1
|
Dontchos BN, Edmonds CE, Mercaldo SF, Miles RC, Chu KF, Lehman CD. Patient-Assisted Compression in Screening Mammography: Patient Experience and Image Quality. JOURNAL OF BREAST IMAGING 2019; 1:192-198. [PMID: 38424767 DOI: 10.1093/jbi/wbz024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Indexed: 03/02/2024]
Abstract
OBJECTIVE Screening mammography is critical to reduce breast cancer mortality, yet many women cite pain from compression as a reason they avoid this test. We evaluated patient experience and image quality in screening patients opting for a handheld patient-assisted compression (PAC) device. METHODS After institutional review board approval, women screened between February and July 2018 with a synthetic 2D/tomosynthesis mammography unit were offered use of a handheld PAC device. Patient experience through survey, image quality, compression thickness, compression force, and average glandular dose were evaluated and compared between women opting for PAC and women opting for technologist-controlled compression (TC). Multivariable ordinal logistic and linear regression models were estimated to control for age and breast density. In addition, for women opting for PAC, image quality obtained with their current PAC mammogram was compared with that obtained with their prior TC mammogram, by using Wilcoxon/Pearson tests. RESULTS Seventy-three percent of women preferred their mammogram experience with PAC compared with their prior mammogram without PAC. Women using PAC reported decreased anxiety compared with those using TC, after controlling for age and breast density (adjusted odds ratio [aOR] 0.22 [95% confidence interval (CI): 0.09-0.49]). There were no significant differences in image quality, compression thickness, or average glandular dose in exams for women using PAC compared with exams for women using TC. Women using PAC had significantly more compression force than women using TC had (P = 0.012). CONCLUSIONS Mammography with PAC improves patient experience and results in similar image quality compared with mammography with TC.
Collapse
Affiliation(s)
- Brian N Dontchos
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | | - Sarah F Mercaldo
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Randy C Miles
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | - Katrina F Chu
- Massachusetts General Hospital, Department of Radiology, Boston, MA
| | | |
Collapse
|
2
|
Hasnain M, Menon U, Ferrans CE, Szalacha L. Breast cancer screening practices among first-generation immigrant muslim women. J Womens Health (Larchmt) 2014; 23:602-12. [PMID: 24865517 PMCID: PMC4089017 DOI: 10.1089/jwh.2013.4569] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify beliefs about breast cancer, screening practices, and factors associated with mammography use among first-generation immigrant Muslim women in Chicago, IL. METHODS A convenience sample of 207 first-generation immigrant Muslim women (Middle Eastern 51%; South Asian 49%) completed a culturally adapted questionnaire developed from established instruments. The questionnaire was administered in Urdu, Hindi, Arabic, or English, based on participant preference. Internal-consistency reliability was demonstrated for all scales (alpha coefficients ranged from 0.64 to 0.91). Associations between enabling, predisposing, and need variables and the primary outcome of mammography use were explored by fitting logistic regression models. RESULTS Although 70% of the women reported having had a mammogram at least once, only 52% had had one within the past 2 years. Four factors were significant predictors of ever having had a mammogram: years in the United States, self-efficacy, perceived importance of mammography, and intent to be screened. Five factors were significant predictors of adherence (having had a mammogram in the past 2 years): years in the United States, having a primary care provider, perceived importance of mammography, barriers, and intent to be screened. CONCLUSIONS This article sheds light on current screening practices and identifies theory-based constructs that facilitate and hinder Muslim women's participation in mammography screening. Our findings provide insights for reaching out particularly to new immigrants, developing patient education programs grounded in culturally appropriate approaches to address perceived barriers and building women's self-efficacy, as well as systems-level considerations for ensuring access to primary care providers.
