1
|
Anderson RT, Hillemeier MM, Camacho FT, Harvey JA, Bonilla G, Batten GP, Robinson B, Safon CB, Louis C. The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities. J Rural Health 2024; 40:282-291. [PMID: 37787554 DOI: 10.1111/jrh.12798] [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: 02/15/2023] [Revised: 08/10/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia. METHODS Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA. RESULTS A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4). CONCLUSIONS A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.
Collapse
Affiliation(s)
- Roger T Anderson
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Fabian T Camacho
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jennifer A Harvey
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Gloribel Bonilla
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - George P Batten
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - Brenna Robinson
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chris Louis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| |
Collapse
|
2
|
Lent AB, Derksen D, Jacobs ET, Barraza L, Calhoun EA. Policy Recommendations for Improving Rural Cancer Services in the United States. JCO Oncol Pract 2023; 19:288-294. [PMID: 36735900 PMCID: PMC10414721 DOI: 10.1200/op.22.00704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 11/21/2022] [Accepted: 01/04/2023] [Indexed: 02/05/2023] Open
Abstract
Compared with urban residents, rural Americans have seen slower declines in cancer deaths, have lower incidence but higher death rates from cancers that can be prevented through screening, have lower screening rates, are more likely to present with later-stage cancers, and have poorer cancer outcomes and lower survival. Rural health provider shortages and lack of cancer services may explain some disparities. The literature was reviewed to identify factors contributing to rural health care capacity shortages and propose policy recommendations for improving rural cancer care. Uncompensated care, unfavorable payer mix, and low patient volume impede rural physician recruitment and retainment. Students from rural areas are more likely to practice there but are less likely to attend medical school because of lower graduation rates, grades, and Medical College Admission Test (MCAT) scores versus urban students. The cancer care infrastructure is costly and financially challenging in rural areas with high proportions of uninsured and publicly insured patients. A lack of data on oncology providers and equipment impedes coordinated efforts to address rural shortages. Graduate Medical Education funding greatly favors large, urban, tertiary care teaching hospitals over residency training in rural, critical access and community-based hospitals and clinics. Policies have the potential to transform rural health care. This includes increasing advanced practice provider postgraduate oncology training opportunities and expanding the scope of practice; improving health workforce and services data collection and aggregation; transforming graduate medical education subsidies to support rural student recruitment and rural training opportunities; and expanding federal and state financial incentives and payments to support the rural cancer infrastructure.
Collapse
Affiliation(s)
- Adrienne B. Lent
- Department of Kinesiology and Public Health, California Polytechnic State University, San Luis Obispo, CA
| | - Daniel Derksen
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Leila Barraza
- Department of Community, Environment, and Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Elizabeth A. Calhoun
- Office of the Vice Chancellor for Health Affairs, University of Illinois at Chicago, Chicago, IL
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Bauer C, Zhang K, Xiao Q, Lu J, Hong YR, Suk R. County-Level Social Vulnerability and Breast, Cervical, and Colorectal Cancer Screening Rates in the US, 2018. JAMA Netw Open 2022; 5:e2233429. [PMID: 36166230 PMCID: PMC9516325 DOI: 10.1001/jamanetworkopen.2022.33429] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Area-level factors have been identified as important social determinants of health (SDoH) that impact many health-related outcomes. Less is known about how the social vulnerability index (SVI), as a scalable composite score, can multidimensionally explain the population-based cancer screening program uptake at a county level. OBJECTIVE To examine the geographic variation of US Preventive Services Task Force (USPSTF)-recommended breast, cervical, and colorectal cancer screening rates and the association between county-level SVI and the 3 screening rates. DESIGN, SETTING, AND PARTICIPANTS This population-based cross-sectional study used county-level information from the Centers for Disease Control and Prevention's PLACES and SVI data sets from 2018 for 3141 US counties. Analyses were conducted from October 2021 to February 2022. EXPOSURES Social vulnerability index score categorized in quintiles. MAIN OUTCOMES AND MEASURES The main outcome was county-level rates of USPSTF guideline-concordant, up-to-date breast, cervical, and colorectal screenings. Odds ratios were calculated for each cancer screening by SVI quintile as unadjusted (only accounting for eligible population per county) or adjusted for urban-rural status, percentage of uninsured adults, and primary care physician rate per 100 000 residents. RESULTS Across 3141 counties, county-level cancer screening rates showed regional disparities ranging from 54.0% to 81.8% for breast cancer screening, from 69.9% to 89.7% for cervical cancer screening, and from 39.8% to 74.4% for colorectal cancer screening. The multivariable regression model showed that a higher SVI was significantly associated with lower odds of cancer screening, with the lowest odds in the highest SVI quintile. When comparing the highest quintile of SVI (SVI-Q5) with the lowest quintile of SVI (SVI-Q1), the unadjusted odds ratio was 0.86 (95% posterior credible interval [CrI], 0.84-0.87) for breast cancer screening, 0.80 (95% CrI, 0.79-0.81) for cervical cancer screening, and 0.72 (95% CrI, 0.71-0.73) for colorectal cancer screening. When fully adjusted, the odds ratio was 0.92 (95% CrI, 0.90-0.93) for breast cancer screening, 0.87 (95% CrI, 0.86-0.88) for cervical cancer screening, and 0.86 (95% CrI, 0.85-0.88) for colorectal cancer screening, showing slightly attenuated associations. CONCLUSIONS AND RELEVANCE In this cross-sectional study, regional disparities were found in cancer screening rates at a county level. Quantifying how SVI associates with each cancer screening rate could provide insight into the design and focus of future interventions targeting cancer prevention disparities.
Collapse
Affiliation(s)
- Cici Bauer
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Kehe Zhang
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Qian Xiao
- Department of Epidemiology, Human Genetics and Environmental Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Jiachen Lu
- Department of Biostatistics and Data Science, The University of Texas Health Science Center at Houston School of Public Health, Houston
| | - Young-Rock Hong
- Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville
- UFHealth Cancer Center, Gainesville, Florida
| | - Ryan Suk
- Department of Management, Policy and Community Health, The University of Texas Health Science Center at Houston School of Public Health, Houston
| |
Collapse
|
5
|
Brinkworth JF, Shaw JG. On race, human variation, and who gets and dies of sepsis. AMERICAN JOURNAL OF BIOLOGICAL ANTHROPOLOGY 2022. [PMCID: PMC9544695 DOI: 10.1002/ajpa.24527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Jessica F. Brinkworth
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
- Department of Evolution, Ecology and Behavior University of Illinois Urbana‐Champaign Urbana Illinois USA
| | - J. Grace Shaw
- Department of Anthropology University of Illinois Urbana‐Champaign Urbana Illinois USA
- Carl R. Woese Institute for Genomic Biology University of Illinois at Urbana‐Champaign Urbana Illinois USA
| |
Collapse
|
6
|
Shih YCT, Sabik LM, Stout NK, Halpern MT, Lipscomb J, Ramsey S, Ritzwoller DP. Health Economics Research in Cancer Screening: Research Opportunities, Challenges, and Future Directions. J Natl Cancer Inst Monogr 2022; 2022:42-50. [PMID: 35788368 PMCID: PMC9255920 DOI: 10.1093/jncimonographs/lgac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 03/03/2022] [Indexed: 01/26/2023] Open
Abstract
Cancer screening has long been considered a worthy public health investment. Health economics offers the theoretical foundation and research methodology to understand the demand- and supply-side factors associated with screening and evaluate screening-related policies and interventions. This article provides an overview of health economic theories and methods related to cancer screening and discusses opportunities for future research. We review 2 academic disciplines most relevant to health economics research in cancer screening: applied microeconomics and decision science. We consider 3 emerging topics: cancer screening policies in national as well as local contexts, "choosing wisely" screening practices, and targeted screening efforts for vulnerable subpopulations. We also discuss the strengths and weaknesses of available data sources and opportunities for methodological research and training. Recommendations to strengthen research infrastructure include developing novel data linkage strategies, increasing access to electronic health records, establishing curriculum and training programs, promoting multidisciplinary collaborations, and enhancing research funding opportunities.
Collapse
Affiliation(s)
- Ya-Chen Tina Shih
- Section of Cancer Economics and Policy, Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Michael T Halpern
- Healthcare Delivery Research Program, National Cancer Institute, Bethesda, MD, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Scott Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Institute, Seattle, WA, USA
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO, USA
| |
Collapse
|
7
|
van den Bruele AB, Sevilimedu V, Jochelson M, Formenti S, Norton L, Sacchini V. Mobile mammography in New York City: analysis of 32,350 women utilizing a screening mammogram program. NPJ Breast Cancer 2022; 8:14. [PMID: 35064104 PMCID: PMC8782895 DOI: 10.1038/s41523-022-00381-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 12/07/2021] [Indexed: 11/21/2022] Open
Abstract
Mobile mammography vans (mammovans) may help close the gap to access of breast cancer screening by providing resources to underserved communities. Minimal data exists on the populations served, the ability of mammovans to reach underserved populations, and the outcomes of participants. We sought to determine the demographic characteristics, number of breast cancers diagnosed, and number of women who used the American Italian Cancer Foundation (AICF) Mobile, No-Cost Breast Cancer Screening Program within the five boroughs of New York City. Data were collected by the AICF from 2014 to 2019 on a voluntary basis from participants at each screening location. Women aged 40 to 79 years who had not had a mammogram in the previous 12 months were invited to participate. Each participant underwent a clinical breast exam by a nurse practitioner followed by a screening mammogram. Images were read by a board-certified radiologist contracted by the AICF from Multi Diagnostic Services. There were 32,350 participants in this study. Sixty-three percent reported an annual household income ≤$25,000, and 30% did not have health insurance. More than half of participants identified as either African American (28%) or Hispanic (27%). Additional testing was performed for 5359 women found to have abnormal results on screening. In total, 68 cases of breast cancer were detected. Breast cancer disparities are multifactorial, with the greatest factor being limited access to care. Mobile, no-cost mammogram screening programs show great promise in helping to close the gap to screening access.
