors that influence cancer risk at multiple levels, it can be used to inform the development, implementation, and evaluation of interventions to address cancer morbidity and mortality.
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Affiliation(s)
| | | | | | | | | | - E Dias
- UTHealth Houston School of Public Health
| | - J Sheng
- University of Wisconsin-Madison
| | | | | | - B B Green
- Kaiser Permanente Washington Health Research Institute
| | | | | | | | - R Hirschey
- University of North Carolina and Lineberger Comprehensive Cancer Center
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Haynes D, Hughes KD, Borrero M, Haas M, Roach L, Blaes A. Estimating uninsured and underinsured women eligible for Minnesota's Breast Cancer Screening Program. Cancer Causes Control 2024; 35:359-366. [PMID: 37775609 DOI: 10.1007/s10552-023-01792-x] [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: 05/02/2023] [Accepted: 09/06/2023] [Indexed: 10/01/2023]
Abstract
Since its inception in 1991, the mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography. This program has demonstrated evidence showing that it has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.
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Affiliation(s)
- David Haynes
- Institute for Health Informatics, Suite 8-100, 516 Delaware Street SE, Minneapolis, MN, 55455, USA.
| | - Kelly D Hughes
- Minnesota Department of Health, Sage Program, 85 7th Place E, St. Paul, MN, 55101, USA
| | - Maria Borrero
- School of Medicine, University of Minnesota, Minneapolis, MN, 55445, USA
| | - McKenna Haas
- School of Public Health, University of Minnesota, Minneapolis, MN, 55445, USA
| | - Lauren Roach
- School of Public Health, University of Minnesota, Minneapolis, MN, 55445, USA
| | - Anne Blaes
- School of Medicine, University of Minnesota, Minneapolis, MN, 55445, USA
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Bhattacharyya O, Relation T, Fisher JL, Li Y, Oppong BA. County characteristics associated with refusing breast cancer surgery: Evidence from the Surveillance, Epidemiology, and End Results program. Surgery 2023; 174:457-463. [PMID: 37296055 DOI: 10.1016/j.surg.2023.04.047] [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: 03/07/2023] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023]
Abstract
BACKGROUND Individuals' communities impact cancer disparities and are intimately related to social determinants of health. Studies show that personal factors affect treatment refusals for a potentially curable cancer, but few studies have investigated whether community-based characteristics affect the receipt of surgery. METHODS We used Surveillance Epidemiology and End Results Program registries from 2010 to 2015 to examine differences in rates of surgery refusal among non-Hispanic White, non-Hispanic Black, and Hispanic women diagnosed with nonmetastatic breast cancer. The community factor measures were based on county-level factors. Sociodemographic and community differences were analyzed using Pearson's χ2 tests and analysis of variance. Multivariate logistic regression of predictors of surgery refusal and the Cox proportional hazard model of disease-specific mortality were performed. RESULTS Surgery refusers among non-Hispanic Black and Hispanic all races lived in counties with lower rates of educational attainment, median family and household income, and higher rates of poverty, unemployment, foreign-born, language isolation, urban population, and women more than 40 years old having mammography in last 2 years. Multivariate analysis shows surgery refusal rates increased in counties having a high percentage of urban population and declined in counties with an increased percentage of less than high school level education, unemployment, and median household income. Breast cancer-specific mortality increased significantly with surgery refusal. CONCLUSION Residence in counties with the lowest socioeconomic status and disproportionately populated by racial and ethnic minorities is associated with surgery refusal. Given the high mortality associated with refusing surgery, culturally sensitive education on the benefits of care may be appropriate.
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Affiliation(s)
- Oindrila Bhattacharyya
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH; The William Tierney Center for Health Services Research, Regenstrief Institute, Inc, Indianapolis, IN
| | - Theresa Relation
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH; MetroHealth Systems Case Western Reserve University, Cleveland, OH
| | - James L Fisher
- James Cancer Hospital and Solove Research Institute, The Ohio State University, Columbus, OH
| | - Yaming Li
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH
| | - Bridget A Oppong
- James Comprehensive Cancer Center, The Ohio State University, Columbus, OH; Division of Surgical Oncology, Department of Surgery, The Ohio State University, Columbus, OH.
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Haynes D, Hughes KD, Borerro M, Haas M, Roach L, Blaes A. Estimating Uninsured and Underinsured Women Eligible for Minnesota's Breast Cancer Screening Program. RESEARCH SQUARE 2023:rs.3.rs-2886477. [PMID: 37293106 PMCID: PMC10246289 DOI: 10.21203/rs.3.rs-2886477/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The mission of the National Breast and Cervical Cancer Early Detection Program's (NBCCEDP) mission is to improve access to mammography and other health services for underserved women. Since its inception in 1991, this national program has improved breast cancer screening rates for women who are uninsured and underinsured. However, the literature has shown that NBCCEDP screenings are decreasing, and only reach a portion of eligible women. Reliable estimates at the sub-county level are needed to identify and reach eligible women. Our work builds upon previous estimates by integrating uninsured and insurance status into spatially adaptive filters. We use spatially adaptive filters to create small area estimates of standardized incidence ratios describing the utilization rate of NBCCEDP services in Minnesota. We integrate the American Community Survey (2010-2014) insurance status data to account for the percentage that an individual is uninsured. We test five models that integrate insurance status by age, sex, and race/ethnicity. Our composite model, which adjusts for age, sex, and race/ethnicity insurance statuses, reduces 95% of the estimation error. We estimate that there approximately 49,913.7 women eligible to receive services for Minnesota. We also create small geography (i.e., county and sub-county) estimates for Minnesota. The integration of the insurance data improved our utilization estimate. The development of these methods will allow state programs to more efficiently use their resources and understand their reach.
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Haynes D, Hughes K, Haas M, Richards GL, Robinson B. Breast Cancer Champions: a peer-to-peer education and mobile mammography program improving breast cancer screening rates for women of African heritage. Cancer Causes Control 2023; 34:625-633. [PMID: 37133574 PMCID: PMC10154761 DOI: 10.1007/s10552-023-01704-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
INTRODUCTION Nationally, women of African heritage die at higher rates from breast cancer than women of other races or ethnicities. We developed Breast Cancer Champions (BCC) a peer-to-peer education program, which recruited 12 women and deployed them into the community in August 2020 during the height of the COVID pandemic. BCC aims to improve breast cancer screening rates for women of African heritage through peer-to-peer education, which has proven successful for addressing cancer-related health disparities. METHODS BCC community experts, or "Champions," are peer-to-peer educators that conduct awareness and screening events in their communities. Champion's education activities were tracked by bi-weekly check-in calls, which recorded the activity type, location, and the number of participants for each event. We used spatial and statistical analyses to determine the efficacy of the program at increasing screening rates for women within the area of Champion activity versus women outside of their activity area. RESULTS Over 15 months, Champions conducted 245 in-person or online events to engage women in their community for screening. More women of African heritage were screened in areas Champions were active during the intervention compared to historical data comparing areas outside of the Champion activity in the prior 15 months (X 2 = 3.0845, p = 0.079). CONCLUSION BCC successes could be attributed to pivoting to online community building when in-person events were restricted and enabling Champions to design and conduct their own events, which increased outreach possibilities. We demonstrate improved screening outcomes associated with an updated peer-to-peer education program.
