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Price MD, Mali ME, Dedey F, Dzefi-Tettey K, Li Y, Almeida C, Brownson KE, Price RR, Sutherland EK. Mammography and Breast Ultrasonography Services in Ghana, Availability, and Geographic Access. JCO Glob Oncol 2024; 10:e2400218. [PMID: 39208381 PMCID: PMC11462162 DOI: 10.1200/go.24.00218] [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: 05/20/2024] [Revised: 07/11/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
PURPOSE Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. METHODS A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. RESULTS Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. CONCLUSION Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.
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Affiliation(s)
- Matthew D. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD
| | - Meghan E. Mali
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
| | - Florence Dedey
- Department of Surgery, University of Ghana Medical School, Accra, Ghana
| | | | - Yao Li
- Department of Geography & Earth Sciences, The University of North Carolina at Charlotte, Charlotte, NC
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Cameron Almeida
- University of Alabama Birmingham School of Medicine, Birmingham, AL
| | - Kirstyn E. Brownson
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Huntsman Cancer Institute, Salt Lake City, UT
| | - Raymond R. Price
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Surgery, The University of Utah School of Medicine, Salt Lake City, UT
- Intermountain Health, Salt Lake City, UT
| | - Edward Kofi Sutherland
- The University of Utah, Center for Global Surgery, Salt Lake City, UT
- Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
- Ensign Global College, Kpong, Ghana
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2
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Rao M, Densley S, Marciniak A, Burgoa S, Zerrouki Y, Okwaraji G, Lobaina D, Jhumkhawala V, Knecht M, Kitsantas P, Sacca L. Dissemination and implementation science frameworks and strategies to increase breast cancer screening for at-risk women in the United States: A scoping review. J Public Health Res 2024; 13:22799036241268841. [PMID: 39119619 PMCID: PMC11304495 DOI: 10.1177/22799036241268841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/11/2024] [Indexed: 08/10/2024] Open
Abstract
Dissemination and implementation science (D&I) can help bridge the gap between research and practice by addressing how to facilitate and maintain pre-existing evidence-based interventions (EBIs) in various contexts within different fields, including that of breast cancer screening and treatment. Yet, despite the availability of D&I frameworks and strategies, there is a lack of studies exploring knowledge transfer dissemination and implementation models, strategies, and frameworks in the setting of breast cancer care. There is a need for studies that create guidelines and roadmaps built on theoretical foundations of D&I research to scale up successful D&I of strategies, frameworks, and protocols proven to cater to the needs of all breast cancer patients when seeking screening and treatment services. The Arksey and O'Malley (2005) York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; (5) collating, summarizing, and reporting results. Most cited barriers (n = 46) sorted into the category of "Recruitment, Measurement, and Delivery Challenges." The predominant ERIC strategy, featured in a noteworthy 84% of studies, was "Tailor strategies" (#16), which belongs to the "Adapt and tailor to context: culture, language, data analysis, collection" domain. This study can guide researchers, physicians, and community workers in improving accessibility, affordability, and quality of breast cancer screening and adequate follow-up opportunities through D&I strategies and models improving the reach and sustainability of evidence-based programs in at-risk female populations.
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Affiliation(s)
- Meera Rao
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sebastian Densley
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Adeife Marciniak
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Sara Burgoa
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Yasmine Zerrouki
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Goodness Okwaraji
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Diana Lobaina
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Vama Jhumkhawala
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Michelle Knecht
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Panagiota Kitsantas
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
| | - Lea Sacca
- Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, USA
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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.
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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
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4
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Williams AD, Moo TA. The Impact of Socioeconomic Status and Social Determinants of Health on Disparities in Breast Cancer Incidence, Treatment, and Outcomes. CURRENT BREAST CANCER REPORTS 2023. [DOI: 10.1007/s12609-023-00473-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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5
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Eid MK, Abu-Odah H, Wehedi DT, Su JJ, Abed Y. Policymakers' and patients’ perspectives on breast cancer management in the Gaza Strip-Palestine: A qualitative study. Eur J Oncol Nurs 2022; 61:102223. [DOI: 10.1016/j.ejon.2022.102223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/03/2022] [Accepted: 10/08/2022] [Indexed: 11/16/2022]
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A first look at breast cancer screening in over 1000 community health centers in the United States. Prev Med 2022; 161:107115. [PMID: 35724699 DOI: 10.1016/j.ypmed.2022.107115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 06/03/2022] [Accepted: 06/12/2022] [Indexed: 11/24/2022]
Abstract
Community Health Centers (CHCs) primarily serve low-income and vulnerable patients. Breast cancer screening recently became a quality-of-care metric in the annual Uniform Data System (UDS) report, and this study examines the first year of breast cancer screening data among 1375 CHCs in the United States. Clinics with available screening data (n = 1070) were categorized based on US region, state expansion of Medicaid to low-income adults under the Affordable Care Act, ranked terciles of race/ethnic composition (non-Hispanic Black, non-Hispanic Asian, and Hispanic/Latino patients), and proportion uninsured. Less than half of women eligible for breast cancer screening, 43.6% (95% CI:42.6%, 44.6%), were up-to-date. CHCs with medium or high proportions of Black (PR: 0.91, 0.86) and uninsured (PR: 0.90, 0.86) patients had between 9%-14% lower breast cancer screening rates than CHCs with low proportions of these populations. CHCs in Medicaid expansion states and in Northeastern states had significantly higher screening rates than non-expansion states and the Midwest, South, and Western states. In conclusion, our findings show that only half of women eligible who received care within CHCs were screened for breast cancer. Disparities in breast cancer screening rates are seen for clinics with high proportions of Black and uninsured patients, along with clinics outside the northeast and clinics in non-Medicaid expansion states. Targeted solutions centered around reducing cost, improving quality, and reducing structural disparities are needed to address low rates of breast cancer screening in low-income women who visited CHCs and already experience healthcare inequities.
