Mammography use among older women of seven Latin American and Caribbean cities

Breast Cancer in the Caribbean

Breast cancer (BC) is one of the leading causes of death among women globally. In the Caribbean, there is a higher mortality rate compared with North American and European countries which have higher incidence rates. We conducted a literature review to examine the BC dynamic in the Caribbean and determine the areas where further investigations are needed. The PubMed database was used for identifying relevant studies using a combination of specific keyword searches. All studies focusing on BC within the defined Caribbean population were selected for this review. A total of 117 papers were included. The data were organized and presented under the following headings and reported according to the country where available: BC incidence and mortality, patient demographics, clinicopathology, genetics, behavioral risks, diagnosis and treatment, and BC control. Our review uncovered major variability in the incidence, management, etiology, and mortality of BC among Caribbean countries. Low-resource countries are burdened by more advanced disease with expected poorer BC outcomes (i.e., shorter periods of disease-free survival). Countries with established national cancer registries seem to have a better approach to the management of BC. The introduction of cancer treatment programs in association with international nonprofit groups has shown tremendous improvement in quality, accessible cancer care for patients, particularly in low- and middle-income settings. BC research is relatively limited in the Caribbean, lacking in both scope and consistency. The unique Caribbean BC population of diverse ethnicities, environmental influence, immigrants, socioeconomic status, and sociocultural practices allows an optimal opportunity for epidemiological investigations that can provide deeper insights into the status of BC.

Social determinants of mammography screening among women aged 50 to 59, Peru 2015

Breast cancer (BC) screening could reduce its mortality; however, its access is influenced by societal forces. Our objective is to identify the social determinants associated with mammography screening (MS) in women aged 50 to 59 in Peru. In this cross-sectional analysis of the Peruvian Demographic Health Survey, 2015, MS within the past two years was evaluated through self-report. Prevalence for MS was 21.9% [95% CI: 18.9 to 25.1]. The average age was 54 years (s.d.: 2.5). The higher the socioeconomic status, the higher the prevalence of screening (3.2% vs 41.4% in extreme quintiles, p < .001). In the adjusted models, higher socioeconomic status (PR: 5.81, 95% CI: 2.28 to 14.79), higher education level (PR: 2.03, 95% CI: 1.30 a 3,15) and having health insurance from the Ministry of Health (PR: 2.21, 95% CI: 1.28 to 3.82) and EsSalud (PR: 4.37, 95% CI: 2.67 to 7.15), were positively associated with MS. Social inequalities in screening access exist and might translate into inequalities in cancer morbidity and mortality. The Peruvian government urgently needs to improve screening rates in these vulnerable populations.

Employment Condition Modifies the Using Patterns of Screening Mammography in Workers Insured by the Mexican Government: A Case-Control Study

Background:

Our main aim was to investigate whether the employment condition modifies the use patterns of the screening mammography in workers insured by the Mexican government (Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado, ISSSTE; medical facilities of the Mexican government).

Methods:

A case–control study age-matched was done in women insured by the Mexican government, aged 40–69 years, attending a general hospital (ISSSTE). All subjects were submitted to an interview and anthropometric data registry. In the interview were obtained: demographic data, of schooling, breast cancer family history, and reproductive history; besides, mammography history during the past 2 years and place of performance (in or outside of the ISSSTE). Finally, it was evaluated whether the mammography use in the ISSSTE was related to their employment condition: Active workers (cases) vs. dependents or retired workers (controls).

Results:

The sample was of 252 women: 126 cases and 126 controls. Cases obtained less mammograms in the ISSSTE (P = 0.03, odds ratio = 0.54, 95% confidence interval, CI 0.30–0.96), than their dependents or the retired workers. Furthermore, cases with high education (university or higher) also obtained fewer mammograms in the ISSSTE (P = 0.03, odds ratio = 0.26, 95% CI 0.05–0.93).