Collapse
Affiliation(s)
- Memoona Hasnain
- Department of Family Medicine, College of Medicine, University of Illinois at Chicago, Chicago, Illinois
| | - Usha Menon
- College of Nursing, The Ohio State University, Columbus, Ohio
| | | | - Laura Szalacha
- Center for Research and Transdisciplinary Scholarship, College of Nursing, The Ohio State University, Columbus, Ohio
| |
Collapse
|
3
|
Feldstein AC, Perrin N, Rosales AG, Schneider J, Rix MM, Glasgow RE. Patient Barriers to Mammography Identified During a Reminder Program. J Womens Health (Larchmt) 2011; 20:421-428. [PMID: 21275649 DOI: 10.1089/jwh.2010.2195] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Background: Patient mammogram reminders are effective at increasing screening, but patient barriers remain. We evaluated patient characteristics and reported barriers for their association with mammogram completion after a reminder program. Methods: This retrospective cohort study used data from electronic records and a subgroup survey. Participants were female Kaiser Permanente Northwest health maintenance organization (HMO) members aged 50-69 who were 20 months past their last mammogram (index date) and had received a reminder intervention (n = 4708). A mailed survey was completed by 340 of 667 (50.2%) women who received it. The intervention was a "mammogram due soon" postcard 20 months after the last mammogram, followed by up to two automated phone calls and one live call for nonresponders. The outcome was mammogram completion at 10 months after index date. Results: Characteristics associated with lower mammogram completion rates were aged <60 (odds ratio [OR] 0.69, p < 0.0001), health plan membership <5 years (OR 0.81, p = 0.019), family income <$40,000/year (OR 0.77, p = 0.018), and obesity (OR 0.67, p < 0.0001). Obese women were more likely than nonobese women to report "too much pain" from mammograms (31.3% vs.18.8%, p < 0.01). Younger women were more likely to endorse that they were "too busy" (19.1% vs. 6.4%, p < 0.001) and had more worries about mammogram accuracy (2.5 vs. 2.3 on a 5-point scale, p < 0.05). Pain mediated the relationship between obesity and mammogram completion rates (indirect effect = -0.111, p = 0.008). Conclusions: Important barriers to mammogram completion remain even after an effective mammogram reminder system among insured patients. Tailored interventions are necessary to overcome these barriers.
Collapse
Affiliation(s)
- Adrianne C Feldstein
- Kaiser Permanente Northwest, Portland, Oregon.,Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - A Gabriela Rosales
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Jennifer Schneider
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | - Mary M Rix
- Center for Health Research, Kaiser Permanente Northwest, Portland, Oregon
| | | |
Collapse
|
4
|
Craig BM, Quinn GP, Vadaparampil ST. Sensitivity of self-report mammography use in older women. Am J Prev Med 2009; 37:441-4. [PMID: 19840700 PMCID: PMC3864094 DOI: 10.1016/j.amepre.2009.07.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2009] [Revised: 05/27/2009] [Accepted: 07/14/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Recent survey evidence indicates a decline in mammography use among older women. PURPOSE The objective of this study was to detect sensitivity of self-reported mammography use and pose evidence-based suggestions to increase survey accuracy. METHODS Using the 1991-2006 Medicare Current Beneficiary Survey, 15,357 women, aged > or =65 years, were selected based on use of mammography services. The women were interviewed in the community setting at random periods after screening and asked, Have you had a mammogram or breast X-ray since [today's date or previous supplement round interview date] a year ago? Statistical analyses were conducted between March 11 and April 28 of 2008. This study tested whether sensitivity (i.e., probability of an affirmative response) was dependent on length of the recall period and on respondent demographic and socioeconomic characteristics. RESULTS Overall, 90.4% of the older women self-reported use; however, sensitivity decreased as the recall period lengthened (90% at 6 months, 80% at 12 months). This time effect was significantly higher among older, economically disadvantaged women. Sensitivity also decreased an additional 13.8% if the event occurred in the previous calendar year, and 3.5% if conducted in a non-English language or by proxy. CONCLUSIONS Greatest sensitivity occurred during the 6-month period after service without straddling calendar years. These findings may aid the tailoring of future surveys for older adults, improving the recall of preventive services.