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7
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Castaldi M, Smiley A, Kechejian K, Butler J, Latifi R. Disparate access to breast cancer screening and treatment. BMC Womens Health 2022; 22:249. [PMID: 35733197 PMCID: PMC9219222 DOI: 10.1186/s12905-022-01793-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 05/26/2022] [Indexed: 12/03/2022] Open
Abstract
Background Barriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers’ initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.
Methods Women 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.
Results Women from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.
Conclusion Disparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women’s fears.
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Affiliation(s)
- Maria Castaldi
- New York Medical College, Valhalla, NY, 10595, USA. .,Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA. .,Department of Surgery, NYC Health + Hospitals/Jacobi, Bronx, NY, 10461, USA.
| | - Abbas Smiley
- Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA
| | - Katharine Kechejian
- New York Medical College, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA
| | - Jonathan Butler
- Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA
| | - Rifat Latifi
- New York Medical College, Valhalla, NY, 10595, USA.,Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA
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8
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Erdrich J, Cordova-Marks F, Monetathchi AR, Wu M, White A, Melkonian S. Disparities in Breast-Conserving Therapy for Non-Hispanic American Indian/Alaska Native Women Compared with Non-Hispanic White Women. Ann Surg Oncol 2022; 29:1019-1030. [PMID: 34490527 PMCID: PMC8724083 DOI: 10.1245/s10434-021-10730-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Little is known about the surgical patterns of American Indian/Alaska Native (AI/AN) breast cancer patients. The purpose of this study is to determine whether there are disparities in breast cancer surgery and radiation therapy between non-Hispanic AI/AN (NH-AI/AN) women and non-Hispanic White (NHW) women. METHODS Data from the National Program of Cancer Registries of the Centers for Disease Control and Surveillance, Epidemiology, and End Results were used for this cross-sectional study. Female patients with invasive breast cancer diagnosed 2010-2015 were stratified by race/ethnicity, surgical procedure, radiation, and region. Percentage distributions of mastectomy and lumpectomy were compared overall and by region and stage. RESULTS From 2010 to 2015 there were 3292 NH-AI/AN women and 165,225 NHW women diagnosed with breast cancer. For early stage (AJCC stage 1 and 2), NH-AI/AN women had overall significantly higher percentage of mastectomy (41% vs 34.4%, p < 0.001) and significantly lower percentage of lumpectomy (59% vs 65.6%) compared with NHW women, without significant differences in post-lumpectomy radiation (71% vs 70%). There were regional variations, notably in the Northern Plains, where the percentage of mastectomy for early-stage disease was 48.9% for NH-AI/AN women versus 35.9% for NHW women, and in Alaska with 47% for NH-AI/AN women versus 33.3% for NHW women (p < 0.001). There were no overall significant differences in type of surgery or radiation for late-stage disease between groups. CONCLUSION This is the first study to show disparities in surgical management of NH-AI/AN women with breast cancer. For early-stage disease, NH-AI/AN women undergo a higher percentage of mastectomy. Future clinical directions could focus on the factors that drive awareness, decision-making, and access to breast conservation.
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Affiliation(s)
- Jennifer Erdrich
- Division of Surgical Oncology, Department of Surgery, College of Medicine, University of Arizona, Tucson, USA.
| | - Felina Cordova-Marks
- Department of Health Promotion Sciences, College of Public Health, University of Arizona, Tucson, USA
| | | | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Arica White
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, USA
| | - Stephanie Melkonian
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Albuquerque, USA
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Abstract
Neighborhood has significant implications for breast cancer screening, stage, treatment, and mortality. Patients residing in neighborhoods with high deprivation or rurality face barriers and challenges to accessing and receiving care. Consequently, they experience higher mortality rates than their financially affluent or urban counterparts. There are multiple gaps in the literature on the relationship between place of residence and the use of systemic therapies or emerging surgical strategies for disease management. As the management of breast cancer continues to evolve, additional studies are needed to understand the implications of place on the implementation and dissemination of new and emerging treatment modalities.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH 43210, USA.