Conclusions:

Women active workers with higher education are obtaining less screening mammograms in the ISSSTE than their dependents or the retired workers.

Psychosocial correlates of cervical cancer screening among older Hispanic women

Early detection through screening can reduce mortality rates of cervical cancer, and yet Hispanic women who have incidence rates higher than their non-Hispanic White counterparts are least likely to participate in cancer screening initiatives. This study utilized data from the 2008 wave of the Health and Retirement Study to investigate the psychosocial correlates associated with older Hispanic women's participation in cervical cancer screening services. Logistic regression models were used. Findings indicated that greater life satisfaction and religiosity were associated with a greater likelihood of participating in cervical cancer screening. Despite ongoing national conversations, evidence indicates there is agreement that underserved women need to be screened, particularly the older Hispanic population.

Inequalities in socioeconomic status and race and the odds of undergoing a mammogram in Brazil

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.

Female breast cancer in Central and South America

RATIONALE AND OBJECTIVE

The burden of breast cancer has increased worldwide. Breast cancer mortality has been increasing in Central and South America (CSA) in the last few decades. We describe the current burden of breast cancer in CSA and review the current status of disease control.

METHODS

We obtained regional- and national-level incidence data from 48 population-based cancer registries in 13 countries and cancer deaths from the WHO mortality database for 18 countries. We estimated world population age-standardized incidence and mortality rates per 100,000 person-years for 2003-2007 and the estimated annual percentage change to describe time trends.

RESULTS

In the most recent 5-year period, Argentina, Brazil, and Uruguay had the highest incidence rates (67.7-71.9) and Bolivia and El Salvador had the lowest (7.9-12.7). For most countries, mortality rates were ≤12.3, except in Uruguay, Argentina and Cuba (14.9-20.5). Age-specific rates increased after the age of 40-50 years and reached a maximum after age 65 years (mean age at diagnosis 56-62 years). Most countries have developed national screening guidelines; however, there is limited capacity for screening.

CONCLUSION

The geographic variation of breast cancer rates may be explained by differences in the prevalence of reproductive patterns, lifestyle factors, early detection, and healthcare access. Extending early-detection programs is challenging because of inequalities in healthcare access and coverage, limited funding, and inadequate infrastructure, and thus it may not be feasible. Given the current status of breast cancer in CSA, data generated by population-based cancer registries is urgently needed for effective planning for cancer control.

Risk Factors and Current Health-Seeking Patterns of Migrants in Northeastern Mexico: Healthcare Needs for a Socially Vulnerable Population

This study identified risk factors for health and access to healthcare services of migrants during their journey across Mexico to the United States. Data were collected in shelters located in Monterrey, the largest city of northeastern Mexico, through a basic clinical examination and a survey completed by 75 migrants; 92% of them were undocumented Central Americans. During their transit, they are at a high risk of contracting, developing, and transmitting diseases. The need of working to survive affects health-seeking behavior and a constant fear of being traced keeps migrants away from public health services, which delays diagnosis and treatment of diseases. Negligent lifestyles, such as smoking, drinking (31.8% of men and 11.1% of women), and drug abuse (13% of men and 11% of women), were found. Regarding tuberculosis (TB), undocumented migrants are usually not screened, even though they come from countries with a high TB burden. Besides, they might be overexposed to TB because of their living conditions in overcrowded places with deficient hygiene, protection, and malnutrition (54.7% of the sample). Possible comorbidities like acquired immune deficiency syndrome (AIDS; 4%) and diabetes (2.7%, but probably under-diagnosed) were referred. Migrants have little TB knowledge, which is independent of their level of education or a previous experience of deportation. About one-third of the migrants were totally unfamiliar with TB-related symptoms, while 36% had correct knowledge of basic TB symptoms. We conclude that a shortage of information on the highly vulnerable migratory population combined with a lack of social support and health education among migrants may play a significant role in the spread of communicable diseases. We recommend that health authorities address this urgent, binational, public health concern in order to prevent outbreaks of emerging infections.