Collapse
Affiliation(s)
- Benjamin M Craig
- Health Outcomes and Behavior Program, Moffitt Cancer Center, University of South Florida, Tampa, FL 33612-9416, USA.
| | | | | |
Collapse
|
5
|
Downey L, Tyree PT, Lafferty WE. Preventive screening of women who use complementary and alternative medicine providers. J Womens Health (Larchmt) 2009; 18:1133-43. [PMID: 19630554 PMCID: PMC2825724 DOI: 10.1089/jwh.2008.1230] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Many women use complementary and alternative medicine (CAM). Although CAM use has been associated with reductions in conventionally recommended pediatric preventive care (e.g., vaccination), little is known about associations between CAM use and receipt of recommended preventive screening in women. METHODS Using Washington State insurance data from 2000 to 2003, the authors generated clustered logistic regression models, examining associations between provider-based CAM use and receipt of screening tests for Chlamydia trachomatis, breast cancer, and cervical cancer: (1) contrasting women who used CAM providers only (alternative use) and women who used both conventional and CAM providers (complementary use) with women who used conventional care only and (2) testing associations between screening and use of four specific CAM provider types-naturopathic physicians, chiropractors, massage therapists, and acupuncturists. RESULTS Both alternative and complementary use was associated with reduced Chlamydia screening. Cancer screening increased with complementary use but decreased with alternative use of CAM. Use of naturopathy was associated with decreased mammography, whereas all four CAM therapies were positively associated with Papanicolaou testing. CONCLUSIONS When used in conjunction with conventional care, use of provider-based CAM may signal high interest in various types of health-promoting behavior, including cancer screening. Negative associations between CAM and Chlamydia screening and between naturopathy and mammography require additional study. Interventions with CAM providers and their patients, aimed at improving rates of conventionally recommended screening, might encourage greater focus on preventive care, an important task when CAM providers serve as women's only contact with the healthcare system.
Collapse
Affiliation(s)
- Lois Downey
- Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle, WA 98195-9455, USA.
| | | | | |
Collapse
|
6
|
Nekhlyudov L, Habel LA, Achacoso NS, Jung I, Haque R, Collins LC, Schnitt SJ, Quesenberry CP, Fletcher SW. Adherence to long-term surveillance mammography among women with ductal carcinoma in situ treated with breast-conserving surgery. J Clin Oncol 2009; 27:3211-6. [PMID: 19433691 DOI: 10.1200/jco.2008.18.5876] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
PURPOSE Breast-conserving surgery (BCS) is an effective treatment for ductal carcinoma in situ (DCIS) but women who undergo BCS remain at risk for recurrences. Whether mammographic surveillance after BCS occurs and by whom is not known. METHODS We reviewed medical records of women diagnosed with DCIS between 1990 and 2001 and treated with BCS. Using descriptive statistics, generalized estimating, and logistic regression modeling, we examined the rates and predictors of surveillance mammography over a 10-year period after BCS. Results The cohort included 3,037 women observed for a median of 4.8 years (range, 0.5 to 15.7). Of the 2,676 women observed for at least 1 year after BCS, most (79%) had at least one surveillance mammogram during the first year of follow-up; 69% in year 5 and 61% in year 10. Among those observed for 5 years, surveillance mammograms were more likely among women age 60 to 69 years (odds ratio [OR], 1.72; 95% CI, 1.26 to 2.34), users of menopausal hormone therapy at diagnosis (OR, 1.26; 95% CI, 1.01 to 1.57) as well as those treated with adjuvant radiation (OR, 1.28; 95% CI, 1.08 to 1.53) and adjuvant radiation with tamoxifen (OR, 1.61; 95% CI, 1.13 to 2.30). Surveillance mammograms were less likely among obese women (OR, 0.70; 95% CI, 0.56 to 0.86). The findings were similar among women observed for 10 years. Only 34% and 15% of women observed for 5 and 10 years, respectively, had a surveillance mammogram during each year of follow-up. CONCLUSION Surveillance mammography after BCS among insured women with DCIS often did not occur yearly and declined over time after treatment. Patients and providers must remain vigilant about surveillance after BCS.