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Affiliation(s)
- David Haynes
- Institute for Health Informatics, University of Minnesota, 516 Delaware Street SE, Suite 8-110, Minneapolis, MN, 55455, USA.
| | - Kelly Hughes
- Sage Programs, Minnesota Department of Health, St. Paul, MN, 55164, USA
| | - McKenna Haas
- School of Public Health, University of Minnesota, Minneapolis, MN, 55455, USA
| | - Gay Lynn Richards
- Sage Programs, Minnesota Department of Health, St. Paul, MN, 55164, USA
| | - Benita Robinson
- Sage Programs, Minnesota Department of Health, St. Paul, MN, 55164, USA
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Dhanasekara CS, Khan H, Rahman RL. Impact of Access to Breast Care For West Texas Program on Early Detection and Regional Breast Cancer Mortality. Cancer Control 2023; 30:10732748231167254. [PMID: 37158405 PMCID: PMC10176556 DOI: 10.1177/10732748231167254] [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: 05/10/2023] Open
Abstract
INTRODUCTION This study aimed to assess whether the Access to Breast Care for West Texas (ABC4WT) program impacted regional breast cancer detection and mortality in the Texas Council of Governments (COG)1 region. METHODS Interrupted time series analyses were utilized to evaluate the impact of the intervention. Spearman's rank correlation and cross-orrelation analyses were performed to assess the relationship between the total number of screenings and (i) the total number of breast cancer detected and (ii) the proportion of early-stage cancer detected and the (pre-whitened) residuals. A three-way interaction model compared pre-and post-intervention mortality in COG 1 with the COG 9 region (control). RESULTS Increased screening rate was associated with increased breast and early-stage cancer incidences (P = .001 and P = .002, respectively). There were significant positive cross-correlations between the total number of screenings and the total number of breast cancer detected (r = .996) and the proportion of early-stage cancer detected (r = .709) without a lag even after pre-whitening. Univariate analysis showed that regional mortality decreased with time (P < .001) and after intervention (P = .001). Multivariate analysis did not show any significant difference in time (P = .594), intervention (P = .453), and time and intervention interaction (P = .273). The three-way interaction model showed no difference in the baseline mortality and pre-intervention trend difference in COG 1 and COG 9 regions. However, there was a significant pre-post intervention trend difference in mortality COG 1 compared to the COG 9 region (P = .041). CONCLUSION Implementing the ABC4WT program was associated with the early detection of breast cancer and reducing regional mortality in the COG 1 region.
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Affiliation(s)
| | - Hafiz Khan
- Department of Public Health, Texas Tech University Health Sciences Center, Lubbock, TX, USA
| | - Rakhshanda L Rahman
- Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA
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Melkonian SC, Jim MA, Pete D, Poel A, Dominguez AE, Echo-Hawk A, Zhang S, Wilson RJ, Haverkamp D, Petras L, Pohlenz A. Cancer disparities among non-Hispanic urban American Indian and Alaska Native populations in the United States, 1999-2017. Cancer 2022; 128:1626-1636. [PMID: 35119703 PMCID: PMC10929659 DOI: 10.1002/cncr.34122] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/21/2021] [Accepted: 12/30/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Disparities in cancer incidence have not been described for urban American Indian/Alaska Native (AI/AN) populations. The purpose of the present study was to examine incidence rates (2008-2017) and trends (1999-2017) for leading cancers in urban non-Hispanic AI/AN (NH AI/AN) compared to non-Hispanic White (NHW) populations living in the same urban areas. METHODS Incident cases from population-based cancer registries were linked with the Indian Health Service patient registration database for improved racial classification of NH AI/AN populations. This study was limited to counties in Urban Indian Health Organization service areas. Analyses were conducted by geographic region. Age-adjusted rates (per 100,000) and trends (joinpoint regression) were calculated for leading cancers. RESULTS Rates of colorectal, liver, and kidney cancers were higher overall for urban NH AI/AN compared to urban NHW populations. By region, rates of these cancers were 10% to nearly 4 times higher in NH AI/AN compared to NHW populations. Rates for breast, prostate, and lung cancer were lower in urban NH AI/AN compared to urban NHW populations. Incidence rates for kidney, liver, pancreatic, and breast cancers increased from 2% to nearly 7% annually between 1999 to 2017 in urban NH AI/AN populations. CONCLUSIONS This study presents cancer incidence rates and trends for the leading cancers among urban NH AI/AN compared to urban NHW populations for the first time, by region, in the United States. Elevated risk of certain cancers among urban NH AI/AN populations and widening cancer disparities highlight important health inequities and missed opportunities for cancer prevention in this population.
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Affiliation(s)
- Stephanie C. Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Melissa A. Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Dornell Pete
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Amy Poel
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Adrian E. Dominguez
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | - Abigail Echo-Hawk
- Seattle Indian Health Board, Urban Indian Health Institute, Seattle, Washington
| | | | - Reda J. Wilson
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Lindsey Petras
- American Indian Cancer Foundation, Minneapolis, Minnesota
| | - Ashley Pohlenz
- American Indian Cancer Foundation, Minneapolis, Minnesota
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Insurance-Mediated Disparities in Gynecologic Oncology Care. Obstet Gynecol 2022; 139:305-312. [PMID: 34991133 PMCID: PMC8759538 DOI: 10.1097/aog.0000000000004643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Accepted: 10/28/2021] [Indexed: 11/26/2022]
Abstract
Insurance coverage has lagged behind improvements in gynecologic cancer care, with one third of women never seeing a gynecologic oncologist and half experiencing financial toxicity during cancer treatment. With 102,000 new cases of gynecologic cancer, 30,000 associated deaths annually, and increasing rates of endometrial cancer, gynecologic cancer is a growing problem. Although gynecologic cancer care has advanced significantly in the past decade owing to new therapeutics and specialized training in radical surgery, even insured women face major barriers to accessing and affording quality gynecologic cancer care. This commentary reviews current literature on insurance-mediated disparities in gynecologic cancer and provides education to clinicians on barriers to care. One third of women with a gynecologic cancer never see a gynecologic oncologist. Up to 40% of Medicare Advantage plans lack an in-network gynecologic oncologist, and 33% of private insurance plans do not include an in-network National Cancer Institute-accredited cancer center, limiting access to surgical advances and clinical trials. Women with Medicaid insurance and gynecologic cancer are 25% less likely to receive guideline-concordant care. Among insured women, 50% experience financial toxicity during gynecologic cancer treatment, and costs may be even higher for certain Medicare enrollees. Addressing these insurance-mediated disparities will be important to help our patients fully benefit from the scientific advances in our field and thrive after a gynecologic cancer diagnosis.