Collapse
Affiliation(s)
| | - Varadan Sevilimedu
- Department of Epidemiology & Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Maxine Jochelson
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Silvia Formenti
- Department of Radiation Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Larry Norton
- Breast Medicine, Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Virgilio Sacchini
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
| |
Collapse
|
8
|
Shete S, Deng Y, Shannon J, Faseru B, Middleton D, Iachan R, Bernardo B, Balkrishnan R, Kim SJ, Huang B, Millar MM, Fuemmler B, Jensen JD, Mendoza JA, Hu J, Lazovich D, Robertson L, Demark-Wahnefried W, Paskett ED. Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States. JAMA Netw Open 2021; 4:e2128000. [PMID: 34605915 PMCID: PMC8491105 DOI: 10.1001/jamanetworkopen.2021.28000] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. Objectives To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. Design, Setting, and Participants This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. Main Outcomes and Measures Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. Results The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. Conclusions and Relevance In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.
Collapse
Affiliation(s)
- Sanjay Shete
- Division of Cancer Prevention, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Jackilen Shannon
- Oregon Health & Sciences University, Portland State University School of Public Health, Portland
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City
| | | | | | - Brittany Bernardo
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus
| | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | - Bin Huang
- Department of Cancer Biostatistics, University of Kentucky, Lexington
| | | | - Bernard Fuemmler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | | | - Jason A. Mendoza
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City
| | - DeAnn Lazovich
- University of Minnesota School of Public Health, Minneapolis
| | - Linda Robertson
- UPMC Hillman Cancer Center, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, College of Medicine, Columbus
| |
Collapse
|
9
|
Utilization of Lung Cancer Screening in the Medicare Fee-for-Service Population. Chest 2020; 158:2200-2210. [DOI: 10.1016/j.chest.2020.05.592] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/02/2020] [Accepted: 05/14/2020] [Indexed: 01/20/2023] Open
|
10
|
Madigan LI, Dinh P, Graham JD. Neoadjuvant endocrine therapy in locally advanced estrogen or progesterone receptor-positive breast cancer: determining the optimal endocrine agent and treatment duration in postmenopausal women-a literature review and proposed guidelines. Breast Cancer Res 2020; 22:77. [PMID: 32690069 PMCID: PMC7370425 DOI: 10.1186/s13058-020-01314-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 07/06/2020] [Indexed: 12/20/2022] Open
Abstract
Introduction For patients with locally advanced estrogen receptor or progesterone receptor-positive breast cancer, neoadjuvant endocrine therapy (NET) facilitates down-staging of the tumor and increased rates of breast-conserving surgery. However, NET remains under-utilized, and there are very limited clinical guidelines governing which therapeutic agent to use, or the optimal duration of treatment in postmenopausal women. This literature review aims to discuss the evidence surrounding (1) biomarkers for patient selection for NET, (2) the optimal neoadjuvant endocrine agent for postmenopausal women with locally advanced breast cancer, and (3) the optimal duration of NET. In addition, we make initial recommendations towards developing a clinical guideline for the prescribing of NET. Method A wide-ranging search of online electronic databases was conducted using a truncated PIC search strategy to identify articles that were relevant to these aims and revealed a number of key findings. Results Randomized trials have consistently demonstrated that aromatase inhibitors are more effective than tamoxifen, in terms of objective response rate and rate of BCS, and should be used as first-line NET. The three available aromatase inhibitors have so far been demonstrated to be biologically equivalent, with the choice of aromatase inhibitor not having been shown to affect clinical outcomes. There is increasing evidence for extending the duration of NET beyond 3 to 4 months, to at least 6 months or until maximal clinical response is achieved. While on-treatment levels of the proliferation marker Ki67 are predictive of long-term outcome, the choice of adjuvant therapy in patients who have received NET and then surgery is best guided by the preoperative endocrine prognostic index, or PEPI, which incorporates Ki67 with other clinical parameters. Conclusion This study reveals that in appropriately selected patients, NET can provide equivalent clinical benefit to neoadjuvant chemotherapy in the same cohort, if suitable treatments and durations are chosen. Our findings highlight the need for better defined biomarkers both for guiding patient selection and for measuring outcomes. Development of standard guidelines for the prescribing of NET has the potential to improve both clinical outcomes and quality of life in this patient cohort.
Collapse
Affiliation(s)
- Lauren I Madigan
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia.,Present Address: South Eastern Sydney Local Health District, and St. George and Sutherland Clinical Schools, UNSW Medicine, Sydney, Australia
| | - Phuong Dinh
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia.,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia
| | - J Dinny Graham
- Sydney Medical School - Westmead, The University of Sydney, Sydney, Australia. .,Westmead Breast Cancer Institute, Westmead Hospital, Westmead, Australia. .,The Westmead Institute for Medical Research, The University of Sydney, Westmead, Australia.
| |
Collapse
|
11
|
Adams SA, Haynes VE, Brandt HM, Choi SK, Young V, Eberth JM, Hébert JR, Friedman DB. Cervical cancer screening behaviors and proximity to federally qualified health centers in South Carolina. Cancer Epidemiol 2020; 65:101681. [PMID: 32035294 DOI: 10.1016/j.canep.2020.101681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 12/18/2019] [Accepted: 01/28/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Lack of participation in cervical cancer screening in underserved populations has been attributed to access to care, particularly among women in rural areas. Federally Qualified Health Centers (FQHCs) were created to address this need in medically underserved populations. This study observed proximity to three health centers in relation to cervical cancer screening rates in South Carolina. METHODS Data were obtained from FQHC patient visits (from 3 centers) between 2007-2010 and were limited to women eligible for cervical cancer screening (n = 24,393). ArcGIS was used to geocode patients addresses and FQHC locations, and distance was calculated. Modified Poisson regression was used to estimate relative risk of obtaining cervical cancer screening within one yearor ever, stratified by residential area. RESULTS Findings differed markedly by center and urban/rural status. At two health clinics, rural residents living the furthest away from the clinic (∼9 miles difference between quartile 4 and quartile 1) were more likely to be ever screened (RRs = 1.05 and 1.03, p-values < 0.05), while urban residents living the furthest away were less likely to be ever screened (RR = 0.85, p-value < 0.05). At the third center, only urban residents living the furthest away were more likely to be ever screened (RR = 1.02, p-value < 0.05). CONCLUSIONS Increased travel distance significantly increased the likelihood of cervical cancer screening at two FQHC sites while significantly decreasing the likelihood of screening at the 3rd site. These findings underscore the importance of contextual and environmental factors that impact use of cervical cancer screening services.
Collapse
Affiliation(s)
- Swann Arp Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; College of Nursing, University of South Carolina, 1601 Greene Street Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Venice E Haynes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Seul Ki Choi
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States; Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, South Korea.
| | - Vicki Young
- South Carolina Primary Care Association, 3 Technology Circle Columbia, SC, 29203, United States.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - James R Hébert
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States; Statewide Cancer Prevention and Control Program, University of South Carolina, 915 Greene Street Columbia, SC, 29208, United States.
| |
Collapse
|
12
|
Tailor TD, Tong BC, Gao J, Choudhury KR, Rubin GD. A Geospatial Analysis of Factors Affecting Access to CT Facilities: Implications for Lung Cancer Screening. J Am Coll Radiol 2019; 16:1663-1668. [DOI: 10.1016/j.jacr.2019.06.020] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/18/2019] [Accepted: 06/20/2019] [Indexed: 12/22/2022]
|
13
|
Padilla CM, Painblanc F, Soler-Michel P, Vieira VM. Mapping Variation in Breast Cancer Screening: Where to Intervene? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E2274. [PMID: 31252599 PMCID: PMC6651541 DOI: 10.3390/ijerph16132274] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/07/2019] [Accepted: 06/22/2019] [Indexed: 11/24/2022]
Abstract
Small geographic areas with lower mammography screening participation rates may reflect gaps in screening efforts. Our objective was to use spatial analyses to understand disparities in mammography screening use and to identify factors to increase its uptake in areas that need it in Lyon metropolitan area, France. Data for screened women between the ages of 50 and 74 were analyzed. Census blocks of screened and non screened women were extracted from the mammography screening programme 2015-2016 dataset. We used spatial regression models, within a generalized additive framework to determine clusters of census blocks with significantly higher prevalence of non-participation of mammography screening. Smoothed risk maps were crude and adjusted on the following covariates: deprivation index and opportunistic screening. Among 178,002 women aged 50 to 74, 49.9% received mammography screening. As hypothesized, women living in highly deprived census blocks had lower participation rates compared to less deprived blocks, 45.2% vs. 51.4% p < 0.001. Spatial analyses identified four clusters, one located in an urban area and three in suburban areas. Moreover, depending on the location of the cluster, the influence came from different variables. Knowing the impact of site-specific risk factors seems to be important for implementing an appropriate prevention intervention.