Collapse
Affiliation(s)
- Larissa Nekhlyudov
- Department of Ambulatory Care and Prevention, Harvard Medical School/Harvard Pilgrim Health Care, 133 Brookline Ave, 6th Floor, Boston, MA 02215, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Declining Screening Mammography Rates: A Multigenerational Loss of Opportunity? AJR Am J Roentgenol 2009; 192:388-9. [DOI: 10.2214/ajr.08.1705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
8
|
The recent decline in mammography rates is limited to low- to average-risk women. Am J Surg 2009; 196:821-6; discussion 826. [PMID: 19095095 DOI: 10.1016/j.amjsurg.2008.07.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2008] [Revised: 07/08/2008] [Accepted: 07/08/2008] [Indexed: 11/23/2022]
Abstract
INTRODUCTION There has recently been a decline in mammography rates noted in the general population. We sought to determine whether similar trends hold in high-risk populations. METHODS Mammography rates from the National Health Interview Survey for 2000 and 2005 were analyzed for differences among risk-stratified populations of women over the age of 40. RESULTS Although high-risk women (those with a personal of family history of breast cancer) were more likely to report having had a mammogram than lower risk women, they, too, showed a small decline in mammography rates. This, however, did not reach statistical significance. The decline in mammography rates in lower risk women, however, was significant and correlated with that of the general population. CONCLUSIONS The decline in breast cancer-screening rates noted over the past 5 years has been predominantly in lower-risk women.
Collapse
|
9
|
Assessing and increasing breast cancer screening. Prev Med 2008; 47:483-4. [PMID: 18755213 DOI: 10.1016/j.ypmed.2008.07.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2008] [Revised: 07/30/2008] [Accepted: 07/30/2008] [Indexed: 11/23/2022]
|
10
|
Ryerson AB, Miller JW, Eheman CR, Leadbetter S, White MC. Recent trends in U.S. mammography use from 2000-2006: a population-based analysis. Prev Med 2008; 47:477-82. [PMID: 18602946 DOI: 10.1016/j.ypmed.2008.06.010] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2007] [Revised: 06/10/2008] [Accepted: 08/11/2008] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We previously reported a decrease in regular mammogram use from 2000 through 2005. To determine whether a downward trend continued in 2006 we re-examined mammography utilization reported in Behavioral Risk Factor Surveillance System data from 2000 through 2006. METHODS Age-adjusted percentages of women who reported having had a mammogram in the past 2 years were estimated by demographic and socioeconomic characteristics. Logistic regression was used to assess the linear time trends. RESULTS The total age-adjusted proportion of all women aged > or =40 years who reported having had a mammogram within the 2 preceding years did not change when comparing data from 2000 (76.5% [95% CI: 75.9-77.0]) to 2006 (76.1% [75.7-76.6]). However, among those with health care coverage, a statistically significant decline in utilization occurred among women age 40 through 59 years, and non-Hispanic white women. CONCLUSIONS A substantial proportion of women are not being screened by mammography as recommended. Recent data suggest that patterns of utilization have leveled off or declined among certain subgroups of women. These data underscore the need to more effectively address current barriers to the utilization of mammography.
Collapse
Affiliation(s)
- A Blythe Ryerson
- National Center for Chronic Disease Prevention and Health Promotion, Coordinating Center for Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway NE, Mailstop K-55, Atlanta, GA 30341, USA.
| | | | | | | | | |
Collapse
|
11
|
Kim J, Jang SN. Socioeconomic disparities in breast cancer screening among US women: trends from 2000 to 2005. J Prev Med Public Health 2008; 41:186-94. [PMID: 18515996 DOI: 10.3961/jpmph.2008.41.3.186] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVES This study describes trends in the socioeconomic disparities in breast cancer screening among US women aged 40 or over, from 2000 to 2005. We assessed 1) the disparities in each socioeconomic dimension; 2) the changes in screening mammography rates over time according to income, education, and race; and 3) the sizes and trends of the disparities over time. METHODS Using data from the Behavioral Risk Factor Surveillance System (BRFSS) from 2000 to 2005, we calculated the age-adjusted screening rate according to relative household income, education level, health insurance, and race. Odds ratios and the relative inequality index (RII) were also calculated, controlling for age. RESULTS Women in their 40s and those with lower relative incomes were less likely to undergo screening mammography. The disparity based on relative income was greater than that based on education or race (the RII among low-income women across the survey years was 3.00 to 3.48). The overall participation rate and absolute differences among socioeconomic groups changed little or decreased slightly across the survey years. However, the degree of each socioeconomic disparity and the relative inequality among socioeconomic positions remained quite consistent. CONCLUSIONS These findings suggest that the trend of the disparity in breast cancer screening varied by socioeconomic dimension. Continued differences in breast cancer screening rates related to income level should be considered in future efforts to decrease the disparities in breast cancer among socioeconomic groups. More focused interventions, as well as the monitoring of trends in cancer screening participation by income and education, are needed in different social settings.