| | - Barnabas Obeng-Gyasi
- Department of Radiology, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA
| | - Willi Tarver
- Division of Cancer Prevention & Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Room 526, Columbus, OH 43210, USA
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10
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Kim SE, Bachorik AE, Bertrand KA, Gunn CM. Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States. J Womens Health (Larchmt) 2021; 31:848-855. [PMID: 34935471 DOI: 10.1089/jwh.2021.0396] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Socioeconomic and health-related factors, including comorbid illness, may affect mammography screening rates and subsequently contribute to breast cancer outcomes. We explored the association between diabetes and mammography screening, and whether this association varied between racial, ethnic, and geographic groups. Methods: Cross-sectional data from the 2012, 2014, 2016, and 2018 Behavioral Risk Factor Surveillance System were used to fit logistic regression models assessing the association between diabetes and up-to-date mammography screening in 497,600 women, aged 50-74 years. Participants were considered exposed if they responded "yes" to "(Ever told) you have diabetes?" and up to date on screening if they responded "yes" to having a mammogram within the past 2 years. Models were adjusted for age, health status, socioeconomic, and access variables. Results: The majority of participants were White (79.6%), non-Hispanic (88.9%), and up to date on screening (78.8%). Overall, 16.8% reported having diabetes. In fully adjusted models, White women with diabetes were 12% more likely to be up to date on screening (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.06-1.19) than those without diabetes. Black/African American women and those of Hispanic ethnicity with diabetes were more likely to report being up to date with mammography (ORBlack: 1.28, 95% CI: 1.12-1.45; ORHispanic: 1.19, 95% CI: 1.13-1.24) than those without. Patterns were similar across geographic regions. Conclusions: Women of ages 50-74 years with diabetes were more likely to be up to date on screening than women without diabetes. Chronic disease management may represent an opportunity to address cancer screening.
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Affiliation(s)
- Sydney E Kim
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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11
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Miller MM, Meneveau MO, Rochman CM, Schroen AT, Lattimore CM, Gaspard PA, Cubbage RS, Showalter SL. Impact of the COVID-19 pandemic on breast cancer screening volumes and patient screening behaviors. Breast Cancer Res Treat 2021; 189:237-246. [PMID: 34032985 PMCID: PMC8145189 DOI: 10.1007/s10549-021-06252-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/04/2021] [Indexed: 12/14/2022]
Abstract
Purpose In order to facilitate targeted outreach, we sought to identify patient populations with a lower likelihood of returning for breast cancer screening after COVID-19-related imaging center closures. Methods Weekly total screening mammograms performed throughout 2019 (baseline year) and 2020 (COVID-19-impacted year) were compared. Demographic and clinical characteristics, including age, race, ethnicity, breast density, breast cancer history, insurance status, imaging facility type used, and need for interpreter, were compared between patients imaged from March 16 to October 31 in 2019 (baseline cohort) and 2020 (COVID-19-impacted cohort). Census data and an online map service were used to impute socioeconomic variables and calculate travel times for each patient. Logistic regression was used to identify patient characteristics associated with a lower likelihood of returning for screening after COVID-19-related closures. Results The year-over-year cumulative difference in screening mammogram volumes peaked in week 21, with 2962 fewer exams in the COVID-19-impacted year. By week 47, this deficit had reduced by 49.4% to 1498. A lower likelihood of returning for screening after COVID-19-related closures was independently associated with younger age (odds ratio (OR) 0.78, p < 0.001), residence in a higher poverty area (OR 0.991, p = 0.014), lack of health insurance (OR 0.65, p = 0.007), need for an interpreter (OR 0.68, p = 0.029), longer travel time (OR 0.998, p < 0.001), and utilization of mobile mammography services (OR 0.27, p < 0.001). Conclusion Several patient factors are associated with a lower likelihood of returning for screening mammography after COVID-19-related closures. Knowledge of these factors can guide targeted outreach to vulnerable patients to facilitate breast cancer screening. Supplementary Information The online version contains supplementary material available at 10.1007/s10549-021-06252-1.
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Affiliation(s)
- Matthew M Miller
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA.