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Haynes D, Hughes KD, Rau A, Joseph AM. The effect of pre-aggregation scale on spatially adaptive filters. Spat Spatiotemporal Epidemiol 2022; 40:100476. [PMID: 35120678 PMCID: PMC10688538 DOI: 10.1016/j.sste.2021.100476] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 11/30/2021] [Accepted: 12/18/2021] [Indexed: 11/16/2022]
Abstract
Choropleth mapping continues to be a dominant mapping technique despite suffering from the Modifiable Areal Unit Problem (MAUP), which may distort disease risk patterns when different administrative units are used. Spatially adaptive filters (SAF) are one mapping technique that can address the MAUP, but the limitations and accuracy of spatially adaptive filters are not well tested. Our work examines these limitations by using varying levels of data aggregation using a case study of geocoded breast cancer screening data and a synthetic georeferenced population dataset that allows us to calculate SAFs at the individual-level. Data were grouped into four administrative boundaries (i.e., county, Zip Code Tabulated Areas, census tracts, and census blocks) and compared to individual-level data (control). Correlation assessed the similarity of SAFs, and map algebra calculated error maps compared to control. This work describes how pre-aggregation affects the level of spatial detail, map patterns, and over and under-prediction.
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Affiliation(s)
- David Haynes
- Institute for Health Informatics, University of Minnesota, Suite 8-100, 516 Delaware Street SE, Minneapolis, MN 55455, United States.
| | - Kelly D Hughes
- Minnesota Department of Health, Sage Program, 85 7th Place E, Saint Paul, MN 55101, United States.
| | - Austin Rau
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, 420 Delaware Street SE, Minneapolis, MN 55455, United States.
| | - Anne M Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, 420 Delaware St SE; MMC 194, Minneapolis, MN 55455, United States.
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Hines RB, Johnson AM, Lee E, Erickson S, Rahman SMM. Trends in Breast Cancer Survival by Race-Ethnicity in Florida, 1990-2015. Cancer Epidemiol Biomarkers Prev 2021; 30:1408-1415. [PMID: 34210675 DOI: 10.1158/1055-9965.epi-20-1746] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 02/16/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period. METHODS This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes. RESULTS Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women. CONCLUSIONS Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities. IMPACT These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women.
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Affiliation(s)
- Robert B Hines
- University of Central Florida College of Medicine, Orlando, Florida.
| | - Asal M Johnson
- Stetson University, Public Health Program, Deland, Florida
| | - Eunkyung Lee
- University of Central Florida College of Health Professions and Sciences, Orlando, Florida
| | | | - Saleh M M Rahman
- University of Central Florida College of Medicine, Orlando, Florida
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Novel mapping methods to describe utilization of free breast cancer screening from a state program. Prev Med Rep 2021; 23:101415. [PMID: 34189019 PMCID: PMC8219894 DOI: 10.1016/j.pmedr.2021.101415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 05/19/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
Introduction The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) is a cancer screening program whose mission is to reduce cancer morbidities for uninsured and underinsured women. A primary activity is to connect women to breast cancer screening. The eligible population and utilization of NBCCEDP screening services have never been quantified at a sub-state level, which hampers effective program evaluation. Here, the Minnesota NBCCEDP, “Sage”, serves as a case study to demonstrate novel spatial analysis methods that depict variation of screening rates at the local level. Methods Women who received breast cancer screening through Sage between 2011 and 2015 were geocoded (N = 74,712 screenings); analysis occurred between 2017 and 2019. We determine an eligible population using a synthetic population dataset that provides geographic residence and demographic information. We introduce a novel spatial analysis technique, spatially adaptive filters (SAFs), to create a utilization map of Sage breast screening services by Minnesota women. Results Between 2011 and 2015, an average of 36,979 women per year were eligible for NBCCEDP breast cancer screening services, representing 3% of the Minnesota female population 40 and older. For Minnesota NBCCEDP eligible women, the state average breast cancer screening utilization rate was 37.2%, but varied considerably by local regions within the state (range 0% to 131%, SD = 18.7%). Conclusions This geospatial model estimated screening service utilization at the local level and enables Minnesota’s Sage program to target specific areas they have yet to reach. Similar programs could employ this model to direct program activities.
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Liu Z, Liu J, Liu R, Xue M, Zhang W, Zhao X, Zhu J, Xia P. Downregulated ZNF132 predicts unfavorable outcomes in breast Cancer via Hypermethylation modification. BMC Cancer 2021; 21:367. [PMID: 33827486 PMCID: PMC8028803 DOI: 10.1186/s12885-021-08112-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 03/28/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND An important mechanism that promoter methylation-mediated gene silencing for gene inactivation is identified in human tumorigenesis. Methylated genes have been found in breast cancer (BC) and beneficial biomarkers for early diagnosis. Prognostic assessment of breast cancer remain little known. Zinc finger protein 132 (ZNF132) is downregulated by promoter methylation in prostate cancer and esophageal squamous cell carcinoma. However, no study provides information on the status of ZNF132, analyzes diagnosis and prognostic significance of ZNF132 in BC. METHODS In the present study, the expression of ZNF132 mRNA and protein level was determined based on the Cancer Genome Atlas (TCGA) RNA-Seq database and clinical samples analysis and multiple cancer cell lines verification. P rognostic significance of ZNF132 in BC was assessed using the Kaplan-Meier plotter. Molecular mechanisms exploration of ZNF132 in BC was performed using the multiple bioinformatic tools. Hypermethylated status of ZNF132 in BC cell lines was confirmed via Methylation specific polymerase chain reaction (MSP) analysis. RESULTS The expression of ZNF132 both the mRNA and protein levels was downregulated in BC tissues. These results were obtained based on TCGA database and clinical sample analysis. Survival analysis from the Kaplan-Meier plotter revealed that the lower level of ZNF132 was associated with a shorter Relapse Free Survival (RFS) time. Receiver operating characteristic curve (ROC) of 0.887 confirmed ZNF132 had powerful sensitivity and specificity to distinguish between BC and adjacent normal tissues. Bioinformatic analysis showed that 6% ((58/960)) alterations of ZNF132 were identified from cBioPortal. ZNF132 participated in multiple biological pathways based on the Gene Set Enrichment Analysis (GSEA) database including the regulation of cell cycle and glycolysis. Finally, MSP analysis demonstrated that ZNF132 was hypermethylated in a panel of breast cancer cell lines and 5-aza-2'-deoxycytidine (5-Aza-dC) treatment restored ZNF132 expression in partial cell lines. CONCLUSIONS Results revealed that hypermethylation of ZNF132 contributed to its downregulated expression and could be identified as a new diagnostic and prognostic marker in BC.