Collapse
Affiliation(s)
- Jaeyoung Kim
- Department of Environmental Health, Harvard School of Public Health, USA
| | | |
Collapse
|
12
|
Baker SG, Kramer BS. Estimating the cumulative risk of a false-positive under a regimen involving various types of cancer screening tests. J Med Screen 2008; 15:18-22. [PMID: 18416950 DOI: 10.1258/jms.2008.007076] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES When evaluating screening for the early detection of cancer, it is important to estimate both harms and benefits. One common harm is a false-positive (FP), which is a positive screening result, perhaps followed by an invasive test, with no cancer detected on the diagnostic work-up or within a specified time period. An important goal is to estimate the risk of at least one FP, which we call the cumulative risk of an FP, if persons took a regimen of various screening tests, as is commonly recommended. The estimation is complicated because the data come from a study in which subjects are offered various screening tests in rounds with some missing tests in most subjects. Previous methods for estimating cumulative risk of FPs with a single type of test are not directly applicable, so a new approach was developed. METHODS The tests were ordered by appearance, where the last test was either the first FP (analogous to a failure time) or the last test taken with no FPs having occurred on that test or previously (analogous to a censoring time). We applied a Kaplan-Meier approach for survival analysis with the innovation that the hazard for a first FP for a given test depends on the type of test and number of previous tests of that type which were taken. RESULTS The method is illustrated with data from the screening arm of the randomized Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. With an FP defined as a diagnostic work-up in the absence of cancer (or advanced adenoma) within three years, the probability of at least one FP among 14 tests in men was 60.5% with 95% confidence interval of (59.3%, 61.6%). CONCLUSION A simple estimate is proposed for the probability of at least one FP if persons took a regimen of multiple screening tests of different types. The methodology is useful for summarizing the burden of multiphasic screening programmes.
Collapse
Affiliation(s)
- Stuart G Baker
- Division of Cancer Prevention, National Cancer Institute, 6130 Executive Blvd. MSC 7354, Bethesda, MD 20892-7354, USA.
| | | |
Collapse
|
13
|
Boncz I, Sebestyén A, Pintér I, Battyány I, Ember I. The effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities. J Med Screen 2008; 15:14-7. [PMID: 18416949 DOI: 10.1258/jms.2008.007070] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVES To analyse the effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities in Hungary. SETTING The nationwide dataset of the Hungarian National Health Insurance Fund Administration covering the years 2000-2005. METHODS Data derived from the nationwide database of the Hungarian National Health Insurance Fund Administration. The study includes all women undergoing mammography before (2000-2001) and after (2002-2003/2004-2005) the introduction of organized screening. RESULTS The number of women having non-organized (opportunistic/diagnostic) mammograms was around 250,000 in 2000-2001, but increased to 350,000 in 2005. In the age group 45-64 years in 2000-2001, only 27.4% of all women undergoing mammography were examined within locally-organized programmes. After the introduction of the nationwide programme, this percentage increased to 61.0% in 2002-2003, and 56.3% in 2004-2005. After the introduction of the nationwide organized programme (2002-2003), the proportion of organized screening mammographies remained among the highest in county Hajdú-Bihar (78.4%) and Zala (88.3%) and increased significantly in county Vas (87.7%). CONCLUSION The introduction of an organized nationwide screening programme in Hungary resulted in increases in the number of screening mammographies, and also of non-organized mammographies. Although the ratio of organized screening versus non-organized mammography changed in favour of screening mammographies, there are large within-country differences between counties.