Collapse
Affiliation(s)
- Cindy M Padilla
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France.
| | - François Painblanc
- Université Rennes, EHESP, REPERES (Recherche en pharmaco-épidémiologie et recours aux soins)-EA 7449 Rennes, France
| | - Patricia Soler-Michel
- Centre régional de coordination des dépistages des cancers Auvergne Rhône Alpes, 5 bis, rue Cléberg, 69322 Lyon CEDEX 05, France
| | - Veronica M Vieira
- Program in Public Health, University of California, Irvine, CA 92697, USA
| |
Collapse
|
14
|
Veron L, Gelot A, Gusto G, Arveux P, Delaloge S, Boutron‐Ruault M. Modifiable risk factors for advanced
vs
. early breast cancer in the French E3N cohort. Int J Cancer 2019; 146:850-860. [DOI: 10.1002/ijc.32354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 03/05/2019] [Accepted: 03/25/2019] [Indexed: 12/16/2022]
Affiliation(s)
- Lucie Veron
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
| | - Amandine Gelot
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Gaelle Gusto
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | - Patrick Arveux
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
| | | | - Marie‐Christine Boutron‐Ruault
- Inserm U1018, Center for Research in Epidemiology and Population Health (CESP) Villejuif France
- Paris‐South Saclay University Villejuif France
| |
Collapse
|
15
|
Tailor TD, Choudhury KR, Tong BC, Christensen JD, Sosa JA, Rubin GD. Geographic Access to CT for Lung Cancer Screening: A Census Tract-Level Analysis of Cigarette Smoking in the United States and Driving Distance to a CT Facility. J Am Coll Radiol 2019; 16:15-23. [DOI: 10.1016/j.jacr.2018.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 06/15/2018] [Accepted: 07/05/2018] [Indexed: 02/08/2023]
|
16
|
Lee CI, Zhu W, Onega TL, Germino J, O’Meara ES, Lehman CD, Henderson LM, Haas JS, Kerlikowske K, Sprague BL, Rauscher GH, Tosteson AN, Alford-Teaster J, Wernli KJ, Miglioretti DL. The Effect of Digital Breast Tomosynthesis Adoption on Facility-Level Breast Cancer Screening Volume. AJR Am J Roentgenol 2018; 211:957-963. [PMID: 30235000 PMCID: PMC6438161 DOI: 10.2214/ajr.17.19350] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine whether digital breast tomosynthesis (DBT) adoption was associated with a decrease in screening mammography capacity across Breast Cancer Screening Consortium facilities, given concerns about increasing imaging and interpretation times associated with DBT. SUBJECTS AND METHODS Facility characteristics and examination volume data were collected prospectively from Breast Cancer Screening Consortium facilities that adopted DBT between 2011 and 2014. Interrupted time series analyses using Poisson regression models in which facility was considered a random effect were used to evaluate differences between monthly screening volumes during the 12-month preadoption period and the 12-month postadoption period (with the two periods separated by a 3-month lag) and to test for changes in month-to-month facility-level screening volume during the preadoption and postadoption periods. RESULTS Across five regional breast imaging registries, 15 of 83 facilities (18.1%) adopted DBT for screening between 2011 and 2014. Most had no academic affiliation (73.3% [11/15]), were nonprofit (80.0% [12/15]), and were general radiology practices (66.7% [10/15]). Facility-level monthly screening volumes were slightly higher during the postadoption versus preadoption periods (relative risk [RR], 1.09; 95% CI, 1.06-1.11). Monthly screening volumes remained relatively stable within the preadoption period (RR, 1.00 per month; 95% CI 1.00-1.01 per month) and the postadoption period (RR, 1.00; 95% CI, 1.00-1.01 per month). CONCLUSION In a cohort of facilities with varied characteristics, monthly screening examination volumes did not decrease after DBT adoption.
Collapse
Affiliation(s)
- Christoph I. Lee
- University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109;
| | - Weiwei Zhu
- Kaiser Permanente Washington Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101;
| | - Tracy L. Onega
- Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756;
| | - Jessica Germino
- University of Washington School of Medicine; 825 Eastlake Avenue East, Seattle, WA 98109;
| | - Ellen S. O’Meara
- Kaiser Permanente Washington Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101;
| | - Constance D. Lehman
- Massachusetts General Hospital; Harvard Medical School; 15 Parkman Street, Boston, MA 02114-3117;
| | - Louise M. Henderson
- University of North Carolina, Chapel Hill; 130 Mason Farm Road, 3124 Bioinformatics Building, CB 7515, Chapel Hill, NC 27514;
| | - Jennifer S. Haas
- Brigham and Women’s Hospital; Harvard Medical School; Dana Farber Harvard Cancer Institute; Harvard School of Public Health; 1620 Tremont Street, Boston, MA 02120;
| | - Karla Kerlikowske
- University of California, San Francisco; 4150 Clement Street, San Francisco, CA 94121;
| | - Brian L. Sprague
- University of Vermont; 1 S. Prospect Street, Room 4225, Burlington, VT 05401;
| | - Garth H. Rauscher
- University of Illinois at Chicago; 1603 W. Taylor, 952 SPHPI, Chicago, IL 60612;
| | - Anna N.A. Tosteson
- Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756;
| | - Jennifer Alford-Teaster
- Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine; One Medical Center Drive, Lebanon, NH 03756;
| | - Karen J. Wernli
- Kaiser Permanente Washington Health Research Institute; 1730 Minor Avenue #1600, Seattle, WA, 98101;
| | - Diana L. Miglioretti
- University of California, Davis; One Shields Avenue, Med Sci 1C, Room 145, Davis, CA 95616;
| |
Collapse
|
17
|
Rosenkrantz AB, Moy L, Fleming MM, Duszak R. Associations of County-level Radiologist and Mammography Facility Supply with Screening Mammography Rates in the United States. Acad Radiol 2018; 25:883-888. [PMID: 29373212 DOI: 10.1016/j.acra.2017.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. MATERIALS AND METHODS Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. RESULTS Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%-88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22-0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06-0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. CONCLUSION Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.
Collapse
Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016.
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016
| | - Margaret M Fleming
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| |
Collapse
|
18
|
Jewett PI, Gangnon RE, Elkin E, Hampton JM, Jacobs EA, Malecki K, LaGro J, Newcomb PA, Trentham-Dietz A. Geographic access to mammography facilities and frequency of mammography screening. Ann Epidemiol 2018; 28:65-71.e2. [PMID: 29439783 PMCID: PMC5819606 DOI: 10.1016/j.annepidem.2017.11.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 12/20/2022]
Abstract
PURPOSE To assess the association between geographic access to mammography facilities and women's mammography utilization frequency. METHODS Using data from the population-based 1995-2007 Wisconsin Women's Health study, we used proportional odds and logistic regression to test whether driving times to mammography facilities and the number of mammography facilities within 10 km of women's homes were associated with mammography frequency among women aged 50-74 years and whether associations differed between Rural-Urban Commuting Areas and income and education groups. RESULTS We found evidence for nonlinear relationships between geographic access and mammography utilization (nonlinear effects of driving times and facility density, P-values .01 and .005, respectively). Having at least one nearby mammography facility was associated with greater mammography frequency among urban women (1 vs. 0 facilities, odds ratio 1.26, 95% confidence interval, 1.09-1.47), with similar effects among rural women. Adding more facilities had decreasing marginal effects. Long driving times tended to be associated with lower mammography frequency. We found no effect modification by income, education, or urbanicity. In rural settings, mammography nonuse was higher, facility density smaller, and driving times to facilities were longer. CONCLUSIONS Having at least one mammography facility near one's home may increase mammography utilization, with decreasing effects per each additional facility.
Collapse
Affiliation(s)
- Patricia I Jewett
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison.
| | - Ronald E Gangnon
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison; Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison
| | - Elena Elkin
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - John M Hampton
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
| | - Elizabeth A Jacobs
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison; Department of Medicine, University of Wisconsin, Madison
| | - Kristen Malecki
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
| | - James LaGro
- Department of Urban and Regional Planning, University of Wisconsin, Madison
| | - Polly A Newcomb
- Fred Hutchinson Cancer Research Center, Seattle, WA; University of Washington School of Public Health, Seattle
| | - Amy Trentham-Dietz
- University of Wisconsin Carbone Cancer Center, Madison; Department of Population Health Sciences, University of Wisconsin, Madison
| |
Collapse
|
19
|
Sano H, Goto R, Hamashima C. Does lack of resources impair access to breast and cervical cancer screening in Japan? PLoS One 2017; 12:e0180819. [PMID: 28704430 PMCID: PMC5509210 DOI: 10.1371/journal.pone.0180819] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 06/21/2017] [Indexed: 11/29/2022] Open
Abstract
Objectives To assess the impact of the quantity of resources for breast and cervical cancer screening on the participation rates in screening in clinical settings in municipalities, as well as to clarify whether lack of resources impairs access to cancer screening in Japan. Methods Of the 1,746 municipalities in 2010, 1,443 (82.6%) and 1,469 (84.1%) were included in the analyses for breast and cervical cancer screening, respectively. In order to estimate the effects of the number of mammography units and of gynecologists on the participation rates in breast and cervical cancer screening in clinical settings, multiple regression analyses were performed using the interaction term for urban municipalities. Results The average participation rate in screening in clinical settings was 6.01% for breast cancer, and was 8.93% for cervical cancer. The marginal effect of the number of mammography units per 1,000 women was significantly positive in urban municipalities (8.20 percent point). The marginal effect of the number of gynecologists per 1,000 women was significantly positive in all municipalities (2.54 percent point) and rural municipalities (3.68 percent point). Conclusions Lack of mammography units in urban areas and of gynecologists particularly in rural areas impaired access to breast and cervical cancer screening. Strategies are required that quickly improve access for the residents and increase their participation rates in cancer screening.