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Affiliation(s)
- Zhao Liu
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Jiaxin Liu
- Department of Gerontological Surgery, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Ruimiao Liu
- Department of Clinical Laboratory, Peoples Hospital of Xi'an (Fourth Hospital of Xi'an), Xi'an, 710004, Shaanxi, China
| | - Man Xue
- Department of General Surgery, Tongchuan Mining Bureau Central Hospital, Tongchuan, 727000, Shaanxi, China
| | - Weifan Zhang
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Xinhui Zhao
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China
| | - Jiang Zhu
- Department of Breast Disease, Shaanxi Provincial Cancer Hospital, Xi'an, 710061, Shaanxi, China
| | - Peng Xia
- Department of Surgical Oncology, The First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, 710061, Shaanxi, China.
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Davis KM, Monga N, Sonubi C, Asumu H, DeBenedectis CM, Spalluto LB. Educational Strategies to Achieve Equitable Breast Imaging Care. JOURNAL OF BREAST IMAGING 2021; 3:231-239. [PMID: 38424828 DOI: 10.1093/jbi/wbaa082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 03/02/2024]
Abstract
As the population of the United States becomes increasingly diverse, radiologists must learn to both understand and mitigate the impact of health disparities. Significant health disparities persist in radiologic care, including breast imaging. Racial and ethnic minorities, women from lower socioeconomic status, those living in rural areas, and the uninsured bear a disproportionate burden of breast cancer morbidity and mortality. Currently, there is no centralized radiology curriculum focusing on breast health disparities available to residents, breast imaging fellows, or practicing breast radiologists. While patient-, provider-, and system-level initiatives are necessary to overcome disparities, our purpose is to describe educational strategies targeted to breast imaging radiologists at all levels to provide equitable care to a diverse population. These strategies may include, but are not limited to, diversifying the breast imaging workforce, understanding the needs of a diverse population, cultural sensitivity and bias training, and fostering awareness of the existing issues in screening mammography access, follow-up imaging, and clinical care.
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Affiliation(s)
- Katie M Davis
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | - Natasha Monga
- Case Western Reserve University - The MetroHealth System, Department of Radiology, Cleveland, OH
| | | | - Hazel Asumu
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | | | - Lucy B Spalluto
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center, Nashville, TN
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14
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Aleshire ME, Adegboyega A, Escontrías OA, Edward J, Hatcher J. Access to Care as a Barrier to Mammography for Black Women. Policy Polit Nurs Pract 2021; 22:28-40. [PMID: 33076774 PMCID: PMC8175007 DOI: 10.1177/1527154420965537] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.
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Affiliation(s)
- Mollie E. Aleshire
- School of Nursing, University of Louisville, Louisville, Kentucky, United States
| | | | - Omar A. Escontrías
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
| | - Jean Edward
- College of Nursing, University of Kentucky, Lexington, United States
| | - Jennifer Hatcher
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
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15
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Wong FL, Miller JW. Centers for Disease Control and Prevention's National Breast and Cervical Cancer Early Detection Program: Increasing Access to Screening. J Womens Health (Larchmt) 2020; 28:427-431. [PMID: 30969905 DOI: 10.1089/jwh.2019.7726] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screening and diagnostic services to low-income, uninsured, and underinsured women across the nation. Although the program has provided services to more than 5 million women since 1991, there remains a significant burden of breast and cervical cancer with inequities among certain populations. To reduce this burden and improve health equity, the NBCCEDP is expanding its scope to include population-based strategies to increase screening in health systems and communities through the implementation of patient and provider evidence-based interventions, connecting women in communities to clinical services, increasing opportunities to access screening, and enhancing the targeting of women in need of services. The goal is to reach more women and make sure women are getting the right screening test at the right time.
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Affiliation(s)
- Faye L Wong
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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16
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Tangka F, Kenny K, Miller J, Howard DH. The eligibility and reach of the national breast and cervical cancer early detection program after implementation of the affordable care act. Cancer Causes Control 2020; 31:473-489. [PMID: 32157463 DOI: 10.1007/s10552-020-01286-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 02/19/2020] [Indexed: 01/17/2023]
Abstract
INTRODUCTION The uninsured rate declined following passage of the Affordable Care Act in 2010. It is unclear how this decrease affected the size of the population eligible for existing safety net programs. We evaluated trends in the number of women eligible for breast and cervical cancer screening and diagnostic services under the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the reach of the program. METHODS Using the Census Bureau's Small Area Health Insurance Estimates data, we calculated the number of women who met the NBCCEDP eligibility criteria based on age, income, and insurance status. We used these data in conjunction with program to estimate the proportion of eligible women served by the NBCCEDP. RESULTS The number of women eligible for breast cancer screening and diagnostic services under the program declined from 5.4 (90% CI 5.2-5.6) to 2.8 (90% CI 2.6-3.0) million from 2011 to 2017. The number of women eligible for cervical cancer screening and diagnostic services declined from 10.3 (90% CI 10.0-10.6) to 5.3 (90% CI 5.1-5.6) million. The share of eligible women served by the program was 15.0% (90% CI 14.8-15.1%) for breast services in 2016-2017 and 6.8% (90% CI 6.7-6.8%) for cervical services in 2015-2017. CONCLUSION Insurance coverage expansions may have contributed to a decrease in the number of program-eligible women. There are many more women eligible for the program than are served.
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Affiliation(s)
- Florence Tangka
- Division of Cancer Prevention and Control, Winship Cancer Center, Emory University, Atlanta, GA, 30030, USA
| | - Kristy Kenny
- Division of Cancer Prevention and Control, Winship Cancer Center, Emory University, Atlanta, GA, 30030, USA
| | - Jacqueline Miller
- Division of Cancer Prevention and Control, Winship Cancer Center, Emory University, Atlanta, GA, 30030, USA
| | - David H Howard
- Department of Health Policy and Management, Winship Cancer Center, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30030, USA.
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17
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Schutt RK, Woodford ML. Increasing health service access by expanding disease coverage and adding patient navigation: challenges for patient satisfaction. BMC Health Serv Res 2020; 20:175. [PMID: 32143726 PMCID: PMC7059366 DOI: 10.1186/s12913-020-5009-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 02/18/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Cancer control programs have added patient navigation to improve effectiveness in underserved populations, but research has yielded mixed results about their impact on patient satisfaction. This study focuses on three related research questions in a U.S. state cancer screening program before and after a redesign that added patient navigators and services for chronic illness: Did patient diversity increase; Did satisfaction levels improve; Did socioeconomic characteristics or perceived barriers explain improved satisfaction. METHODS Representative statewide patient samples were surveyed by phone both before and after the program design. Measures included satisfaction with overall health care and specific services, as well as experience of eleven barriers to accessing health care and self-reported health and sociodemographic characteristics. Multiple regression analysis is used to identify independent effects. RESULTS After the program redesign, the percentage of Hispanic and African American patients increased by more than 200% and satisfaction with overall health care quality rose significantly, but satisfaction with the program and with primary program staff declined. Sociodemographic characteristics explained the apparent program effects on overall satisfaction, but perceived barriers did not. Further analysis indicates that patients being seen for cancer risk were more satisfied if they had a patient navigator. CONCLUSIONS Health care access can be improved and patient diversity increased in public health programs by adding patient navigators and delivering more holistic care. Effects on patient satisfaction vary with patient health needs, with those being seen for chronic illness likely to be less satisfied with their health care than those being seen for cancer risk. It is important to use appropriate comparison groups when evaluating the effect of program changes on patient satisfaction and to consider establishing appropriate satisfaction benchmarks for patients being seen for chronic illness.