The challenge of cancer in middle-income countries with an ageing population: Mexico as a case study

Mexico is undergoing rapid population ageing as a result of its epidemiological transition. This study explores the interface between this rapid population ageing and the burden of cancer. The number of new cancer cases is expected to increase by nearly 75% by 2030 (107,000 additional cases per annum), with 60% of cases in the elderly (aged ≥ 65). A review of the literature was supplemented by a bibliometric analysis of Mexico's cancer research output. Cancer incidence projections for selected sites were estimated with Globocan software. Data were obtained from recent national census, surveys, and cancer death registrations. The elderly, especially women and those living in rural areas, face high levels of poverty, have low rates of educational attainment, and many are not covered by health insurance schemes. Out of pocket payments and private health care usage remain high, despite the implementation of Seguro Popular that was designed to achieve financial protection for the lowest income groups. A number of cancers that predominate in elderly persons are not covered by the scheme and individuals face catastrophic expenditure in seeking treatment. There is limited research output in those cancer sites that have a high burden in the elderly Mexican population, especially research that focuses on outcomes. The elderly population in Mexico is vulnerable to the effects of the rising cancer burden and faces challenges in accessing high quality cancer care. Based on our evidence, we recommend that geriatric oncology should be an urgent public policy priority for Mexico.

[Access to early breast cancer diagnosis in the Brazilian Unified National Health System: an analysis of data from the Health Information System]

The recent reduction in breast cancer mortality in high-income countries resulted from improvements in early detection and treatment. Breast cancer is the most common cancer in Brazilian women. Since 2004, the government has recommended annual clinical breast examination for women aged ≥ 40 years and biannual mammograms for those aged 50-69. This article investigates the degree of implementation of these guidelines using data from the Brazilian Unified National Health System for 2010 according to major geographic region and age group. The findings showed low national mammogram coverage in the target population (32% in the 50-59-year group; 25% from 60 to 69 years). The percentage of women with abnormal radiological findings who underwent biopsy was also low (27% for 50-59 years; 63% for 60-69 years). The number of breast cancer surgeries exceeded the number of cases detected by mammography but was well below the estimated number of incident breast cancer cases in 2010. There are striking regional inequalities in access to early detection and surgery, being the lowest access in the North Region and the highest in the South Region.

Breast and cervical cancer screening and associated factors among older adult women in South Africa

BACKGROUND

Little is known about the cancer screening prevalence and correlates in older adults from different racial backgrounds. In the context of heightened efforts for prevention and early diagnosis, we collected information on screening for two major types of cancers: cervical and breast cancer in order to establish their prevalence estimates and correlates among older South African women who participated in the Study of Global Ageing and Adults Health (SAGE) in 2008.

MATERIALS AND METHODS

We conducted a national population-based cross-sectional study with a multi-stage stratified cluster sample of 3,840 individuals aged 50 years or older in South Africa in 2008. In this analysis, we only considered the female subsample of (n=2202). The measures used included socio-demographic characteristics, health variables, anthropometric and blood pressure measurements. Multivariable regression analysis was performed to assess the association of socio-demographic factors, health variables and cancer screening.

RESULTS

Overall, regarding cervical cancer screening, 24.3% ever had a Papanicolaou (PAP) smear test, and regarding breast cancer screening, 15.5% ever had a mammography. In multivariate logistic regression analysis, younger age, higher education, being from the White or Coloured population group, urban residence, greater wealth, and suffering from two or more chronic conditions were associated with cervical cancer screening, and higher education, being from the White or Indian/Asian population group, greater wealth, having a health insurance, and suffering from two or more chronic conditions were associated with breast cancer screening.

CONCLUSIONS

Cancer screening coverage remains low among elderly women in South Africa in spite of the national guideline recommendations for regular screening in order to reduce the risk of dying from these cancers if not detected early. There is a need to improve accessibility and affordability of early cervical and breast cancer screening for all women to ensure effective prevention and management of cervical and breast cancer.