| | - Max O Meneveau
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Carrie M Rochman
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Anneke T Schroen
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Courtney M Lattimore
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Patricia A Gaspard
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Richard S Cubbage
- Department of Radiology and Medical Imaging, University of Virginia Health System, 1215 Lee St., Charlottesville, VA, 22903, USA
| | - Shayna L Showalter
- Department of Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA
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12
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Disparities in the Use of Emergency Department Advanced Imaging in Medicare Beneficiaries. AJR Am J Roentgenol 2020; 216:519-525. [PMID: 33356434 DOI: 10.2214/ajr.20.23161] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE. The purpose of our study was to assess potential disparities in the utilization of advanced imaging during emergency department (ED) visits. MATERIALS AND METHODS. This retrospective study was conducting using 5% Research Identifiable Files. All CT and MRI (together defined as "advanced imaging") examinations associated with ED visits in 2015 were identified for continuously enrolled Medicare beneficiaries. Individuals with medical claims 30 days before the index ED event were excluded, and encounters that occurred in hospitals without advanced imaging capabilities were also excluded. Patient characteristics were identified using Medicare files and hospital characteristics using the American Hospital Association Annual Survey of Hospitals. Multivariate logistic regression was used for the analysis. RESULTS. Of 86,976 qualifying ED encounters, 52,833 (60.74%) ED encounters were for female patients; 29.03% (n = 25,245) occurred at rural hospitals and 15.81% (n = 13,750) at critical access hospitals. Race distribution was 83.13% White, 11.05% Black, and 5.82% Other. Compared with ED patients at urban hospitals, those at rural and critical access hospitals were 6.9% less likely (odds ratio [OR] = 0.931, p = 0.015) and 18.0% less likely (OR = 0.820, p < 0.0001), respectively, to undergo advanced imaging. Compared with White patients, Black patients were 31.6% less likely (OR = 0.684, p < 0.0001) to undergo advanced imaging. Relative to their urban counterparts, both White (OR = 0.941, p = 0.05) and Black (OR = 0.808, p = 0.047) rural ED patients were less likely to undergo advanced imaging. CONCLUSION. Among Medicare beneficiaries receiving care in U.S. EDs, significant disparities exist in advanced imaging utilization. Although imaging appropriateness was not investigated, these findings suggest inequity. Further research is necessary to understand why consistent health benefits do not translate into consistent imaging access among risk-adjusted ED patients.
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13
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Li L, Ji J, Besculides M, Bickell N, Margolies LR, Jandorf L, Taioli E, Mazumdar M, Liu B. Factors associated with mammography use: A side-by-side comparison of results from two national surveys. Cancer Med 2020; 9:6430-6451. [PMID: 32677744 PMCID: PMC7476827 DOI: 10.1002/cam4.3128] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 04/11/2020] [Accepted: 04/22/2020] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Mammography use is affected by multiple factors that may change as public health interventions are implemented. We examined two nationally representative, population-based surveys to seek consensus and identify inconsistencies in factors associated with mammography use in the entirety of the US population, and by black and white subgroups. METHODS Self-reported mammography use in the past year was extracted for 12 639 and 169 116 women aged 40-74 years from the 2016 National Health Interview Survey (NHIS) and the 2016 Behavioral Risk Factor Surveillance System (BRFSS), respectively. We applied a random forest algorithm to identify the risk factors of mammography use and used a subset of them in multivariable survey logistic regressions to examine their associations with mammography use, reporting predictive margins and effect sizes. RESULTS The weighted prevalence of past year mammography use was comparable across surveys: 54.31% overall, 54.50% in white, and 61.57% in black in NHIS and 53.24% overall, 56.97% in white, and 62.11% in black in BRFSS. Overall, mammography use was positively associated with black race, older age, higher income, and having health insurance, while negatively associated with having three or more children at home and residing in the Western region of the US. Overweight and moderate obesity were significantly associated with increased mammography use among black women (NHIS), while severe obesity was significantly associated with decreased mammography use among white women (BRFSS). CONCLUSION We found higher mammography use among black women than white women, a change in the historical trend. We also identified high parity as a risk factor for mammography use, which suggests a potential subpopulation to target with interventions aimed at increasing mammography use.
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Affiliation(s)
- Lihua Li
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Institute for Healthcare Delivery ScienceMount Sinai Health SystemNew YorkNYUSA
| | - Jiayi Ji
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Institute for Healthcare Delivery ScienceMount Sinai Health SystemNew YorkNYUSA
| | - Melanie Besculides
- Institute for Healthcare Delivery ScienceMount Sinai Health SystemNew YorkNYUSA
| | - Nina Bickell
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Laurie R. Margolies
- Department of Diagnostic, Molecular and Interventional RadiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Lina Jandorf
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Emanuela Taioli
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Madhu Mazumdar
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Institute for Healthcare Delivery ScienceMount Sinai Health SystemNew YorkNYUSA
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
| | - Bian Liu
- Department of Population Health Science and PolicyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Tisch Cancer InstituteIcahn School of Medicine at Mount SinaiNew YorkNYUSA
- Institute for Translational EpidemiologyIcahn School of Medicine at Mount SinaiNew YorkNYUSA
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14
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Miles RC. Closing the Gap: Disparities in Breast Cancer Mortality among African American Women. Radiol Imaging Cancer 2020; 2:e200124. [PMID: 33778738 DOI: 10.1148/rycan.2020200124] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114-2696
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15
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Hughes AE, Lee SC, Eberth JM, Berry E, Pruitt SL. Do mobile units contribute to spatial accessibility to mammography for uninsured women? Prev Med 2020; 138:106156. [PMID: 32473958 PMCID: PMC7388587 DOI: 10.1016/j.ypmed.2020.106156] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2019] [Revised: 03/18/2020] [Accepted: 05/24/2020] [Indexed: 10/24/2022]
Abstract
Limited spatial accessibility to mammography, and socioeconomic barriers (e.g., being uninsured), may contribute to rural disparities in breast cancer screening. Although mobile mammography may contribute to population-level access, few studies have investigated this relationship. We measured mammography access for uninsured women using the variable two-step floating catchment area (V2SFCA) method, which estimates access at the local level using estimated potential supply and demand. Specifically, we measured supply with mammography machine certifications in 2014 from FDA and brick-and-mortar and mobile facility data from the community-based Breast Screening and Patient Navigation (BSPAN) program. We measured potential demand using Census tract-level estimates of female residents aged 45-74 from 5-year 2012-2016 American Community Survey data. Using the sign test, we compared mammography access estimates based on 3 facility groupings: FDA-certified, program brick-and-mortar only, and brick-and-mortar plus mobile. Using all mammography facilities, accessibility was high in urban Dallas-Ft. Worth, low for the ring of adjacent counties, and high for rural counties outlying this ring. Brick-and-mortar-based estimates were lower for the outlying ring, and mobile-unit contribution to access was observed more in urban tracts. Weak mobile-unit contribution across the study area may indicate suboptimal dispatch of mobile units to locations. Geospatial methods could identify the optimal locations for mobile units, given existing brick-and-mortar facilities, to increase access for underserved areas.