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Affiliation(s)
- Russell K Schutt
- Department of Sociology, University of Massachusetts Boston and Harvard Medical School, Boston, MA, 02125-3393, USA.
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18
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Melkonian SC, Jim MA, Haverkamp D, Wiggins CL, McCollum J, White MC, Kaur JS, Espey DK. Disparities in Cancer Incidence and Trends among American Indians and Alaska Natives in the United States, 2010-2015. Cancer Epidemiol Biomarkers Prev 2019; 28:1604-1611. [PMID: 31575554 PMCID: PMC6777852 DOI: 10.1158/1055-9965.epi-19-0288] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 06/12/2019] [Accepted: 07/30/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Cancer incidence rates for American Indian and Alaska Native (AI/AN) populations vary by geographic region in the United States. The purpose of this study is to examine cancer incidence rates and trends in the AI/AN population compared with the non-Hispanic white population in the United States for the years 2010 to 2015. METHODS Cases diagnosed during 2010 to 2015 were identified from population-based cancer registries and linked with the Indian Health Service (IHS) patient registration databases to describe cancer incidence rates in non-Hispanic AI/AN persons compared with non-Hispanic whites (whites) living in IHS purchased/referred care delivery area counties. Age-adjusted rates were calculated for the 15 most common cancer sites, expressed per 100,000 per year. Incidence rates are presented overall as well as by region. Trends were estimated using joinpoint regression analyses. RESULTS Lung and colorectal cancer incidence rates were nearly 20% to 2.5 times higher in AI/AN males and nearly 20% to nearly 3 times higher in AI/AN females compared with whites in the Northern Plains, Southern Plains, Pacific Coast, and Alaska. Cancers of the liver, kidney, and stomach were significantly higher in the AI/AN compared with the white population in all regions. We observed more significant decreases in cancer incidence rates in the white population compared with the AI/AN population. CONCLUSIONS Findings demonstrate the importance of examining cancer disparities between AI/AN and white populations. Disparities have widened for lung, female breast, and liver cancers. IMPACT These findings highlight opportunities for targeted public health interventions to reduce AI/AN cancer incidence.
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Affiliation(s)
- Stephanie C Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico.
| | - Melissa A Jim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Donald Haverkamp
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, New Mexico
| | - Charles L Wiggins
- New Mexico Tumor Registry, University of New Mexico Comprehensive Cancer Center, Albuquerque, New Mexico
| | - Jeffrey McCollum
- Division of Epidemiology and Disease Prevention, Indian Health Service, Rockville, Maryland
| | - Mary C White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Judith S Kaur
- Native American Programs, Mayo Clinic, Jacksonville, Florida
| | - David K Espey
- Office of the Director, Centers for Disease Control and Prevention, Albuquerque, New Mexico
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19
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Jerome-D'Emilia B, Suplee P, Kushary D. A 10-Year Evaluation of New Jersey's National Breast and Cervical Cancer Early Detection Program: Comparison of Stage at Diagnosis in Enrollees and Nonenrollees. J Womens Health (Larchmt) 2019; 29:230-236. [PMID: 31436495 DOI: 10.1089/jwh.2019.7724] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: The New Jersey Cancer Education and Early Detection (NJCEED) program provides breast cancer screening to low income, uninsured, and underinsured women. The purpose of this study was to evaluate the effectiveness of the NJCEED program by considering stage at diagnosis for women enrolled in NJCEED compared to women diagnosed in the state of New Jersey who were not enrollees. Materials and Methods: The sample included 47,162 women diagnosed with breast cancer; of those, 1,364 women were NJCEED enrollees. Enrollees were significantly different from nonenrollees in age, race, ethnicity, education, and poverty level. Results: In the logistic regression, NJCEED enrollees had 88.3% higher odds of being diagnosed at a late stage compared with nonenrollees (odds ratio [OR]: 1.883, confidential interval [CI]: 1.678-2.109). African American women had 54.9% higher odds of being diagnosed at a later stage (OR: 1.549, CI: 1.457-1.646). The likelihood of a late stage diagnosis increased as poverty level increased. Conclusion: These results were consistent with other National Breast and Cervical Cancer Early Detection Program state evaluations, and with evaluations of the national program. Providing a free screening service is not in itself adequate to encourage screening in low-income uninsured women.
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Affiliation(s)
| | - Patricia Suplee
- Rutgers School of Nursing-Camden, Rutgers University, Camden, New Jersey
| | - Debashis Kushary
- Rutgers University, School of Arts and Sciences, Camden, New Jersey
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20
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Rim SH, Allaire BT, Ekwueme DU, Miller JW, Subramanian S, Hall IJ, Hoerger TJ. Cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2019; 30:819-826. [PMID: 31098856 PMCID: PMC6613985 DOI: 10.1007/s10552-019-01178-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 05/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE To estimate the cost-effectiveness of breast cancer screening in the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using a modified CISNET breast cancer simulation model, we estimated outcomes for women aged 40-64 years associated with three scenarios: breast cancer screening within the NBCCEDP, screening in the absence of the NBCCEDP (no program), and no screening through any program. We report screening outcomes, cost, quality-adjusted life-years (QALYs), incremental cost-effectiveness ratios (ICERs), and sensitivity analyses results. RESULTS Compared with no program and no screening, the NBCCEDP lowers breast cancer mortality and improves QALYs, but raises health care costs. Base-case ICER for the program was $51,754/QALY versus no program and $50,223/QALY versus no screening. Probabilistic sensitivity analysis ICER for the program was $56,615/QALY [95% CI $24,069, $134,230/QALY] versus no program and $51,096/QALY gained [95% CI $26,423, $97,315/QALY] versus no screening. CONCLUSIONS On average, breast cancer screening in the NBCCEDP was cost-effective compared with no program or no screening.