Cervical and female breast cancers in the Americas: current situation and opportunities for action

OBJECTIVE

To understand better the current regional situation and public health response to cervical cancer and female breast cancer in the Americas.

METHODS

Data on cervical cancer and female breast cancers in 33 countries, for the period from 2000 to the last year with available data, were extracted from the Pan American Health Organization (PAHO) Regional Mortality Database and analysed. Changes in mortality rates over the study period - in all countries except those with small populations and large fluctuations in time-series mortality data - were calculated using Poisson regression models. Information from the PAHO Country Capacity Survey on noncommunicable diseases was also analysed.

FINDINGS

The Bahamas, Trinidad and Tobago and Uruguay showed relatively high rates of death from breast cancer, whereas the three highest rates of death from cervical cancer were observed in El Salvador, Nicaragua and Paraguay. Several countries - particularly Paraguay and Venezuela - have high rates of death from both types of cancer. Although mortality from cervical cancer has generally been decreasing in the Americas, decreases in mortality from breast cancer have only been observed in a few countries in the Region of the Americas. All but one of the 25 countries in the Americas included in the PAHO Country Capacity Survey reported having public health services for the screening and treatment of breast and cervical cancers.

CONCLUSION

Most countries in the Americas have the public health capacity needed to screen for - and treat - breast and cervical cancers and, therefore, the potential to reduce the burden posed by these cancers.

Perception, attitude and practices of women towards pelvic examination and Pap smear in Jamaica

Background:

Studies have shown that women's ability to access contraceptive methods depend on their socio-economic, educational, professional status, and the health and well-being of their families and themselves. Therefore, the embarking of the Governments of the Caribbean on important initiatives relating to gynecological matters is very important and timely.

Aims:

This study aims to examine the perception, attitude and practice of Jamaican women towards the matter of pelvic examination.

Patients and Methods:

The current study used an extracted sample of 7,168 women in their reproductive years (15-49 yrs) from a study which was undertaken by the National Family Planning Board in 2002 on Reproductive Health. Data was analyzed using SPSS for Windows, Version 16.0 (SPSS Inc.; Chicago, Ill. USA). Logistic regression was used to analyze factors/variables pertaining to Pelvic examination.

Results:

The findings revealed that older women are more likely to have done a Pelvic examination compared to younger women (χ² = 675.29, P < 0.001). Age, number of pregnancies that resulted in miscarriages, number of pregnancies that resulted in induced abortion, age of first sexual intercourse, number of years of schooling, area of residence and socio-economic class are statistically significant factors of Pelvic examinations in Jamaica. Therefore, the model had significant predictive power where (χ² = 1022.79, P < 0.001).

Conclusion:

The multidimensional nature of the variables, which emerged in the current study, indicate that a multisectoral approach should be used to address low pelvic and Pap smear examination among Jamaican women.

The demographic, system, and psychosocial origins of mammographic screening disparities: prediction of initiation versus maintenance screening among immigrant and non-immigrant women

Disparities in breast screening are well documented. Less clear are differences within groups of immigrant and non-immigrant minority women or differences in adherence to mammography guidelines over time. A sample of 1,364 immigrant and non-immigrant women (African American, English Caribbean, Haitian, Dominican, Eastern European, and European American) were recruited using a stratified cluster-sampling plan. In addition to measuring established predictors of screening, women reported mammography frequency in the last 10 years and were (per ACS guidelines at the time) categorized as never, sub-optimal (<1 screen/year), or adherent (1+ screens/year) screeners. Multinomial logistic regression showed that while ethnicity infrequently predicted the never versus sub-optimal comparison, English Caribbean, Haitian, and Eastern European women were less likely to screen systematically over time. Demographics did not predict the never versus sub-optimal distinction; only regular physician, annual exam, physician recommendation, and cancer worry showed effects. However, the adherent categorization was predicted by demographics, was less likely among women without insurance, a regular physician, or an annual exam, and more likely among women reporting certain patterns of emotion (low embarrassment and greater worry). Because regular screening is crucial to breast health, there is a clear need to consider patterns of screening among immigrant and non-immigrant women as well as whether the variables predicting the initiation of screening are distinct from those predicting systematic screening over time.