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Affiliation(s)
- Amy E Hughes
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Simon C Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
| | - Jan M Eberth
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA.
| | - Emily Berry
- Moncrief Cancer Center, Fort Worth, TX, USA.
| | - Sandi L Pruitt
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, USA; Harold C. Simmons Comprehensive Cancer Center, Dallas, TX, USA.
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16
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Effect of a national population-based breast cancer screening policy on participation in mammography and stage at breast cancer diagnosis in Taiwan. Health Policy 2020; 124:478-485. [DOI: 10.1016/j.healthpol.2020.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 02/12/2020] [Accepted: 02/14/2020] [Indexed: 12/11/2022]
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17
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Chung HL, Parikh JR. Telemammography: Technical Advances Improve Patient Access in Breast Care. JOURNAL OF BREAST IMAGING 2020; 2:152-156. [PMID: 38424884 DOI: 10.1093/jbi/wbz088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Indexed: 03/02/2024]
Abstract
Screening mammography's efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist's interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation's mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today's information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control's Healthy People 2020 goals related to breast cancer.
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Affiliation(s)
- Hannah L Chung
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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18
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Moss JL, Ehrenkranz R, Perez LG, Hair BY, Julian AK. Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults. J Epidemiol Community Health 2019; 73:1128-1135. [PMID: 31615890 DOI: 10.1136/jech-2019-212425] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. METHODS We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. RESULTS Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. CONCLUSION Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.
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Affiliation(s)
- Jennifer L Moss
- National Cancer Institute, Bethesda, Maryland, USA .,Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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19
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Kim E, Moy L, Gao Y, Hartwell CA, Babb JS, Heller SL. City Patterns of Screening Mammography Uptake and Disparity across the United States. Radiology 2019; 293:151-157. [PMID: 31429681 DOI: 10.1148/radiol.2019190647] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Eric Kim
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Linda Moy
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Yiming Gao
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - C. Austen Hartwell
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - James S. Babb
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
| | - Samantha L. Heller
- From the Department of Radiology (E.K., L.M., Y.G., C.A.H., S.L.H.) and Bernard and Irene Schwartz Center for Biomedical Imaging (L.M., J.S.B.), New York University School of Medicine, New York University Langone Health, Laura and Isaac Perlmutter Cancer Center, 160 E 34th St, 3rd Floor, New York, NY 10016
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20
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Saini G, Ogden A, McCullough LE, Torres M, Rida P, Aneja R. Disadvantaged neighborhoods and racial disparity in breast cancer outcomes: the biological link. Cancer Causes Control 2019; 30:677-686. [PMID: 31111277 PMCID: PMC7043809 DOI: 10.1007/s10552-019-01180-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Accepted: 05/09/2019] [Indexed: 02/07/2023]
Abstract
Neighborhoods encompass complex environments comprised of unique economic, physical, and social characteristics that have a profound impact on the residing individual's health and, collectively, on the community's wellbeing. Neighborhood disadvantage (ND) is one of several factors that prominently contributes to racial breast cancer (BC) health disparities in American women. African American (AA) women develop more aggressive breast cancer features, such as triple-negative receptor status and more advanced histologic grade and tumor stage, and suffer worse clinical outcomes than European American (EA) women. While the adverse effects of neighborhood disadvantage on health, including increased risk of cancer and decreased longevity, have recently come into focus, the specific molecular mechanisms by which neighborhood disadvantage increases BC risk and worsens BC outcomes (survivorship, recurrence, mortality) are not fully elucidated. This review illuminates the probable biological links between neighborhood disadvantage and predominantly BC risk, with an emphasis on stress reactivity and inflammation, epigenetics and telomere length in response to adverse neighborhood conditions.
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Affiliation(s)
- Geetanjali Saini
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Angela Ogden
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Lauren E McCullough
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Mylin Torres
- Department of Radiation Oncology, Glenn Family Breast Center, Winship Cancer Institute, Emory University, Atlanta, GA, 30322, USA
| | - Padmashree Rida
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA
| | - Ritu Aneja
- Department of Biology, Georgia State University, Atlanta, GA, 30303, USA.