Collapse
Affiliation(s)
- Imre Boncz
- Department of Health Economics, Policy and Management, University of Pécs, Vörösmarty út 4, Pécs, Hungary.
| | | | | | | | | |
Collapse
|
14
|
Chagpar AB, Polk HC, McMasters KM. Racial trends in mammography rates: a population-based study. Surgery 2008; 144:467-72. [PMID: 18707047 DOI: 10.1016/j.surg.2008.05.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2008] [Accepted: 05/22/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND The rates of mammography have been declining over the last 5 years. The objective of this study was to examine racial disparities in this trend. METHODS The National Health Interview Survey is a population-based interview survey conducted annually. Caucasian and African-American women over 40 years of age who completed the cancer module of this survey in 2000 and 2005 formed the cohort of interest for this study. RESULTS In 2000, 69.8% of Caucasian and 64.4% of African-American women over the age of 40 had had a mammogram within the preceding 2 years. In 2005, these rates declined to 66.7% and 62.9% respectively. This decline only reached statistical significance in the Caucasian population (P = .0006 vs P = .4998). While on univariate analysis a significant difference was seen between rates of mammography in Caucasian and African-American women (P < .0001), multivariate analysis controlling for education, income, and insurance status, did not find race to be a significant independent predictor of mammography rates in each year. CONCLUSION Rates of mammography are declining, particularly in Caucasian populations. While minority women are less likely to report having had a mammogram, this apparent racial disparity is explained by differences in education, income and insurance status.
Collapse
Affiliation(s)
- Anees B Chagpar
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, KY, USA.
| | | | | |
Collapse
|
15
|
Vogt TM, Feldstein AC, Aickin M, Hu WR, Uchida AR. Electronic medical records and prevention quality: the prevention index. Am J Prev Med 2007; 33:291-6. [PMID: 17888855 DOI: 10.1016/j.amepre.2007.05.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2006] [Revised: 05/01/2007] [Accepted: 05/29/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND The Prevention Index is a methodology for using electronic medical records to identify and evaluate practice variations in the delivery of preventive care. METHODS The Prevention Index was used to evaluate the provision of 10 recommended adult preventive services using electronic medical record data for the years 1999 through 2002 among the 450,000 members of a large Northwest integrated care system. The analyses were conducted in 2005. The Prevention Index determines the proportion of person-time that is covered using consensus guidelines as a standard of care. It is analyzed at the population level and produces quality measures at the individual, practice, clinic, and system levels. The Prevention Index also removes diagnostic services in evaluating preventive care. RESULTS Overall, about 47% of recommended person-time was actually covered by the services in 2002. For nine services with care guidelines, the percent of covered person-time ranged from 19% for chlamydia screening to 80% for blood pressure screening. The percent of recommended person-time covered by these preventive services varied widely across clinical practices. From 17% to 53% of preventive screening tests were delivered for non-screening purposes. CONCLUSIONS There are wide variations across clinical practices in the adherence to standard prevention guidelines, and also wide variations across different recommended clinical services. The Prevention Index methodology may allow the identification of the source of these variations, allowing system corrections and other remedial actions to be applied precisely and efficiently.
Collapse
Affiliation(s)
- Thomas M Vogt
- Kaiser Permanente Center for Health Research-Hawaii, 501 Alakawa Street, Honolulu, HI 96817, USA.