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Affiliation(s)
- Sun Hee Rim
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA.
| | | | - Donatus U Ekwueme
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
| | - Jacqueline W Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
| | | | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, MS S107-4, Atlanta, GA, 30341, USA
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21
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Fedewa SA, Yabroff KR, Smith RA, Goding Sauer A, Han X, Jemal A. Changes in Breast and Colorectal Cancer Screening After Medicaid Expansion Under the Affordable Care Act. Am J Prev Med 2019; 57:3-12. [PMID: 31128952 DOI: 10.1016/j.amepre.2019.02.015] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Medicaid expansions following the Affordable Care Act have improved insurance coverage in low-income adults, but little is known about its impact on cancer screening. This study examined associations between Medicaid expansion timing and colorectal cancer (CRC) and breast cancer (BC) screening. METHODS Up-to-date and past 2-year CRC (n=95,400) and BC (women, n=43,279) screening prevalence were computed among low-income respondents aged 50-64 years in 2012, 2014, and 2016 Behavioral Risk Factor Surveillance System data. Respondents were grouped according to Medicaid expansion timing as: very early ([VE] six states expanding March 1, 2010-April 14, 2011), early (21 states expanding January 1, 2014-August 15, 2014), late (five states expanding January 1, 2015-July 1, 2016), and non-expansion states (19 states). Absolute adjusted difference-in-differences (aDDs) were computed in 2018-2019 (ref, non-expansion states). RESULTS Between 2012 and 2016, absolute up-to-date CRC screening increased by 8.8%, 2.9%, 2.4%, and 3.8% among low-income adults in VE, early, late, and non-expansion states, respectively. Past 2-year CRC screening increased by 8.0% in VE and 2.8% in non-expansion states, with an aDD of 4.9% (p=0.041). In 2012-2016, up-to-date BC screening increased by 5.1%, 4.9%, and 3.7% among low-income women in VE, early, and non-expansion states, respectively, but aDDs were not statistically significant. CONCLUSIONS Prevalence of CRC and BC screening among low-income adults rose in Medicaid expansion states, though increases were significantly higher than those in non-expansion states only for recent CRC screening in VE expansion states. Large-scale improvements in cancer screening may take several years following expansion in access to care.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia.
| | - K Robin Yabroff
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Xuesong Han
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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22
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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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23
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Lee SJC, Higashi RT, Inrig SJ, Sanders JM, Zhu H, Argenbright KE, Tiro JA. County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2). Transl Behav Med 2018; 7:349-357. [PMID: 27402023 DOI: 10.1007/s13142-016-0427-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-and-spoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub- and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub- and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local "spoke" organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders' concerns about uncompensated care. A program that leverages local organizations' ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery.
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Affiliation(s)
- Simon J Craddock Lee
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA. .,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Robin T Higashi
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Stephen J Inrig
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Mount St. Mary's University, Los Angeles, CA, USA
| | - Joanne M Sanders
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Hong Zhu
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
| | - Keith E Argenbright
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.,Moncrief Cancer Institute, Fort Worth, TX, USA
| | - Jasmin A Tiro
- University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.,Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA
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24
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Tangka FK, Subramanian S, Mobley LR, Hoover S, Wang J, Hall IJ, Singh SD. Racial and ethnic disparities among state Medicaid programs for breast cancer screening. Prev Med 2017; 102:59-64. [PMID: 28647544 PMCID: PMC5840870 DOI: 10.1016/j.ypmed.2017.06.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 06/02/2017] [Accepted: 06/18/2017] [Indexed: 11/15/2022]
Abstract
Breast cancer screening by mammography has been shown to reduce breast cancer morbidity and mortality. The use of mammography screening though varies by race, ethnicity, and, sociodemographic characteristics. Medicaid is an important source of insurance in the US for low-income beneficiaries, who are disproportionately members of racial or ethnic minorities, and who are less likely to be screened than women with higher socioeconomic statuses. We used 2006-2008 data from Medicaid claims and enrollment files to assess racial or ethnic and geographic disparities in the use of breast cancer screening among Medicaid-insured women at the state level. There were disparities in the use of mammography among racial or ethnic groups relative to white women, and the use of mammography varied across the 44 states studied. African American and American Indian women were significantly less likely than white women to use mammography in 30% and 39% of the 44 states analyzed, respectively, whereas Hispanic and Asian American women were the minority groups most likely to receive screening compared with white women. There are racial or ethnic disparities in breast cancer screening at the state level, which indicates that analyses conducted by only using national data not stratified by insurance coverage are insufficient to identify vulnerable populations for interventions to increase the use of mammography, as recommended.
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Affiliation(s)
- Florence K Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States.
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Lee Rivers Mobley
- School of Public Health and Andrew Young School of Policy Studies, Georgia State University, 1 Park Place, Suite 700, Atlanta, GA 30341, United States
| | - Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Jiantong Wang
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413, United States
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States
| | - Simple D Singh
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway NE, MS F-76, Atlanta, GA 30341-3717, United States
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Quang C, Hill S, Blair S, Dyess DL, Liles JS. Patient and Tumor Disparities in Breast Cancer Based on Insurance Status. Am Surg 2017. [DOI: 10.1177/000313481708300840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study seeks to determine whether uninsured breast cancer patients are more likely to present with advanced disease relative to insured patients. We retrospectively reviewed newly diagnosed breast cancer patients over a 27-month period. Patients were sorted based on insurance status at diagnosis. Demographic and tumor-specific data were collected and analyzed using non-parametric testing. We identified 276 breast tumors in 260 patients. Out of the 260 patients, 71 patients (27.3%) were uninsured and were more likely to be black (P < 0.05), present with a breast-specific complaint rather than an abnormal mammogram (P < 0.05), and present with more advanced disease (52% stage II or worse vs 26.6% in the insured population; P < 0.01). Percentage of invasive carcinoma and tumor biology were independent of insurance status. Insured patients were more likely to receive surgery as first therapy (76.5 vs 46.0%, P < 0.01), whereas uninsured patients were more likely to receive chemotherapy suggesting multimodality treatment. Uninsured patients had a longer time to therapy initiation (56.0 days vs 44.5 days, P < 0.05). Our study confirms that uninsured patients present with higher stage disease are more likely to have breast-specific complaints and are more likely to require chemotherapy as first-line treatment confirming the under-utility of screening mammography within our uninsured patients.