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21
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Testing the decoy effect to increase interest in colorectal cancer screening. PLoS One 2019; 14:e0213668. [PMID: 30913209 PMCID: PMC6435152 DOI: 10.1371/journal.pone.0213668] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/26/2019] [Indexed: 12/01/2022] Open
Abstract
Literature on consumer choice has demonstrated that the inclusion of an inferior alternative choice (decoy) can increase interest in a target product or action. In two online studies, we tested the impact of decoys on the probability of previous non-intenders to have a screening test which could significantly lower their chances of dying of colorectal cancer. We find that the presence of a decoy increased the probability to choose screening at the target hospital (over no screening) from 39% to 54% and 37% to 59% depending on how many hospital attributes were communicated and how strongly the decoy was dominated by the target. We also show that the presence of the decoy was associated with lower levels of reported decisional complexity while not undermining information seeking and knowledge acquisition. These findings offer a ‘proof of principle’ that decoys have the potential to increase screening uptake without negatively influencing informed choice.
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22
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Lee SC, Higashi RT, Sanders JM, Zhu H, Inrig SJ, Mejias C, Argenbright KE, Tiro JA. Effects of program scale-up on time to resolution for patients with abnormal screening mammography results. Cancer Causes Control 2018; 29:995-1005. [PMID: 30140972 DOI: 10.1007/s10552-018-1074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/17/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Effects of geographic program expansion to rural areas on screening program outcomes are understudied. We sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties. METHODS We calculated proportions undergoing diagnostic follow-up and resolved ≤ 60 days. We calculated median TTR for each time period and abnormal result BI-RADS 0, 4, 5. Cox proportional hazards regressions estimated time period and patient characteristic effects on TTR. Wilcoxon rank sum tests evaluated whether TTR differed between women who did or did not transfer between counties for services. RESULTS TTR ranged from 14 to 17 days for BI-RADs 0, 4, and 5; 12.4% transferred to a different county, resulting in longer median TTR (26 vs. 16 days; p < .001). Of those completing follow-up, 92% were resolved ≤ 60 days (median 15 days). For BI-RAD 3, TTR was 208 days (including required 180 day waiting period). Follow-up was significantly lower for women with BI-RAD 3 (59% vs. 96%; p < .0001). CONCLUSION Expansion maintained timely service delivery, increasing access to screening among rural, uninsured women. Policies adding a separate quality metric for BI-RAD 3 could encourage follow-up monitoring to address lower completion and longer TTR among women with this result.
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Affiliation(s)
- Simon Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA.
| | - Robin T Higashi
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Joanne M Sanders
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Hong Zhu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
| | - Stephen J Inrig
- Mount St. Mary's University, 10 Chester Place, Los Angeles, CA, 90007, USA
| | - Caroline Mejias
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Keith E Argenbright
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
- Moncrief Cancer Institute, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
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23
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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.
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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
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24
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Miles RC, Onega T, Lee CI. Addressing Potential Health Disparities in the Adoption of Advanced Breast Imaging Technologies. Acad Radiol 2018; 25:547-551. [PMID: 29729855 DOI: 10.1016/j.acra.2017.05.021] [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: 04/26/2017] [Accepted: 05/31/2017] [Indexed: 11/16/2022]
Abstract
With the advent of new screening technologies, including digital breast tomosynthesis, screening ultrasound, and breast magnetic resonance imaging, there is growing concern that existing disparities among traditionally underserved populations will worsen. These newer screening modalities purport improved cancer detection over mammography alone but are not offered at all screening facilities and often require a larger co-pay or out-of-pocket expense. Thus, the potential for worsening disparities with regard to access and appropriate utilization of supplemental screening technologies exists. Currently, there is a dearth of literature on the topic of health disparities related to access and the use of supplemental breast cancer screening and their impact on outcomes. Identifying and addressing explanatory factors for persistent and potentially worsening disparities remain a central focus of efforts to improve equity in breast cancer care. Therefore, this paper provides an overview of factors that may contribute to present and future disparities in breast cancer screening and outcomes, and explores specific relevant topics requiring greater research efforts as more personalized, multimodality breast cancer screening approaches are adopted into clinical practice.
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Affiliation(s)
- Randy C Miles
- Department of Radiology, Massachusetts General Hospital, 55 Fruit St, Boston, MA 02114.
| | - Tracy Onega
- Departments of Medicine and Community & Family Medicine, Dartmouth Institute for Health Policy & Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Department of Health Services, University of Washington School of Public Health, Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
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25
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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: 36] [Impact Index Per Article: 6.0] [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.