Heterogeneity in breast and cervical cancer screening practices among female Hispanic immigrants in the United States

This study examined differences in cervical and breast cancer (CC and BC) screening among a heterogeneous group of Hispanic women. Data from 247 women (mean age = 38.7 ± 13.3) from Mexico, the Dominican Republic, Puerto Rico, and countries throughout Central and South America regarding participation in Pap smears, mammography, clinical breast exam (CBE) and breast self-exams (BSE), CC and BC knowledge, and acculturation were analyzed. Differences in CBE and BSE screening behaviors were found based on country of origin (P < .01). However, after adjusting for the independent variables, only acculturation and knowledge remained significant correlates to BSE and CBE (P < .01). Dominican women had higher BC knowledge scores (P < .01) adhered most to BC screening guidelines. Heterogeneity in BC and CC screening was found among Hispanic sub-groups and suggests that health promotion programs should be tailored appropriately, particularly among recent immigrants.

Mammogram screening in Chile: using mixed methods to implement health policy planning at the primary care level

Breast cancer has the highest incidence of all cancers among women in Chile. In 2005, a national health program progressively introduced free mammography screening for women aged 50 and older; however, three years later the rates of compliance with mammographic screening was only 12% in Santiago, the capital city of Chile. This implementation article combines the findings of two previous studies that applied qualitative and quantitative methods to improve mammography screening in an area of Santiago. Socio-cultural and accessibility factors were identified as barriers and facilitators during the qualitative phase of the study and then applied to the design of a quantitative randomized clinical trial. After six months of intervention, 6% of women in the standard care group, 51.8% in the low intensity intervention group, and 70.1% in the high intensity intervention group had undergone a screening mammogram. This review discusses how the utilization of mixed methods research can contribute to the improvement of the implementation of health policies in local communities.

Strategies for increasing mammography screening in primary care in Chile: results of a randomized clinical trial

BACKGROUND

Breast cancer is the cancer with the highest incidence among women in Chile and in many Latin American countries. Breast cancer screening has very low compliance among Chilean women.

METHODS

We compared the effects on mammography screening rates of standard care, of a low-intensity intervention based on mail contact, and of a high-intensity intervention based on mail plus telephone or personal contact. A random sample of 500 women with the age of 50 to 70 years registered at a community clinic in Santiago who had not had a mammogram in the past 2 years were randomly assigned to one of the three intervention groups. Six months after randomization, participants were re-evaluated for their compliance with mammography screening. The outcome was measured by self-report and by electronic clinical records. An intention to treat model was used to analyze the results.

RESULTS

Between 92% and 93% of participants completed the study. Based on electronic records, mammography screening rates increased significantly from 6% in the control group to 51.8% in the low-intensity group and 70.1% in the high-intensity group. About 14% of participants in each group received opportunistic advice, 100% of participants in the low- and high-intensity groups received the mail contact, and 50% in the high-intensity group received a telephone or personal contact.

CONCLUSION

A primary care intervention based on mail or brief personal contact could significantly improve mammogram screening rates.

IMPACT

A relatively simple intervention could have a strong impact in breast cancer prevention in underserved communities.

Socioeconomic factors, immigration status, and cancer screening among Mexican American women aged 75 and older

To explore the association between socioeconomic factors and acculturation with cancer screening methods, we analyzed data from the Hispanic Established Population for the Epidemiologic Study of the Elderly, on 1,272 women aged 75 and older residing in the United States in 2004-2005. We found that lower Pap smear or mammography uses were associated with older age, lower education, and having public health insurance compared with private. Other factors associated with mammography use were depressive symptoms, cognition, and functional limitations. In sum, socioeconomic factors and health insurance coverage, but not acculturation, determine cancer screening utilization in very old Mexican American women.