Collapse
Affiliation(s)
- Hiroshi Sano
- Faculty of Economics, Shiga University, Hikone, Shiga, Japan
- * E-mail:
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Kanagawa, Japan
| | - Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Chuo-ku, Tokyo, Japan
| |
Collapse
|
20
|
Fujita M, Sato Y, Nagashima K, Takahashi S, Hata A. Impact of geographic accessibility on utilization of the annual health check-ups by income level in Japan: A multilevel analysis. PLoS One 2017; 12:e0177091. [PMID: 28486522 PMCID: PMC5423628 DOI: 10.1371/journal.pone.0177091] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 04/20/2017] [Indexed: 11/18/2022] Open
Abstract
Although both geographic accessibility and socioeconomic status have been indicated as being important factors for the utilization of health care services, their combined effect has not been evaluated. The aim of this study was to reveal whether an income-dependent difference in the impact of geographic accessibility on the utilization of government-led annual health check-ups exists. Existing data collected and provided by Chiba City Hall were employed and analyzed as a retrospective cohort study. The subjects were 166,966 beneficiaries of National Health Insurance in Chiba City, Japan, aged 40 to 74 years. Of all subjects, 54,748 (32.8%) had an annual health check-up in fiscal year 2012. As an optimal index of geographic accessibility has not been established, five measures were calculated: travel time to the nearest health care facility, density of health care facilities (number facilities within a 30-min walking distance from the district of residence), and three indices based on the two-step floating catchment area method. Three-level logistic regression modeling with random intercepts for household and district of residence was performed. Of the five measures, density of health care facilities was the most compatible according to Akaike's information criterion. Both low density and low income were associated with decreased utilization of the health check-ups. Furthermore, a linear relationship was observed between the density of facilities and utilization of the health check-ups in all income groups and its slope was significantly steeper among subjects with an equivalent income of 0.00 yen than among those with equivalent income of 1.01-2.00 million yen (p = 0.028) or 2.01 million yen or more (p = 0.040). This result indicated that subjects with lower incomes were more susceptible to the effects of geographic accessibility than were those with higher incomes. Thus, better geographic accessibility could increase the health check-up utilization and also decrease the income-related disparity of utilization.
Collapse
Affiliation(s)
- Misuzu Fujita
- Chiba University Graduate School of Medicine, Department of Public Health, Chiba City, Chiba, Japan
- * E-mail:
| | - Yasunori Sato
- Chiba University Graduate School of Medicine, Department of Global Clinical Research, Chiba City, Chiba, Japan
| | - Kengo Nagashima
- Chiba University Graduate School of Medicine, Department of Global Clinical Research, Chiba City, Chiba, Japan
| | - Sho Takahashi
- Chiba University Hospital, Clinical Research Center, Chiba City, Chiba, Japan
| | - Akira Hata
- Chiba University Graduate School of Medicine, Department of Public Health, Chiba City, Chiba, Japan
| |
Collapse
|
21
|
Hamashima C, Goto R. Potential capacity of endoscopic screening for gastric cancer in Japan. Cancer Sci 2016; 108:101-107. [PMID: 27727490 PMCID: PMC5276833 DOI: 10.1111/cas.13100] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 10/04/2016] [Accepted: 10/06/2016] [Indexed: 11/28/2022] Open
Abstract
In 2016, the Japanese government decided to introduce endoscopic screening for gastric cancer as a national program. To provide endoscopic screening nationwide, we estimated the proportion of increase in the number of endoscopic examinations with the introduction of endoscopic screening, based on a national survey. The total number of endoscopic examinations has increased, particularly in clinics. Based on the national survey, the total number of participants in gastric cancer screening was 3 784 967. If 30% of the participants are switched from radiographic screening to endoscopic screening, approximately 1 million additional endoscopic examinations are needed. In Japan, the participation rates in gastric cancer screening and the number of hospitals and clinics offering upper gastrointestinal endoscopy vary among the 47 prefectures. If the participation rates are high and the numbers of hospitals and clinics are small, the proportion of increase becomes larger. Based on the same assumption, 50% of big cities can provide endoscopic screening with a 5% increase in the total number of endoscopic examinations. However, 16.7% of the medical districts are available for endoscopic screening within a 5% increase in the total number of endoscopic examinations. Despite the Japanese government's decision to introduce endoscopic screening for gastric cancer nationwide, its immediate introduction remains difficult because of insufficient medical resources in rural areas. This implies that endoscopic screening will be initially introduced to big cities. To promote endoscopic screening for gastric cancer nationwide, the disparity of medical resources must first be resolved.
Collapse
Affiliation(s)
- Chisato Hamashima
- Division of Cancer Screening Assessment and Management, Center for Public Health Science, National Cancer Center, Tokyo, Japan
| | - Rei Goto
- Graduate School of Business Administration, Keio University, Yokohama, Japan
| |
Collapse
|
22
|
Melo ECP, de Oliveira EXG, Chor D, Carvalho MS, Pinheiro RS. Inequalities in socioeconomic status and race and the odds of undergoing a mammogram in Brazil. Int J Equity Health 2016; 15:144. [PMID: 27628786 PMCID: PMC5024478 DOI: 10.1186/s12939-016-0435-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 09/05/2016] [Indexed: 12/05/2022] Open
Abstract
Background Access to mammograms, in common with other diagnostic procedures, is strongly conditioned by socioeconomic disparities. Which aspects of inequality affect the odds of undergoing a mammogram, and whether they are the same in different localities, are relevant issues related to the success of health policies. Methods This study analyzed data from the 2008 PNAD - Brazilian National Household Sample Survey (11.607 million women 40 years of age or older), on having had at least one mammogram over life for women 40 years of age or older in each of Brazil’s nine Metropolitan Regions (MR), according to socioeconomic position. The effects of income, schooling, health insurance and race in the different regions were investigated using multivariate logistical regression for each region individually, and for all MRs combined. The age-adjusted odds of a woman having had a mammogram according to race and stratified by two income strata (and two schooling strata) were also analyzed. Results Having a higher income increases four to seven times a woman’s odds of having had at least one mammogram in all MRs except Curitiba. For schooling, the gradient, though less steep, is favorable to women with more years of study. Having health insurance increases two to three times the odds in all MRs. Multivariate analysis did not show differences due to race (except for the Fortaleza MR), but the stratified analysis by income and schooling shows effects of race in most MRs, with greater differences for women with higher socioeconomic status. Conclusions This study confirms that income and schooling, as well as having health insurance, are still important determinants of inequality in health service use in Brazil. Additionally, race also contributes to the odds of having had a mammogram. The point is not to isolate the effect of each factor, but to evaluate how their interrelations may exacerbate differences, generating patterns of cumulative adversity, a theme that is still little explored in Brazil. This is much more important when we consider that race has only recently started be included in analyses of health outcomes in Brazil.
Collapse
Affiliation(s)
- Enirtes Caetano Prates Melo
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil. .,Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.
| | | | - Dóra Chor
- Department of Epidemiology, National School of Public Health, Oswaldo Cruz Foundation -DEMQS/ENSP, Rua Leopoldo Bulhões, 1480, room 806. Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | - Marilia Sá Carvalho
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Scientific Computing Program, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil
| | - Rejane Sobrino Pinheiro
- Health Information and Networks Research Group, Oswaldo Cruz Foundation, Rio de Janeiro, RJ, Brazil.,Institute for Studies in Collective Health, Federal University of Rio de Janeiro, Rio de Janeiro, RJ, Brazil
| |
Collapse
|
23
|
Plourde N, Brown HK, Vigod S, Cobigo V. Contextual factors associated with uptake of breast and cervical cancer screening: A systematic review of the literature. Women Health 2016; 56:906-25. [PMID: 26812962 DOI: 10.1080/03630242.2016.1145169] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Existing research on barriers to breast and cervical cancer screening uptake has focused primarily on socio-demographic characteristics of individuals. However, contextual factors, such as service organization, as well as healthcare providers' training and practices, are more feasibly altered to increase health service use. The objective of the authors in this study was to perform a critical systematic review of the literature to identify contextual factors at the provider- and system-level that were associated with breast and cervical cancer screening uptake. Studies published from 2000 to 2013 were identified through PubMed and PsycInfo. Methodologic quality was assessed, and studies were examined for themes related to provider- and system-level factors associated with screening uptake. Thirteen studies met the inclusion criteria. Findings revealed a positive association between patients' receipt of provider recommendation and uptake of breast and cervical cancer screening. Uptake was also higher among patients of female providers. Facilities with flexible appointment times and reminders had higher mammography and Pap test uptake. Similarly, greater organizational commitment to quality and performance had higher breast and cervical cancer screening rates. Knowledge provided in this review could be used in future research to inform the development of public health policy and clinical programs to improve screening uptake.
Collapse
Affiliation(s)
- Natasha Plourde
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
| | - Hilary K Brown
- a Women's College Research Institute , Toronto , Ontario , Canada
| | - Simone Vigod
- b Women's Mental Health Program , Women's College Hospital , Toronto , Ontario , Canada
| | - Virginie Cobigo
- c School of Psychology , University of Ottawa , Ottawa , Ontario , Canada
| |
Collapse
|
24
|
Armaroli P, Villain P, Suonio E, Almonte M, Anttila A, Atkin WS, Dean PB, de Koning HJ, Dillner L, Herrero R, Kuipers EJ, Lansdorp-Vogelaar I, Minozzi S, Paci E, Regula J, Törnberg S, Segnan N. European Code against Cancer, 4th Edition: Cancer screening. Cancer Epidemiol 2015; 39 Suppl 1:S139-52. [PMID: 26596722 DOI: 10.1016/j.canep.2015.10.021] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Revised: 10/09/2015] [Accepted: 10/14/2015] [Indexed: 12/23/2022]
Abstract
In order to update the previous version of the European Code against Cancer and formulate evidence-based recommendations, a systematic search of the literature was performed according to the methodology agreed by the Code Working Groups. Based on the review, the 4th edition of the European Code against Cancer recommends: "Take part in organized cancer screening programmes for: Bowel cancer (men and women); Breast cancer (women); Cervical cancer (women)." Organized screening programs are preferable because they provide better conditions to ensure that the Guidelines for Quality Assurance in Screening are followed in order to achieve the greatest benefit with the least harm. Screening is recommended only for those cancers where a demonstrated life-saving effect substantially outweighs the potential harm of examining very large numbers of people who may otherwise never have, or suffer from, these cancers, and when an adequate quality of the screening is achieved. EU citizens are recommended to participate in cancer screening each time an invitation from the national or regional screening program is received and after having read the information materials provided and carefully considered the potential benefits and harms of screening. Screening programs in the European Union vary with respect to the age groups invited and to the interval between invitations, depending on each country's cancer burden, local resources, and the type of screening test used For colorectal cancer, most programs in the EU invite men and women starting at the age of 50-60 years, and from then on every 2 years if the screening test is the guaiac-based fecal occult blood test or fecal immunochemical test, or every 10 years or more if the screening test is flexible sigmoidoscopy or total colonoscopy. Most programs continue sending invitations to screening up to the age of 70-75 years. For breast cancer, most programs in the EU invite women starting at the age of 50 years, and not before the age of 40 years, and from then on every 2 years until the age of 70-75 years. For cervical cancer, if cytology (Pap) testing is used for screening, most programs in the EU invite women starting at the age of 25-30 years and from then on every 3 or 5 years. If human papillomavirus testing is used for screening, most women are invited starting at the age of 35 years (usually not before age 30 years) and from then on every 5 years or more. Irrespective of the test used, women continue participating in screening until the age of 60 or 65 years, and continue beyond this age unless the most recent test results are normal.