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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
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Miles R, Wan F, Onega TL, Lenderink-Carpenter A, O'Meara ES, Zhu W, Henderson LM, Haas JS, Hill DA, Tosteson ANA, Wernli KJ, Alford-Teaster J, Lee JM, Lehman CD, Lee CI. Underutilization of Supplemental Magnetic Resonance Imaging Screening Among Patients at High Breast Cancer Risk. J Womens Health (Larchmt) 2018; 27:748-754. [PMID: 29341851 DOI: 10.1089/jwh.2017.6623] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Women at high lifetime breast cancer risk may benefit from supplemental breast magnetic resonance imaging (MRI) screening, in addition to routine mammography screening for earlier cancer detection. MATERIALS AND METHODS We performed a cross-sectional study of 422,406 women undergoing routine mammography screening across 86 Breast Cancer Surveillance Consortium (BCSC) facilities during calendar year 2012. We determined availability and use of on-site screening breast MRI services based on woman-level characteristics, including >20% lifetime absolute risk using the National Cancer Institute risk assessment tool. Multivariate analyses were performed to determine sociodemographic characteristics associated with on-site screening MRI use. RESULTS Overall, 43.9% (2403/5468) of women at high lifetime risk attended a facility with on-site breast MRI screening availability. However, only 6.6% (158/2403) of high-risk women obtained breast MRI screening within a 2-year window of their screening mammogram. Patient factors associated with on-site MRI screening use included younger (<40 years) age (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.34-4.21), family history (OR = 1.72, 95% CI: 1.13-2.63), prior breast biopsy (OR = 2.09, 95% CI: 1.22-3.58), and postsecondary education (OR = 2.22, 95% CI: 1.04-4.74). CONCLUSIONS While nearly half of women at high lifetime breast cancer risk undergo routine screening mammography at a facility with on-site breast MRI availability, supplemental breast MRI remains widely underutilized among those who may benefit from earlier cancer detection. Future studies should evaluate whether other enabling factors such as formal risk assessment and patient awareness of high lifetime breast cancer risk can mitigate the underutilization of supplemental screening breast MRI.
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Affiliation(s)
- Randy Miles
- 1 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Fei Wan
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Tracy L Onega
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | | | - Ellen S O'Meara
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Weiwei Zhu
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Louise M Henderson
- 5 Department of Radiology, University of North Carolina , Chapel Hill, Chapel Hill, North Carolina
| | - Jennifer S Haas
- 6 Department of Medicine, Brigham and Women's Hospital, Harvard Medical School , Boston, Massachusetts
| | - Deirdre A Hill
- 7 Department of Internal Medicine, University of New Mexico , Albuquerque, New Mexico
| | - Anna N A Tosteson
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Karen J Wernli
- 2 Kaiser Permanente Washington Health Research Institute , Seattle, Washington
| | - Jennifer Alford-Teaster
- 3 Dartmouth Institute for Health Policy and Clinical Practice , Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon , New Hampshire
| | - Janie M Lee
- 8 Department of Radiology, University of Washington School of Medicine , Seattle, Washington
| | - Constance D Lehman
- 9 Department of Radiology, Massachusetts General Hospital, Harvard Medical School , Boston, Massachusetts
| | - Christoph I Lee
- 10 Department of Radiology, University of Washington School of Medicine ; Department of Health Services, University of Washington School of Public Health ; Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
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Vijayasiri G, Molina Y, Chukwudozie IB, Tejeda S, Pauls HA, Rauscher GH, Campbell RT, Warnecke RB. Racial Disparities in Breast Cancer Survival: The Mediating Effects of Macro-Social Context and Social Network Factors. JOURNAL OF HEALTH DISPARITIES RESEARCH AND PRACTICE 2018; 11:6. [PMID: 34026339 PMCID: PMC8136761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This study attempts to clarify the associations between macro-social and social network factors and the continuing racial disparities in breast cancer survival. The study improves on prior methodologies by using a neighborhood disadvantage measure that assesses both economic and social disadvantage and an ego-network measurement tool that assesses key social network characteristics. Our population-based sample included 786 breast cancer patients (nHWhite=388; nHBlack=398) diagnosed during 2005-2008 in Chicago, IL. The data included census-derived macro-social context, self-reported social network, self-reported demographic and medically abstracted health measures. Mortality data from the National Death Index (NDI) were used to determine 5-year survival. Based on our findings, neighborhood concentrated disadvantage was negatively associated with survival among nHBlack and nHWhite breast cancer patients. In unadjusted models, social network size, network density, practical support, and financial support were positively associated with 5-year survival. However, in adjusted models only practical support was associated with 5-year survival. Our findings suggested that the association between network size and breast cancer survival is sensitive to scaling of the network measure, which helps to explain inconsistencies in past findings. Social networks of nHWhites and nHBlacks differed in size, social support dimensions, network density, and geographic proximity. Among social factors, residence in disadvantaged neighborhoods and unmet practical support explained some of the racial disparity in survival. Differences in late stage diagnosis and comorbidities between nHWhites and nHBlacks also explained some of the racial disparity in survival. Our findings highlight the relevance of social factors, both macro and inter-personal in the racial disparity in breast cancer survival. Findings suggest that reduced survival of nHBlack women is in part due to low social network resources and residence in socially and economically deprived neighborhoods. To improve survival among breast cancer patients social policies need to continue improving health care access as well as racially patterned social and economic disadvantage.