'If I feel something wrong, then I will get a mammogram': understanding barriers and facilitators for mammography screening among Chilean women

BACKGROUND

Breast cancer is the leading cause of cancer among women in Chile and in many Latin American countries. Breast cancer screening is an effective strategy to reduce mortality, but it has a very low compliance among Chilean women.

OBJECTIVE

To understand barriers and facilitators for breast cancer screening in a group of Chilean women aged 50-70.

METHODS

Following the Predisposing, Enabling and Reinforcing (PRECEDE) framework, seven focus groups (N = 48 women) were conducted with women that have had diverse experiences with breast cancer and screening practices. Information was collected using field notes and audio and video recording. Following the grounded theory model, a sequential process of open, axial and selective coding was used for the information analysis. Atlas ti 5.5 software was used for coding and segmenting the data obtained from the interviews.

RESULTS

The presence of symptoms and/or the finding of lumps through breast self-examination (BSE) were the main predisposing factors for getting a mammogram. Secrecy, embarrassment and fatalism about breast cancer were significant cultural factors that influenced the decision to seek mammogram screening. Confidence in medical staff and dignity in the treatment at the clinic were important enabling factors. The main reinforcing factors for getting the test were a sense of fulfilment by doing something good for themselves and getting timely information about the results.

CONCLUSIONS

Primary health care providers should use culturally appropriate strategies to better inform women about the importance of mammography screening and the limitations of BSE for preventing advanced breast cancer.

[Prevalence of non-utilization of mammography and associated factors in elderly women]

This study analyzes the prevalence of non-utilization of mammography among older women, according to socio-demographic variables, health status, and use of preventive health services. This was a cross-sectional study including women 60 years or older. We interviewed 4,621 women 60 to 106 years of age; the majority were widows (51.8%) and had little or no schooling (53.8%). Most (89%) reported health problems, and 66.4% used private medical care. Prevalence of self-reported mammography was 72.1%. Gynecological visits (PR = 2.39; 95%CI: 2.04-2.80), Pap smear (PR = 3.24; 95%CI: 2.89-3.63), years of schooling (PR = 1.07; 95%CI: 1.02-1.12), health care insurance (PR = 1.16; 95%CI: 1.11-1.20), physician visits (PR = 1.23; 95%CI: 1.11-1.37), age (PR = 1.12; 95%CI: 1.08-1.17), marital status (PR = 1.05; 95%CI: 1.00-1.09), and barriers to health services (PR = 0.94; 95%CI: 0.89-0.98) were also associated with non-utilization of mammography. These associations may be partially explained by lack of knowledge, poor access to public health services, and cultural factors related to the aging process and reproductive incapacity.

Inequalities in breast and cervical cancer screening among urban Mexican women

OBJECTIVE

To examine the equity of screening for breast and cervical cancer among women aged 50 and over living in Mexico City according to the Andersen behavioural model.

METHODS

Logistic regressions were used to analyze the associations of predisposing factors, enabling resources and health needs with mammography and Pap testing among 1323 women aged 50 and over living in Mexico City. The data were taken from SABE, a survey conducted in Latin American and Caribbean cities in 1999-2000.

RESULTS

Referring to the previous two years, use of mammography was less frequent (14.8%) than Pap testing (53.7%). Higher education and having private health insurance were associated with receiving both procedures. Being married was associated with receipt of Pap testing, while being unmarried was associated with mammography. Younger women were more likely to receive a Pap test. Other cancer prevention behaviours were strong predictors of mammography and Pap test use.

CONCLUSIONS

There are inequities in access to cancer screening services among women aged 50 and over in Mexico. Cancer prevention programs need to implement strategies that guarantee free and accessible services independently of social conditions or type of health insurance. The observed clustering of screening services suggests that packaging screening programs for gynaecological cancer could be used to increase coverage.