Collapse
Affiliation(s)
- Paola Armaroli
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Patricia Villain
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Eero Suonio
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Maribel Almonte
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ahti Anttila
- Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, 00130 Helsinki, Finland
| | - Wendy S Atkin
- Department of Surgery and Cancer, Imperial College London, St. Mary's Campus, Norfolk Place, London W2 1NY, United Kingdom
| | - Peter B Dean
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Harry J de Koning
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Lena Dillner
- Department of Infectious Disease, Karolinska University Hospital, S-17176 Stockholm, Sweden
| | - Rolando Herrero
- International Agency for Research on Cancer (IARC), 150 Cours Albert Thomas, 69372 Lyon Cedex 08, France
| | - Ernst J Kuipers
- Department of Gastroenterology & Hepatology, Erasmus MC University Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Iris Lansdorp-Vogelaar
- Departments of Public Health, Erasmus MC University Medical Centre, PO Box 2040, 3000CA Rotterdam, The Netherlands
| | - Silvia Minozzi
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy
| | - Eugenio Paci
- ISPO-Cancer Prevention and Research Institute, Occupational and Environmental Epidemiology Unit, Ponte Nuovo - Padiglione Mario Fiori, Via delle Oblate 2, 50141 Florence, Italy
| | - Jaroslaw Regula
- Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Department of Gastroenterology, 02-781 Warsaw, Poland
| | - Sven Törnberg
- Department of Cancer Screening, Stockholm Regional Cancer Centre, PO Box 6909, S-102 39 Stockholm, Sweden
| | - Nereo Segnan
- CPO Piemonte, AOU Città della Salute e della Scienza di Torino, via S. Francesco da Paola 31, 10123 Turin, Italy.
| |
Collapse
|
25
|
Gutnik LA, Castro MC. Does Spatial Access to Mammography Have an Effect on Early Stage of Breast Cancer Diagnosis? A county-level Analysis for New York State. Breast J 2015; 22:127-30. [PMID: 26549798 DOI: 10.1111/tbj.12530] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lily A Gutnik
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts.,Department of Surgery, Montefiore Medical Center, Bronx, New York
| | - Marcia C Castro
- Department of Global Health and Population, Harvard School of Public Health, Boston, Massachusetts
| |
Collapse
|
26
|
Khan-Gates JA, Ersek JL, Eberth JM, Adams SA, Pruitt SL. Geographic Access to Mammography and Its Relationship to Breast Cancer Screening and Stage at Diagnosis: A Systematic Review. Womens Health Issues 2015; 25:482-93. [PMID: 26219677 PMCID: PMC4933961 DOI: 10.1016/j.whi.2015.05.010] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 05/24/2015] [Accepted: 05/26/2015] [Indexed: 11/19/2022]
Abstract
INTRODUCTION A review was conducted to summarize the current evidence and gaps in the literature on geographic access to mammography and its relationship to breast cancer-related outcomes. METHODS Ovid, Medline, and PubMed were searched for articles published between January 1, 2000, and April 1, 2013, using Medical Subject Headings and key terms representing geographic accessibility and breast cancer-related outcomes. Owing to a paucity of breast cancer treatment and mortality outcomes meeting the criteria (N = 6), outcomes were restricted to breast cancer screening and stage at diagnosis. Studies included one or more of the following types of geographic accessibility measures: capacity, density, distance, and travel time. Study findings were grouped by outcome and type of geographic measure. RESULTS Twenty-one articles met the inclusion criteria. Fourteen articles included stage at diagnosis as an outcome, five included mammography use, and two included both. Geographic measures of mammography accessibility varied widely across studies. Findings also varied, but most articles found either increased geographic access to mammography associated with increased use and decreased late-stage at diagnosis or no association. CONCLUSION The gaps and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between geographic mammography access and breast cancer-related outcomes. Future studies should focus on the development and application of more precise and consistent measures of geographic access to mammography.
Collapse
Affiliation(s)
- Jenna A Khan-Gates
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois.
| | - Jennifer L Ersek
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Swann A Adams
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Cancer Prevention and Control Program, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; College of Nursing, University of South Carolina, Columbia, South Carolina
| | - Sandi L Pruitt
- Department of Clinical Science, Southwestern University, Dallas, Texas
| |
Collapse
|
27
|
White N, Mengersen K. Predicting health programme participation: a gravity-based, hierarchical modelling approach. J R Stat Soc Ser C Appl Stat 2015. [DOI: 10.1111/rssc.12111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Affiliation(s)
- Nicole White
- Queensland University of Technology; Brisbane Australia
- Cooperative Research Centre for Spatial Information; Melbourne Australia
| | - Kerrie Mengersen
- Queensland University of Technology; Brisbane Australia
- Cooperative Research Centre for Spatial Information; Melbourne Australia
| |
Collapse
|
28
|
Screening Mammography in a Public Hospital Serving Predominantly African-American Women: A Stage-Survival-Cost Model. Womens Health Issues 2015; 25:322-30. [PMID: 25910513 DOI: 10.1016/j.whi.2015.02.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 02/15/2015] [Accepted: 02/25/2015] [Indexed: 11/23/2022]
Abstract
BACKGROUND Ethnic and socioeconomic disparities pervade breast cancer patterns and outcomes. Mammography guidelines reflect the difficulty in optimizing mortality reduction and cost-effectiveness, with controversy still surrounding the 2009 U.S. Preventive Services Task Force (USPSTF) recommendations. This study simulates USPSTF and American Cancer Society (ACS) guidelines' effects on stage, survival, and cost of treatment in an urban public hospital. METHODS Charts of 274 women diagnosed with stage I, II, or III breast cancer (2008-2010) were reviewed. Published tumor doubling times were used to predict size at diagnosis under simulated screening guidelines. Stage distributions under ACS and USPSTF guidelines were compared with those observed. Cohort survival for observed and hypothetical scenarios was estimated using national statistics. Treatment costs by stage, calculated from Georgia Medicaid claims data, were similarly applied. RESULTS Mean age at diagnosis was 56 years. African Americans predominated (82.5%), with 96% publically insured or uninsured. Simulated stages at diagnosis significantly favored ACS guidelines (43.1% stage 1/38.3% stage 2/9.9% stage 3 vs. USPSTF 23.0%/53.3 %/15.0%), as did 5-year survival and cost of treatment relative to both observed and USPSTF-predicted schema (p<.0001). Following USPSTF guidelines predicted lower survival and additional costs. CONCLUSIONS Following ACS guidelines seems to lead to earlier diagnosis for low-income African-American women and increase 5-year survival with lower overall and breast-specific costs. The data suggest that adjusting screening practices for lower socioeconomic status, ethnic minority women may prove essential in addressing cancer disparities.
Collapse
|
29
|
Smieliauskas F, MacMahon H, Salgia R, Shih YCT. Geographic variation in radiologist capacity and widespread implementation of lung cancer CT screening. J Med Screen 2014; 21:207-15. [PMID: 25118160 PMCID: PMC4407799 DOI: 10.1177/0969141314548055] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Newly released United States Preventive Services Task Force (USPSTF) recommendations for lung cancer screening are expected to increase demand for low-dose computed tomography scanning, but health system capacity constraints might threaten the scale-up of screening. OBJECTIVES To estimate the prevalence of capacity constraints in the radiologist workforce and resulting potential disparities in access to lung cancer screening. METHODS We combined information from health interview surveys to estimate the numbers of smokers who meet the USPSTF eligibility criteria, and information from administrative datasets to estimate the numbers of radiologists and the numbers of scans they currently interpret in Health Service Areas (HSAs) nationwide. We estimated and mapped the prevalence of capacity constrained HSAs - those having a greater than 5% or greater than 25% projected increase in scans over current levels from scaling up screening - and used descriptive statistics and logistic regressions to identify HSA characteristics associated with capacity constraints. RESULTS Scaling up lung cancer screening would increase imaging procedures by an average of 4% across HSAs. Of the 9.6 million eligible smokers, 1,023,943 lived in HSAs with increases of at least 5%. HSAs that were rural, with many eligible smokers, and disproportionately Hispanic or low-income smokers had significantly higher odds of facing capacity constraints. CONCLUSIONS Disparities in access to lung cancer screening appear likely unless policy makers target HSAs with few radiologists for additional resources. Radiologists should be able to absorb the workload imposed by lung cancer screening in most areas of the country.