| | | | | | | | | |
Collapse
|
16
|
Boudreau DM, Luce CL, Ludman E, Bonomi AE, Fishman PA. Concordance of population-based estimates of mammography screening. Prev Med 2007; 45:262-6. [PMID: 17698182 PMCID: PMC2065854 DOI: 10.1016/j.ypmed.2007.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2007] [Revised: 07/05/2007] [Accepted: 07/07/2007] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Estimates of adherence to mammography screening guidelines vary, in part, due to lack of consensus on defining adherence. This study estimated adherence to repeat (two successive on-time screenings) and regular screening (three or more successive screenings) and evaluated the impact of varying operational definitions and evaluation periods. METHODS The study included women aged 50-80 without a history of breast cancer who: were on a biennial screening cycle and due for a screening mammogram between 1995 and 1996; underwent screening (index date) in response to a reminder letter; and belonged to Group Health, an integrated health care delivery system in Washington State, for 6 or more years after the index date. Automated records provided information on enrollment, health care utilization, and procedures. RESULTS Among 1336 women, 67-82% experienced a repeat screen. Adherence to regular screening over the 6-year evaluation period was 42-84%--and higher with longer allowable intervals between screenings, when definitions did not require on-schedule screenings, when intervals were reset after a diagnostic mammogram, and for shorter evaluation periods. CONCLUSION Estimates of adherence to screening guidelines varied by the operational definition of "success" and time period of evaluation. Consensus in definitions and terminology is needed to compare evaluations.
Collapse
|
17
|
Breen N, A Cronin K, Meissner HI, Taplin SH, Tangka FK, Tiro JA, McNeel TS. Reported drop in mammography : is this cause for concern? Cancer 2007; 109:2405-9. [PMID: 17503429 DOI: 10.1002/cncr.22723] [Citation(s) in RCA: 159] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Timely screening with mammography can prevent a substantial number of deaths from breast cancer. The objective of this brief was to ascertain whether recent use of mammography has dropped nationally. METHODS The authors assessed the trend in mammography rates from 1987 through 2005. Then, they used the 2000 and 2005 National Health Interview Survey (NHIS) estimates to characterize trends and current patterns in mammography use. RESULTS After robust, rapid increases in reported use of mammography by women in the U.S. since 1987, estimates from the 2005 NHIS showed a decline compared with 2000 (from 70% to 66%). Although it was small, this decline may be cause for concern, because it signals a change in direction. CONCLUSIONS This report establishes for the nation what already has been observed in some local data. The results confirmed that the use of mammography may be falling. This change needs to be monitored carefully and also may call for intervention.
Collapse
Affiliation(s)
- Nancy Breen
- Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda 20892-7344, Maryland, USA.
| | | | | | | | | | | | | |
Collapse
|
18
|
Chagpar AB, McMasters KM. Trends in Mammography and Clinical Breast Examination: A Population-Based Study. J Surg Res 2007; 140:214-9. [PMID: 17418862 DOI: 10.1016/j.jss.2007.01.034] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2007] [Revised: 01/08/2007] [Accepted: 01/30/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND There are well-accepted clinical guidelines for early detection of breast cancer through mammography and clinical breast examination. The purpose of this study was to determine trends in the utilization of these techniques over the past 5 years. METHODS The National Health Interview Survey is a population-based computer survey of noninstitutionalized civilian Americans conducted annually by the National Center for Health Statistics, Centers for Disease Control and Prevention. We evaluated the reported use of mammography and clinical breast examination in women 40 years of age and older between 2000 and 2005. Data were evaluated using SAS and SAS-callable SUDAAN software. RESULTS Surveyed were 10,994 and 11,128 women over age 40 in 2000 and 2005, respectively. Between these years, there was a decline in women >or=40 years old who reported ever having a mammogram (80.79% versus 79.52%, P<0.0001) and in those who had a mammogram within the preceding 2 years (87.98% versus 86.30%, P=0.0040). In addition, there was a drop in women reporting ever having a clinical breast exam (82.12% versus 75.91%, P<0.0001) and in those reporting having had a clinical breast exam in the 2 years prior to the survey (89.24% versus 87.63%, P=0.0012). Similar results were found in the population aged 50-69. CONCLUSIONS Despite well-established clinical guidelines for early detection of breast cancer, there has been a decline in the rates of annual mammography and clinical breast exam in women over the age of 40 over the past 5 years.
Collapse
Affiliation(s)
- Anees B Chagpar
- Division of Surgical Oncology, Department of Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
| | | |
Collapse
|