The impact of education and literacy levels on cancer screening among older Latin American and Caribbean adults

BACKGROUND

There is limited information related to the effects of education and literacy on cancer screening practices among older adults in Latin American and Caribbean countries.

METHODS

To determine the association between education and cancer screening use, we developed a cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study. The sample included 4,183 men and 6,708 women aged 60 years and older from seven cities. The outcomes are mammogram and Pap smear use in women and prostate examination use in men within the last 2 years.

RESULTS

In general, illiterate or lower-educated older men and women have the lowest rates of cancer screening use compared with higher-educated counterparts. Multivariate logistic models, by city and in a combined sample of six cities showed that high education is associated with higher odds of having a mammogram or a Pap smear in women and a prostate examination in men.

CONCLUSIONS

Older adults with low educational or literacy levels should be targeted for screening programs in these populations.

Health insurance and cervical cancer screening among older women in Latin American and Caribbean cities

BACKGROUND

The purpose of this study is to describe the prevalence of Papanicolaou (Pap) smear use for cervical cancer screening and to estimate its association with type of health care insurance.

METHODS

A cross-sectional study using data from the Health, Well-Being and Aging in Latin America and the Caribbean Study (SABE). The sample includes 6357 women aged 60 and older from seven cities. The outcome was reporting a Pap smear for cervical cancer screening during the previous 2 years. Main independent variable was health care insurance. Covariates were demographic or socioeconomic variables, medical conditions and functional status.

RESULTS

Prevalence of Pap smear use across the seven cities ranged from 21% in Bridgetown to 45% in Mexico City. In a multivariate analysis of the combined sample, without Havana that has universal health care insurance, women with public insurance (OR 0.55, 95% CI 0.43-0.71) or with no insurance (OR 0.23, 95% CI 0.15-0.34) were less likely to have a Pap smear compared with women with private insurance. Also, women with no insurance were less likely to have a Pap smear (OR 0.40, 95% CI 0.30-0.54) compared with women with any health insurance.

CONCLUSIONS

In general, the prevalence of Pap smear use was lower than that reported for Hispanic populations in the United States. Overall, lack of health insurance or having public health insurance determined lower odds for having a Pap smear for cervical cancer screening.

Cervical cancer screening among foreign-born women by birthplace and duration in the United States

OBJECTIVE

Mortality rates for cervical cancer have increased among foreign-born women in the United States in the last two decades. Previous research indicates that rates of Pap testing are lower among foreign-born women than in U.S.-born women. This study identifies screening rates among foreign-born women by birthplace and duration in the United States.

METHODS

We used data from 4 years (1998, 1999, 2000, 2003) of the National Health Interview Survey (NHIS) to estimate Pap testing rates by birthplace (Mexico, Central America, Caribbean, South America, Europe, Russia, Africa, Middle East, India, Asia, and Southeast Asia) and percent of lifetime spent in the United States for women aged>or=18 years (n=70,775). Rates were age standardized to the 2000 U.S. population.

RESULTS

After adjusting for demographic characteristics and health indicators, we found that 18.6% (95% CI 16.7, 20.6) of recent immigrants (<25% of lifetime in the United States) and 9.9% (95% CI 9.0, 10.8) of established immigrants (>or=25% of lifetime in the United States)never received a Pap test in their lifetime compared with 5.8% (95% CI 5.5, 6.1) of U.S.-born women. Adjusted prevalence of never receiving a Pap test was highest among women from Asia, Southeast Asia, and India (19.6%), South America (12.7%), Mexico (11.2%), Caribbean (11.0%), Europe (9.9%), and Central America (9.2%).

CONCLUSIONS

Significant differences exist in rates of screening for cervical cancer between foreign-born groups by birthplace and by duration in the United States. Nationally and locally funded screening programs may benefit from these findings in developing screening strategies for foreign-born women.