Collapse
Affiliation(s)
- Fabrice Smieliauskas
- Department of Health Studies, Program in the Economics of Cancer, University of Chicago, Chicago IL
| | - Heber MacMahon
- Section of Thoracic Radiology, Department of Radiology, University of Chicago, Chicago IL
| | - Ravi Salgia
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago IL
| | - Ya-Chen Tina Shih
- Section of Hospital Medicine, Department of Medicine, Program in the Economics of Cancer, University of Chicago, Chicago IL
| |
Collapse
|
30
|
Elderly breast and colorectal cancer patients' clinical course: patient and contextual influences. Med Care 2014; 52:809-17. [PMID: 25119954 DOI: 10.1097/mlr.0000000000000180] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The social and medical environments that surround people are each independently associated with their cancer course. The extent to which these characteristics may together mediate patients' cancer care and outcomes is not known. METHODS Using multilevel methods and data, we studied elderly breast and colorectal cancer patients (level I) within urban social (level II: ZIP code tabulation area) and health care (level III: hospital service area) contexts. We sought to determine (1) which, if any, observable social and medical contextual attributes were associated with patient cancer outcomes after controlling for observable patient attributes, and (2) the magnitude of residual variation in patient cancer outcomes at each level. RESULTS Numerous patient attributes and social area attributes, including poverty, were associated with unfavorable patient cancer outcomes across the full clinical cancer continuum for both cancers. Health care area attributes were not associated with patient cancer outcomes. After controlling for observable covariates at all 3 levels, there was substantial residual variation in patient cancer outcomes at all levels. CONCLUSIONS After controlling for patient attributes known to confer risk of poor cancer outcomes, we find that neighborhood socioeconomic disadvantage exerts an independent and deleterious effect on residents' cancer outcomes, but the area supply of the specific types of health care studied do not. Multilevel interventions targeted at cancer patients and their social areas may be useful. We also show substantial residual variation in patient outcomes across social and health care areas, a finding potentially relevant to traditional small area variation research methods.
Collapse
|
31
|
Virk-Baker MK, Martin MY, Levine RS, Wang X, Nagy TR, Pisu M. Mammography utilization among Black and White Medicare beneficiaries in high breast cancer mortality US counties. Cancer Causes Control 2014; 24:2187-96. [PMID: 24077760 DOI: 10.1007/s10552-013-0295-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 09/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Disparities in US breast cancer mortality between older Black and White women have increased in the last 20 years. Regular mammography use is important for early detection and treatment: its utilization among older Blacks especially in counties with high Black mortality is of interest, but its extent and determinants are unknown. METHODS We used Medicare claims for Black and White women 65–74 years old in 203 counties with the highest Black breast cancer mortality. Outcomes over 6 years were as follows: ever mammogram, i.e., C 1 screening mammogram, and regular mammogram, i.e., C 3 mammograms. With logistic regressions, we examined the independent effect of race on screening controlling for individual- and county-level factors. RESULTS Of 406,602 beneficiaries, 17 % were Black. Ever and regular mammogram was significantly lower among Blacks (51.6 vs. 56.9 %; 32.9 vs. 43.1 %, respectively). Controlling for covariates, including use of cervical cancer screening, flu shots, or lipids tests, Black women were more likely to have ever mammogram (OR 1.23, CI 1.20–1.25), but not regular mammogram (OR 0.95, CI 0.93–0.97) than White women. County-level managed care penetration was negatively associated with ever and regular mammograms. CONCLUSIONS In Medicare enrollees from these counties, breast cancer screening was low. Black women had same or better odds of screening than White women. Some health care factors, e.g., managed care, were negatively associated with screening. Further studies on the determinants of mammography utilization in older women from these counties are warranted.
Collapse
|
32
|
Henry KA, McDonald K, Sherman R, Kinney AY, Stroup AM. Association between individual and geographic factors and nonadherence to mammography screening guidelines. J Womens Health (Larchmt) 2014; 23:664-74. [PMID: 24865409 DOI: 10.1089/jwh.2013.4668] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study investigates factors that are associated with nonadherence to mammography screening guidelines in Utah, a state where mammography screening rates have remained consistently lower than national averages. METHODS We examined data on reported mammography use among women aged 40-74 years from the 2008 and 2010 Utah Behavioral Risk Factor Surveillance System (n=5,197, weighted n=417,064). Logistic regression models were used to estimate the effects of individual-level and geographic (travel time to nearest mammography facility, geographic accessibility, and rural/urban residence) factors on the odds of a woman not reporting receiving a mammogram in the last 2 years. RESULTS In 2008 and 2010, a disproportionate number of women aged 40-49 (43.1%, 95% confidence interval [CI] 39.9%-46.3%) reported not receiving a mammogram within the last 2 years compared to women 50-74 (26.8%, 95% CI 24.9%-28.7%). None of the geographic factors were significant predictors of screening adherence. Based on covariate adjusted models, statistically significant (p<0.05) factors associated with increased odds of not receiving mammogram within the last 2 years included not having a regular physician, no health insurance, being aged 40-49, income less than $25,000, and the presence of three or more children in the home. CONCLUSION Mammography screening efforts in Utah should focus on improving access to insurance or a regular source of health care. Future research should also consider how best to address extreme time demands and competing priorities that present potential barriers for women with large families, resulting in lower screening levels among these women.
Collapse
Affiliation(s)
- Kevin A Henry
- 1 Department of Epidemiology and the Rutgers Cancer Institute of New Jersey, Rutgers School of Public Health, Rutgers University , New Brunswick, New Jersey
| | | | | | | | | |
Collapse
|
33
|
Buranaruangrote S, Sindhu S, Mayer DK, Ratinthorn A, Khuhaprema T. Factors influencing the stages of breast cancer at the time of diagnosis in Thai women. Collegian 2014; 21:11-20. [PMID: 24772986 DOI: 10.1016/j.colegn.2012.11.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Early diagnosis of breast cancer leads to early treatment therefore improving women's health. However, most Thai women are diagnosed at a late stage. OBJECTIVE This cross-sectional correlational study was designed to explore factors influencing the diagnosis of early stage breast cancer in Thai women. METHOD Thai women (n = 400) newly diagnosed breast cancer at all clinical stages from public hospitals in Bangkok Metropolitan completed a questionnaire about knowledge of breast cancer and screening. The questionnaire addressed pre-diagnosis data about: (1) health care provider's recommendations to undertake breast screening, (2) health coverage for mammography (MM) costs and (3) regularity of breast screening behaviors in terms of breast self-examination (BSE), clinical breast examination (CBE) and MM including stage breast cancer at diagnosis. Data analysis was determined by PASW Statistics version 18 as univariate and multivariate logistic regression. RESULTS Health coverage for MM costs and all three behaviors were significantly related to and could predict the early stages breast cancer at diagnosis (p < 0.05): health coverage for MM costs (OR = 0.32, 95% confidence interval [CI], 0.17-0.63), BSE (OR = 8.08, CI 95%, 3.93-16.63), CBE (OR = 12.54, CI 95%, 2.29-68.65) and MM (OR = 5.89, CL 95%, 1.13-30.73). CONCLUSIONS All three behaviors are essential and related to one another. CBE on a regular basis is the best predictor for early stages breast cancer at diagnosis in Thai context. Nurses should provide information and teach including re-check the woman's skills to perform BSE regularly.
Collapse
|
34
|
Davis TC, Rademaker A, Bennett CL, Wolf MS, Carias E, Reynolds C, Liu D, Arnold CL. Improving mammography screening among the medically underserved. J Gen Intern Med 2014; 29:628-35. [PMID: 24366401 PMCID: PMC3965756 DOI: 10.1007/s11606-013-2743-3] [Citation(s) in RCA: 20] [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: 11/15/2012] [Revised: 07/27/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022]
Abstract
BACKGROUND We evaluated the effectiveness and cost-effectiveness of alternative interventions designed to promote mammography in safety-net settings. METHODS A three-arm, quasi-experimental evaluation was conducted among eight federally qualified health clinics in predominately rural Louisiana. Mammography screening efforts included: 1) enhanced care, 2) health literacy-informed education of patients, and 3) education plus nurse support. Outcomes included mammography screening completion within 6 months and incremental cost-effectiveness. RESULTS Overall, 1,181 female patients ages 40 and over who were eligible for routine mammography were recruited. Baseline screening rates were < 10%. Post intervention screening rates were 55.7% with enhanced care, 51.8% with health literacy-informed education and 65.8% with education and nurse support. After adjusting for race, marital status, self-efficacy and literacy, patients receiving health-literacy informed education were not more likely to complete mammographic screening than those receiving enhanced care; those additionally receiving nurse support were 1.37-fold more likely to complete mammographic screening than those receiving the brief education (95% Confidence Interval 1.08-1.74, p = 0.01). The incremental cost per additional women screened was $2,457 for literacy-informed education with nurse support over literacy-informed education alone. CONCLUSIONS Mammography rates were increased substantially over existing baseline rates in all three arms with the educational initiative, with nurse support and follow-up being the most effective option. However, it is not likely to be cost-effective or affordable in resource-limited clinics.