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Affiliation(s)
- Celia Quang
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Seth Hill
- College of Medicine, University of South Alabama, Mobile, Alabama
| | - Scott Blair
- Department of Surgery, University of South Alabama, Mobile, Alabama
| | - Donna Lynn Dyess
- Department of Surgery, University of South Alabama, Mobile, Alabama
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Subramanian S, Keating NL. Delays in breast cancer diagnosis after a state policy limiting Medicaid enrollment. Cancer 2017. [DOI: 10.1002/cncr.30769] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Sujha Subramanian
- Public Health Research Division; RTI International; Waltham Massachusetts
| | - Nancy L. Keating
- Department of Health Care Policy; Harvard Medical School; Boston Massachusetts
- Division of General Internal Medicine; Brigham and Women's Hospital; Boston Massachusetts
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Koroukian SM, Bakaki PM, Htoo PT, Han X, Schluchter M, Owusu C, Cooper GS, Rose J, Flocke SA. The Breast and Cervical Cancer Early Detection Program, Medicaid, and breast cancer outcomes among Ohio's underserved women. Cancer 2017; 123:3097-3106. [PMID: 28542870 DOI: 10.1002/cncr.30720] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/01/2017] [Accepted: 03/16/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND As an organized screening program, the national Breast and Cervical Cancer Early Detection Program (BCCEDP) was launched in the early 1990s to improve breast cancer outcomes among underserved women. To analyze the impact of the BCCEDP on breast cancer outcomes in Ohio, this study compared cancer stages and mortality across BCCEDP participants, Medicaid beneficiaries, and "all others." METHODS This study linked data across the Ohio Cancer Incidence Surveillance System, Medicaid, the BCCEDP database, death certificates, and the US Census and identified 26,426 women aged 40 to 64 years who had been diagnosed with incident invasive breast cancer during the years 2002-2008 (deaths through 2010). The study groups were as follows: BCCEDP participants (1-time or repeat users), Medicaid beneficiaries (women enrolled in Medicaid before their cancer diagnosis [Medicaid/prediagnosis] or around the time of their cancer diagnosis [Medicaid/peridiagnosis]), and all others (women identified as neither BCCEDP participants nor Medicaid beneficiaries). The outcomes included advanced-stage cancer at diagnosis and mortality. A multivariable logistic and survival analysis was conducted to examine the independent association between the BCCEDP and Medicaid status and the outcomes. RESULTS The percentage of women presenting with advanced-stage disease was highest among women in the Medicaid/peridiagnosis group (63.4%) and lowest among BCCEDP repeat users (38.6%). With adjustments for potential confounders and even in comparison with Medicaid/prediagnosis beneficiaries, those in the Medicaid/peridiagnosis group were twice as likely to be diagnosed with advanced-stage disease (adjusted odds ratio, 2.20; 95% confidence interval, 1.83-2.66). CONCLUSIONS Medicaid/peridiagnosis women are at particularly high risk to be diagnosed with advanced-stage disease. Efforts to reduce breast cancer disparities must target this group of women before they present to Medicaid. Cancer 2017;123:3097-106. © 2017 American Cancer Society.
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Affiliation(s)
- Siran M Koroukian
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Paul M Bakaki
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Phyo Than Htoo
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Xiaozhen Han
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio
| | - Mark Schluchter
- Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, Cleveland, Ohio.,Case Comprehensive Cancer Center, Cleveland, Ohio
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Gregory S Cooper
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Medicine, University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Johnie Rose
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Susan A Flocke
- Case Comprehensive Cancer Center, Cleveland, Ohio.,Department of Family and Community Health, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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Lin JY, Diwanji TP, Snider JW, Knight N, Regine WF. Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy. J Oncol Pract 2016; 12:e405-12. [PMID: 26931401 DOI: 10.1200/jop.2015.009290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening. METHODS We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ(2) tests. RESULTS A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age. CONCLUSION This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.
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Affiliation(s)
- Jolinta Y Lin
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Tejan P Diwanji
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - James W Snider
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Nancy Knight
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - William F Regine
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
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29
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Dalzell LP, Tangka FKL, Powers DS, O'Hara BJ, Holmes W, Joseph K, Royalty J. Data sources for identifying low-income, uninsured populations: application to public health-National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2015; 26:699-709. [PMID: 25916228 PMCID: PMC4732875 DOI: 10.1007/s10552-015-0571-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To provide information on the sources of data for estimating low-income, uninsured populations. To recommend uses of these data sources. To demonstrate the application of these data sources in the public health field, using the National Breast and Cervical Cancer Early Detection Program as an example. METHODS We describe U.S. Census Bureau data sources for identifying low-income, uninsured populations using two population surveys: the Annual Social and Economic Supplement to the Current Population Survey (CPS ASEC) and the American Community Survey (ACS), and using one model-based estimation program, the Small Area Health Insurance Estimates (SAHIE). We provide recommendations for use of these data sources, and we use CPS ASEC and SAHIE to estimate the percent of U.S. women eligible for the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). RESULTS CPS ASEC, ACS, and SAHIE are produced by the U.S. Census Bureau, and they are reliable sources for estimates of the low-income, uninsured populations in the USA. Key characteristics of these three data sources were presented to highlight the strengths of each to meet the needs of various programs at national and local levels. Recommendations are made on the use of the data sources. Based on these three data sources, estimates of NBCCEDP eligibility showed substantial variation over time at the national and state levels, and across states and counties. CONCLUSIONS Publicly funded programs that are directed toward low-income, uninsured individuals require information on their eligible populations to make decisions about program policy and resource allocation, and to monitor and evaluate the effectiveness of the programs. The U.S. Census Bureau produces three data sources (CPS ASEC, ACS, and SAHIE) for these estimates. The percent of U.S. women eligible for NBCCEDP varies over time and across states and counties. The data sources for these estimates are changing in order to measure key dimensions of the Affordable Care Act (ACA) and can provide helpful information for assessing the legislation's impact.
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Affiliation(s)
- Lucinda P Dalzell
- Social, Economic and Housing Statistics Division, 6H123, U.S. Census Bureau, 4600 Silver Hill Road, Washington, DC, 20233-8500, USA,
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Miller JW, Royalty J, Henley J, White A, Richardson LC. Breast and cervical cancers diagnosed and stage at diagnosis among women served through the National Breast and Cervical Cancer Early Detection Program. Cancer Causes Control 2015; 26:741-7. [PMID: 25724415 PMCID: PMC4797940 DOI: 10.1007/s10552-015-0543-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Accepted: 02/20/2015] [Indexed: 01/07/2023]
Abstract
PURPOSE To assess cancers diagnosed and the stage of cancer at the time of diagnosis among low-income, under-insured, or uninsured women who received services through the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). METHODS Using the NBCCEDP database, we examined the number and percent of women diagnosed during 2009-2011 with in situ breast cancer, invasive breast cancer, and invasive cervical cancer by demographic and clinical characteristics, including age, race and ethnicity, test indication (screening or diagnostic), symptoms (for breast cancer), and screening history (for cervical cancer). We examined these characteristics by stage at diagnosis, a new variable included in the database obtained by linking with state-based central cancer registries. RESULTS There were 11,569 women diagnosed with invasive breast cancer, 1,988 with in situ breast cancer, and 583 with invasive cervical cancer through the NBCCEDP. Women who reported breast symptoms or who had diagnostic mammography were more likely to be diagnosed with breast cancer, and at a later stage, than those who did not have symptoms or who had screening mammography. Women who had been rarely or never screened for cervical cancer were more likely to be diagnosed with cervical cancer, and at a later stage, than women who received regular screenings. CONCLUSIONS Women served through the NBCCEDP who have not had prior screening or who have symptoms were more often diagnosed with late-stage disease.