Collapse
Affiliation(s)
- Terry C Davis
- Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, 1501 Kings Highway, Shreveport, LA, 71130, USA,
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Eberth JM, Eschbach K, Morris JS, Nguyen HT, Hossain MM, Elting LS. Geographic disparities in mammography capacity in the South: a longitudinal assessment of supply and demand. Health Serv Res 2014; 49:171-85. [PMID: 23829179 PMCID: PMC3922472 DOI: 10.1111/1475-6773.12081] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Studies have shown that there is sufficient availability of mammography; however, little is known about geographic variation in capacity. The purpose of this study was to determine the locations and extent of over/undersupply of mammography in 14 southern states from 2002 to 2008. DATA SOURCES Mammography facility data were collected from the U.S. Food and Drug Administration (FDA). Population estimates, used to estimate the potential demand for mammography, were obtained from GeoLytics Inc. STUDY DESIGN Using the two-step floating catchment area method, we calculated spatial accessibility at the block group level and categorized the resulting index to represent the extent of under/oversupply relative to the potential demand. PRINCIPAL FINDINGS Results show decreasing availability of mammography over time. The extent of over/undersupply varied significantly across the South. Reductions in capacity occurred primarily in areas with an oversupply of machines, resulting in a 68 percent decrease in the percent of women living in excess capacity areas from 2002 to 2008. The percent of women living in poor capacity areas rose by 10 percent from 2002 to 2008. CONCLUSIONS Our study found decreasing mammography availability and capacity over time, with substantial variation across states. This information can assist providers and policy makers in their business planning and resource allocation decisions.
Collapse
Affiliation(s)
- Jan M Eberth
- Address correspondence to Jan Marie Eberth, Ph.D., Assistant Professor, South Carolina Cancer Prevention and Control Program, Department of Epidemiology and Biostatistics, University of South Carolina, 915 Greene St., Room 234, Columbia, SC 29208; e-mail: . Karl Eschbach, Ph.D., is with the Division of Geriatric Medicine, Departments of Internal and Preventive Medicine and Community Health, University of TexasMedical Branch at Galveston, Galveston, TX. Jeffrey S. Morris, Ph.D., is with the Department of Biostatistics, Division of Quantitative Sciences, University of TexasMDAnderson Cancer Center, Houston, TX. Hoang T. Nguyen, Ph.D., and Linda S. Elting, Dr.P.H., are with the Department of Health Services Research, Division of Cancer Prevention and Population Sciences, University of Texas MD Anderson Cancer Center, Houston, TX. MdMonir Hossain, Ph.D., is with the Division of Biostatistics and Epidemiology, Cincinnati Children's HospitalMedical Center, Cincinnati,OH
| | | | | | | | | | | |
Collapse
|
36
|
Rosales M, Gonzalez P. Mammography screening among Mexican, Central-American, and South-American women. J Immigr Minor Health 2014; 15:225-33. [PMID: 23054548 DOI: 10.1007/s10903-012-9731-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cancer and cancer screening disparities exist across Latino subgroups; however the reasons for these disparities are not fully known. This study examines (1) mammography screening among Latinas born in Mexico, Central-America and South-America and (2) the impact of birthplace and acculturation on mammography screening. Data were derived from the California Health Interview Survey 2007. Analyses included 1,675 Latina women 40 years of age and older. Multivariate logistic regression examined predictors of mammography screening. Mexican and Central-American women were less likely to report ever receiving a mammogram while Mexican women were less likely to report a recent mammogram. Low-acculturated women were less likely to report ever receiving a mammogram and less likely to report recent mammography. Different screening patterns across Latina subgroups were observed. Differences in screening patterns and the factors associated with screening highlight the need for unique intervention strategies tailored specifically to Latinas.
Collapse
Affiliation(s)
- Monica Rosales
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope National Medical Center, 1500 E Duarte Road, Duarte, CA 91010-3000, USA.
| | | |
Collapse
|
37
|
Peipins LA, Miller J, Richards TB, Bobo JK, Liu T, White MC, Joseph D, Tangka F, Ekwueme DU. Characteristics of US counties with no mammography capacity. J Community Health 2013; 37:1239-48. [PMID: 22477670 DOI: 10.1007/s10900-012-9562-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Access to screening mammography may be limited by the availability of facilities and machines, and nationwide mammography capacity has been declining. We assessed nationwide capacity at state and county levels from 2003 to 2009, the most recent year for which complete data were available. Using mammography facility certification and inspection data from the Food and Drug Administration, we geocoded all mammography facilities in the United States and determined the total number of fully accredited mammography machines in each US County. We categorized mammography capacity as counties with zero capacity (i.e., 0 machines) or counties with capacity (i.e.,≥1 machines), and then compared those two categories by sociodemographic, health care, and geographic characteristics. We found that mammography capacity was not distributed equally across counties within states and that more than 27 % of counties had zero capacity. Although the number of mammography facilities and machines decreased slightly from 2003 to 2009, the percentage of counties with zero capacity changed little. In adjusted analyses, having zero mammography capacity was most strongly associated with low population density (OR = 11.0; 95 % CI 7.7-15.9), low primary care physician density (OR = 8.9; 95 % CI 6.8-11.7), and a low percentage of insured residents (OR = 3.3; 95 % CI 2.5-4.3) when compared with counties having at least one mammography machine. Mammography capacity has been and remains a concern for a portion of the US population--a population that is mostly but not entirely rural.
Collapse
Affiliation(s)
- Lucy A Peipins
- Division of Cancer Prevention and Control, Centers for Disease Prevention and Control, Atlanta, GA, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Chen L, Romond E, Chokshi S, Saeed H, Hodskins J, Stevens M, Pasley G, Weiss H, Massarweh S. A prognostic model of early breast cancer relapse after standard adjuvant therapy and comparison with metastatic disease on initial presentation. Breast Cancer Res Treat 2012; 136:565-72. [PMID: 23053651 DOI: 10.1007/s10549-012-2265-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2012] [Accepted: 09/18/2012] [Indexed: 12/20/2022]
Abstract
Breast cancer can metastasize at any time during its course, but timing of systemic relapse cannot be predicted by traditional TNM staging. Characteristics of distant recurrence within the first 3 years of diagnosis may identify a group of patients who could benefit from novel strategies to prevent systemic relapse. Of 1,089 patients with breast cancer treated at our institution between January 2007 and May 2011, we identified 76 with de novo metastases (on presentation) and 40 with systemic relapse after a median follow up of 2.2 years. Compared to relapse, de novo metastatic disease was more likely to be grade 1 or 2 (43.1 vs. 18.4 %, p = 0.032), estrogen receptor (ER) positive (69.7 vs. 47.5 %, p = 0.019), progesterone receptor (PgR) positive (56.6 vs. 32.5 %, p = 0.014), and HER2-positive (27.5 vs. 10.3 %, p = 0.035). In the 815 patients with stage I-III disease who were at risk of systemic relapse, univariate analyses were performed for age, tumor size, grade, ER, PgR, HER2, lymph nodes, and TNM stage. A multivariate Cox regression model was built using step-wise model selection and identified 4 covariates that were significantly associated with risk of early relapse: stage-III (p < 0.001), grade-III (p = 0.002), PgR-negative status (p = 0.014), and HER2-negative status (p = 0.033). A risk-score was developed based on the linear combination of these covariates and time-dependent predictive curves were used to evaluate the predictive accuracy of the proposed risk-score. The highest risk-score group had a 1, 2, and 3-year relapse probabilities of 11.5, 41.2, and 52.5 %, respectively. The corresponding 1, 2, and 3-year relapse probabilities for the overall population were 1.2, 4.4, and 6.3 %, respectively. Our proposed model can be used to select patients at high-risk of early relapse who could benefit from enrollment on clinical trials with novel therapies designed for this group.
Collapse
Affiliation(s)
- Li Chen
- Markey Cancer Center, University of Kentucky, cc452, 800 Rose Street, Lexington, KY 40536, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Lian M, Struthers J, Schootman M. Comparing GIS-based measures in access to mammography and their validity in predicting neighborhood risk of late-stage breast cancer. PLoS One 2012; 7:e43000. [PMID: 22952626 PMCID: PMC3429459 DOI: 10.1371/journal.pone.0043000] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Accepted: 07/16/2012] [Indexed: 12/03/2022] Open
Abstract
Background Assessing neighborhood environment in access to mammography remains a challenge when investigating its contextual effect on breast cancer-related outcomes. Studies using different Geographic Information Systems (GIS)-based measures reported inconsistent findings. Methods We compared GIS-based measures (travel time, service density, and a two-Step Floating Catchment Area method [2SFCA]) of access to FDA-accredited mammography facilities in terms of their Spearman correlation, agreement (Kappa) and spatial patterns. As an indicator of predictive validity, we examined their association with the odds of late-stage breast cancer using cancer registry data. Results The accessibility measures indicated considerable variation in correlation, Kappa and spatial pattern. Measures using shortest travel time (or average) and service density showed low correlations, no agreement, and different spatial patterns. Both types of measures showed low correlations and little agreement with the 2SFCA measures. Of all measures, only the two measures using 6-timezone-weighted 2SFCA method were associated with increased odds of late-stage breast cancer (quick-distance-decay: odds ratio [OR] = 1.15, 95% confidence interval [CI] = 1.01–1.32; slow-distance-decay: OR = 1.19, 95% CI = 1.03–1.37) after controlling for demographics and neighborhood socioeconomic deprivation. Conclusions Various GIS-based measures of access to mammography facilities exist and are not identical in principle and their association with late-stage breast cancer risk. Only the two measures using the 2SFCA method with 6-timezone weighting were associated with increased odds of late-stage breast cancer. These measures incorporate both travel barriers and service competition. Studies may observe different results depending on the measure of accessibility used.
Collapse
Affiliation(s)
- Min Lian
- Department of Medicine, Washington University School of Medicine, St. Louis, Missouri, United States of America.
| | | | | |
Collapse
|
40
|
Lamont EB, He Y, Subramanian SV, Zaslavsky AM. Do socially deprived urban areas have lesser supplies of cancer care services? J Clin Oncol 2012; 30:3250-7. [PMID: 22869877 DOI: 10.1200/jco.2011.40.4228] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Area social deprivation is associated with unfavorable health outcomes of residents across the full clinical course of cancer from the stage at diagnosis through survival. We sought to determine whether area social factors are associated with the area health care supply. PATIENTS AND METHODS We studied the area supply of health services required for the provision of guideline-recommended care for patients with breast cancer and colorectal cancer (CRC) in each of the following three distinct clinical domains: screening, treatment, and post-treatment surveillance. We characterized area social factors in 3,096 urban zip code tabulation areas by using Census Bureau data and the health care supply in the corresponding 465 hospital service areas by using American Hospital Association, American Medical Association, and US Food and Drug Administration data. In two-level hierarchical models, we assessed associations between social factors and the supply of health services across areas. RESULTS We found no clear associations between area social factors and the supply of health services essential to the provision of guideline recommended breast cancer and CRC care in urban areas. The measures of health service included the supply of physicians who facilitate screening, treatment, and post-treatment care and the supply of facilities required for the same services. CONCLUSION Because we found that the supply of types of health care required for the provision of guideline-recommended cancer care for patients with breast cancer and CRC did not vary with markers of area socioeconomic disadvantage, it is possible that previously reported unfavorable breast cancer and CRC outcomes among individuals living in impoverished areas may have occurred despite an apparent adequate area health care supply.
Collapse
|
41
|
Nuño T, Gerald JK, Harris R, Martinez ME, Estrada A, García F. Comparison of breast and cervical cancer screening utilization among rural and urban Hispanic and American Indian women in the Southwestern United States. Cancer Causes Control 2012; 23:1333-41. [DOI: 10.1007/s10552-012-0012-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2011] [Accepted: 06/05/2012] [Indexed: 10/28/2022]
|
42
|
Davis TC, Arnold CL, Rademaker A, Bailey SC, Platt DJ, Reynolds C, Esparza J, Liu D, Wolf MS. Differences in barriers to mammography between rural and urban women. J Womens Health (Larchmt) 2012; 21:748-55. [PMID: 22519704 DOI: 10.1089/jwh.2011.3397] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Few studies have examined differences between rural and urban women in mammography barriers, knowledge, and experiences. Exploring differences can help inform tailored interventions. METHODS Women, aged ≥40, who had not been screened in the past 2 years were recruited from eight federally qualified health centers across Louisiana. They were given a structured interview assessing mammography knowledge, beliefs, barriers, experiences, and literacy. RESULTS Of the 1189 patients who participated, 65.0% were African American, 61.6% were rural, and 44.0% had low literacy. Contrary to guidelines, most believed mammography should be done annually (74.3%) before age 40 (70.5%). Compared to urban women, rural participants were more likely to believe mammography will find small breast lumps early (34.4% vs. 6.5%, p<0.0001) and strongly disagree that mammography is embarrassing (14.6% vs. 8.4%, p=0.0002) or that they are afraid of finding something wrong (21.2% vs.12.3%, p=0.007). Rural women were more likely to report a physician recommendation for mammography (84.3% vs. 76.5%, p=0.006), but they were less likely to have received education (57.2% vs. 63.6%, p=0.06) or to have ever had a mammogram (74.8% vs. 78.1%, p=0.007). In multivariate analyses controlling for race, literacy, and age, all rural/urban differences remained significant, except for receipt of a mammogram. CONCLUSIONS Most participants were unclear about when they should begin mammography. Rural participants reported stronger positive beliefs, higher self-efficacy, fewer barriers, and having a physician recommendation for mammography but were less likely to receive education or screening.
Collapse
Affiliation(s)
- Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, LA 71130, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Fan L, Mohile S, Zhang N, Fiscella K, Noyes K. Self-reported cancer screening among elderly Medicare beneficiaries: a rural-urban comparison. J Rural Health 2012; 28:312-9. [PMID: 22757956 DOI: 10.1111/j.1748-0361.2012.00405.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We examined the rural-urban disparity of screening for breast cancer and colorectal cancer (CRC) among the elder Medicare beneficiaries and assessed rurality's independent impact on receipt of screening. METHODS Using 2005 Medicare Current Beneficiary Survey, we applied weighted logistic regression to estimate the overall rural-urban disparity and rurality's independent impact on cancer screening, controlling for patient, and area factors. RESULTS From urban, large rural, small rural, and isolated rural areas, the rates for mammogram last year were 53%, 52%, 45%, and 44%, respectively. They were 56%, 50%, 48%, and 43% for CRC screening, respectively. After controlling for patient and area level characteristics, rurality is significantly associated with CRC screening, but not mammogram. CONCLUSIONS We found rural-urban disparities for both mammogram and CRC screenings. Patient and area factors totally eliminated the rural-urban disparity for mammogram but not CRC screening. Health promotions to improve cancer screening should focus more on small and isolated rural areas.
Collapse
Affiliation(s)
- Lin Fan
- Department of Community and Preventive Medicine, University of Rochester, Rochester, New York, USA.
| | | | | | | | | |
Collapse
|
44
|
Elkin EB, Snow JG, Leoce NM, Atoria CL, Schrag D. Mammography capacity and appointment wait times: barriers to breast cancer screening. Cancer Causes Control 2012; 23:45-50. [PMID: 22037904 PMCID: PMC3774039 DOI: 10.1007/s10552-011-9853-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2011] [Accepted: 10/01/2011] [Indexed: 10/15/2022]
Abstract
OBJECTIVE To assess the impact of mammography capacity on appointment wait times. METHODS We surveyed by telephone all mammography facilities federally certified in 2008 in California, Connecticut, Georgia, Iowa, New Mexico, and New York using a simulated patient format. County-level mammography capacity, defined as the number of mammography machines per 10,000 women aged 40 and older, was estimated from FDA facility certification records and US Census data. RESULTS 1,614 (86%) of 1,882 mammography facilities completed the survey. Time until next available screening mammogram appointment was <1 week at 55% of facilities, 1-4 weeks at 34% of facilities, and >1 month at 11% of facilities. Facilities in counties with lower capacity had longer wait times, and a one-unit increase in county capacity was associated with 21% lower odds of a facility reporting a wait time >1 month (p < 0.01). There was no association between wait time and the availability of evening or weekend appointments or digital mammography. CONCLUSION Lower mammography capacity is associated with longer wait times for screening mammograms. IMPACT Enhancement of mammography resources in areas with limited capacity may reduce wait times for screening mammogram appointments, thereby increasing access to services and rates of breast cancer screening.
Collapse
Affiliation(s)
- Elena B Elkin
- Health Outcomes Research Group, Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., Box 44, New York, NY 10021, USA.
| | | | | | | | | |
Collapse
|
45
|
Peipins LA, Graham S, Young R, Lewis B, Foster S, Flanagan B, Dent A. Time and distance barriers to mammography facilities in the Atlanta metropolitan area. J Community Health 2011; 36:675-83. [PMID: 21267639 PMCID: PMC5836475 DOI: 10.1007/s10900-011-9359-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To a great extent, research on geographic accessibility to mammography facilities has focused on urban-rural differences. Spatial accessibility within urban areas can nonetheless pose a challenge, especially for minorities and low-income urban residents who are more likely to depend on public transportation. To examine spatial and temporal accessibility to mammography facilities in the Atlanta metropolitan area by public and private transportation, we built a multimodal transportation network model including bus and rail routes, bus and rail stops, transfers, walk times, and wait times. Our analysis of travel times from the population-weighted centroids of the 282 census tracts in the 2-county area to the nearest facility found that the median public transportation time was almost 51 minutes. We further examined public transportation travel times by levels of household access to a private vehicle. Residents in tracts with the lowest household access to a private vehicle had the shortest travel times, suggesting that facilities were favorably located for women who have to use public transportation. However, census tracts with majority non-Hispanic black populations had the longest travel times for all levels of vehicle availability. Time to the nearest mammography facility would not pose a barrier to women who had access to a private vehicle. This study adds to the literature demonstrating differences in spatial accessibility to health services by race/ethnicity and socioeconomic characteristics. Ameliorating spatial inaccessibility represents an opportunity for intervention that operates at the population level.
Collapse
Affiliation(s)
- Lucy A Peipins
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Hwy, NE, K-55, Atlanta, GA 30341, USA.
| | | | | | | | | | | | | |
Collapse
|
46
|
Smith ML, Hochhalter AK, Ahn S, Wernicke MM, Ory MG. Utilization of screening mammography among middle-aged and older women. J Womens Health (Larchmt) 2011; 20:1619-26. [PMID: 21780914 DOI: 10.1089/jwh.2010.2168] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIMS This study examines patterns of screening mammogram use, investigating the relationship of screening with demographic, health status, and healthcare factors. METHODS Data from 1242 women aged ?41 were obtained from a random sample of mailed surveys to community households in an eight-county region in Central Texas in 2010. The dependent variable was the timing of the participants' most recent screening mammography (in the past 12 months, between 1 and 2 years, or >2 years). Predictor variables included demographic, health status, and healthcare access factors. Multinomial logistic regression identified variables associated with screening mammography practices. RESULTS The majority of women reported having at least one mammogram during their lifetime (93.0%) and having a mammography within the past 2 years (76.2%). Participants who reported not having a routine checkup in the past 12 months (odds ratio [OR] 0.12, p<0.001), having a lapse of insurance in the past 3 years (OR 2.95, p<0.05), and living in a health provider shortage area (OR 1.42, p<0.05) were less likely to be screened within the past 2 years. CONCLUSIONS Routine healthcare plays a major role in preventive screening, which indicates screening mammography practices can be enhanced by improving participation in routine checkups with medical providers, continuity of insurance coverage, and women's access to healthcare. Interventions to encourage screening mammography may be particularly needed for women who have experienced a lapse in insurance or have not had a checkup in the past year.
Collapse
Affiliation(s)
- Matthew Lee Smith
- College of Public Health, University of Georgia, 330 River Road, Athens, GA 30602-6522, USA.
| | | | | | | | | |
Collapse
|
47
|
|