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Affiliation(s)
- Jacqueline W Miller
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Hwy NE, Mailstop F-76, Atlanta, GA, 30341, USA,
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31
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Tangka FKL, Howard DH, Royalty J, Dalzell LP, Miller J, O'Hara BJ, Sabatino SA, Joseph K, Kenney K, Guy GP, Hall IJ. Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997-2012. Cancer Causes Control 2015; 26:671-86. [PMID: 25783455 PMCID: PMC4429146 DOI: 10.1007/s10552-015-0524-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 01/08/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) provides breast and cervical cancer screens to low-income, uninsured, and underinsured women. We describe the number and proportion of women eligible for cervical cancer screening services and the proportion of eligible women screened over the period 1997-2012. METHODS Low-income, uninsured, and underinsured women aged 18-64 years who have not had a hysterectomy are eligible for cervical cancer screening through the NBCCEDP. We estimated the number of low-income, uninsured women using data from the US Census Bureau. We adjusted our estimates for hysterectomy status using the National Health Interview Survey and the Behavioral Risk Factor Surveillance System. We used data from the NBCCEDP to describe the number of women receiving NBCCEDP-funded screening and calculated the proportion of eligible women who received screening through the NBCCEDP at the national level (by age group, race/ethnicity) and at the state level by age group. We used the Medical Expenditure Panel Survey to estimate the proportion of NBCCEDP-eligible women who were screened outside the NBCCEDP and the proportion that are not screened. RESULTS We estimate that in 2010-2012, 705,970 women aged 18-64 years, 6.5 % (705,970 of 9.8 million) of the eligible population, received NBCCEDP-funded Pap tests. We estimate that 60.2 % of eligible women aged 18-64 years were screened outside the NBCCEDP and 33.3 % were not screened. The NBCCEDP provided 623,603 screens to women aged 40-64 years, an estimated 16.5 % of the eligible population, and 83,660 screens to women aged 18-39 years, representing an estimated 1.2 % of the eligible population. The estimated proportions of eligible women screened in each state ranged from 1.5 to 32.7 % and 5 % to 73.2 % among the 18-64 and 40-64 years age groups, respectively. Changes in the proportion of eligible women screened over the study period were nonsignificant. CONCLUSIONS Although the program provided cervical screening to over 700,000 women between 2010 and 2012, it served a small percent of those eligible. The proportion of women screened varied substantially across age groups, racial/ethnic groups, and states. Many low-income, uninsured women are not being screened.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mailstop F-76, Atlanta, GA, 30341-3717, USA,
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32
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Tangka FKL, Howard DH, Royalty J, Dalzell LP, Miller J, O'Hara BJ, Sabatino SA, Joseph K, Kenney K, Guy GP, Hall IJ. Erratum to: Cervical cancer screening of underserved women in the United States: results from the National Breast and Cervical Cancer Early Detection Program, 1997-2012. Cancer Causes Control 2015; 26:687. [PMID: 25929885 PMCID: PMC4643590 DOI: 10.1007/s10552-015-0584-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention (CDC), 4770 Buford Highway NE, Mailstop F-76, Atlanta, GA, 30341-3717, USA,
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Subramanian S, Tangka FKL, Ekwueme DU, Trogdon J, Crouse W, Royalty J. Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP. Cancer Causes Control 2015; 26:689-95. [PMID: 25840557 PMCID: PMC4748377 DOI: 10.1007/s10552-015-0569-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2014] [Accepted: 03/19/2015] [Indexed: 11/25/2022]
Abstract
PURPOSE There is substantial variation across the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees in terms of the proportion of the eligible population served by the grantees each year (hereafter referred to as the screening proportion). In this paper, we assess program- and state-level factors to better understand the reason for this variation in breast and cervical cancer screening proportions across the NBCCEDP grantees. METHODS We constructed a longitudinal data set, consisting of data from NBCCEDP grantees for each of the three study years (program-years 2006-2007, 2008-2009, and 2009-2010). We performed multivariate analysis to explain the variation in breast and cervical cancer screening proportions across the grantees. The program-level factors studied were the total federal funds received, average cost of screening women by grantee, and the overall organizational structure. The state-level variables included were urban versus rural mix, access to care, and the size of the eligible population. RESULTS Of the 48 grantees included in the study, those that serve larger populations, as measured by the size of the population and the percentage of women eligible for services, had lower screening proportions. Higher average cost of service delivery was also associated with lower screening proportions. In addition, grantees whose populations were more concentrated in urban areas had lower screening proportions. CONCLUSIONS Overall, the average cost of screening, the overall size of the population eligible, and the concentration of population in urban areas all had a negative relationship to the proportion of eligible women screened by NBCCEDP grantees.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 1440 Main Street, Suite 310, Waltham, MA, 02451-1623, USA,
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The National Breast and Cervical Cancer Early Detection Program: 25 Years of public health service to low-income women. Cancer Causes Control 2015; 26:653-6. [PMID: 25837262 DOI: 10.1007/s10552-015-0565-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 03/17/2015] [Indexed: 01/30/2023]
Abstract
This article presents an overview of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a valuable and successful national public health program in the USA that will soon celebrate its 25th anniversary. Simulation modeling and other analyses have demonstrated that the NBCCEDP has significantly reduced breast and cervical cancer mortality among low-income uninsured and underinsured women in the USA, a major goal of the original legislation. The NBCCEDP has also served to build cancer prevention and control capacity in state and local health agencies and created strong and unique public-private partnerships aimed at improving women's health. As such, the impact of NBCCEDP extends beyond the millions of women served by the program to include increased public health system capacity and effectiveness regarding cancer early detection and control for all women.
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White A, Miller J, Royalty J, Ryerson AB, Benard V, Helsel W, Kammerer W. Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009-2012. Cancer Causes Control 2015; 26:723-32. [PMID: 25809209 DOI: 10.1007/s10552-015-0567-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. This study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group. METHODS For the first NBCCEDP-funded mammogram received during 2009-2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication. RESULTS The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40-49 years, fewer women aged 50-64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50-64 compared to those aged 40-49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). CONCLUSIONS Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50-64 years compared to women aged 40-49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screening mammograms. These findings support the NBCCEDP's priority of serving women aged 50-64 years and providing both screening and diagnostic mammograms.
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Affiliation(s)
- Arica White
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway Northeast, Mailstop F76, Atlanta, GA, 30341-3717, USA,
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Forward. The reach and health impacts of the national breast and cervical cancer early detection program. Cancer Causes Control 2015; 26:649-50. [PMID: 25794898 DOI: 10.1007/s10552-015-0561-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 03/03/2015] [Indexed: 01/30/2023]
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Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program. Cancer Causes Control 2015; 26:805-9. [PMID: 25783456 DOI: 10.1007/s10552-015-0541-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/20/2015] [Indexed: 02/05/2023]
Abstract
This commentary highlights some of the valuable insights gained from a special collection of papers that utilized data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and appear in this special issue. The data and experiences of the NBCCEDP can inform the identification of new opportunities and directions for meeting the cancer screening needs of underserved women in a complex and changing health care environment.
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