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Affiliation(s)
- Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Yamile Molina
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Ifeanyi Beverly Chukwudozie
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Silvia Tejeda
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Heather A. Pauls
- College of Nursing, University of Illinois at Chicago, 845 S. Damen Ave, Chicago, IL 60612
| | - Garth H Rauscher
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
| | - Richard T. Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
| | - Richard B. Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago, 1747 West Roosevelt Rd, Chicago, IL, 60608
- School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612
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28
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Charkhchi P, Kolenic GE, Carlos RC. Access to Lung Cancer Screening Services: Preliminary Analysis of Geographic Service Distribution Using the ACR Lung Cancer Screening Registry. J Am Coll Radiol 2017; 14:1388-1395. [PMID: 29101972 PMCID: PMC5893937 DOI: 10.1016/j.jacr.2017.06.024] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 06/27/2017] [Accepted: 06/29/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE Lung cancer has the highest mortality rate among all types of cancer in the United States. The National Lung Screening Trial demonstrated that low-dose CT for lung cancer screening decreases both lung cancer-related mortality and all-cause mortality. Currently, the only CMS-approved lung cancer screening registry is the Lung Cancer Screening Registry (LCSR) administered by the ACR. The aims of this study were to assess access to lung cancer screening services as estimated by the number and distribution of screening facilities participating in the LCSR, by state, and to evaluate state-level covariates that correlate with access. METHODS The ACR LCSR list of participating lung cancer screening facilities was used as a proxy for the availability of lung cancer screening facilities in each state. Additionally, we normalized the number of facilities by state by the number of screening-eligible individuals using Behavioral Risk Factor Surveillance System data. State-level demographics were obtained from the 2015 Behavioral Risk Factor Surveillance System: poverty level, insured population, unemployed, black, and Latino. State-specific lung cancer incidence and death rates, number of active physicians per 100,000, and Medicare expenditure per capita were obtained. Linear regression models were performed to examine the influence of these state-level covariates on state-level screening facility number. QGIS, an open-source geographic information system, was used to map the distribution of lung cancer screening facilities and to estimate the nearest neighbor index, a measure of facility clustering within each state. RESULTS As of November 18, 2016, 2,423 facilities participated in the LCSR. When adjusted by the rate of screening-eligible individuals per 100,000, the median population-normalized facility number was 15.7 (interquartile range, 10.7-19.3). There was a positive independent effect (coefficient = 12.87; 95% confidence interval, 10.93-14.8) between state-level number of screening facilities and rate of screening-eligible individuals per 100,000. There were no significant correlations between number of facilities and lung cancer outcomes, state demographic characteristics, or physician supply and Medicare expenditure. In most states, facilities are clustered rather than dispersed, with a median nearest neighbor index of 0.65 (interquartile range, 0.51-0.81). CONCLUSIONS Facility number correlated with the rate of screening-eligible individuals per 100,000, a measure of the at-risk population. Alignment of screening facility number and distribution with other clinically relevant epidemiologic factors remains a public health opportunity.
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Affiliation(s)
- Paniz Charkhchi
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Giselle E Kolenic
- Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan
| | - Ruth C Carlos
- Department of Radiology, University of Michigan, Ann Arbor, Michigan; Program for Women's Health Effectiveness Research, University of Michigan, Ann Arbor, Michigan; Institute for Health Policy and Innovation, University of Michigan, Ann Arbor, Michigan.
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Rosenkrantz AB, Liang Y, Duszak R, Recht MP. Travel Times for Screening Mammography: Impact of Geographic Expansion by a Large Academic Health System. Acad Radiol 2017; 24:1125-1131. [PMID: 28483308 DOI: 10.1016/j.acra.2017.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 03/12/2017] [Indexed: 10/19/2022]
Abstract
RATIONALE AND OBJECTIVES This study aims to assess the impact of off-campus facility expansion by a large academic health system on patient travel times for screening mammography. MATERIALS AND METHODS Screening mammograms performed from 2013 to 2015 and associated patient demographics were identified using the NYU Langone Medical Center Enterprise Data Warehouse. During this time, the system's number of mammography facilities increased from 6 to 19, reflecting expansion beyond Manhattan throughout the New York metropolitan region. Geocoding software was used to estimate driving times from patients' homes to imaging facilities. RESULTS For 147,566 screening mammograms, the mean estimated patient travel time was 19.9 ± 15.2 minutes. With facility expansion, travel times declined significantly (P < 0.001) from 26.8 ± 18.9 to 18.5 ± 13.3 minutes (non-Manhattan residents: from 31.4 ± 20.3 to 18.7 ± 13.6). This decline occurred consistently across subgroups of patient age, race, ethnicity, payer status, and rurality, leading to decreased variation in travel times between such subgroups. However, travel times to pre-expansion facilities remained stable (initial: 26.8 ± 18.9 minutes, final: 26.7 ± 18.6 minutes). Among women undergoing mammography before and after expansion, travel times were shorter for the postexpansion mammogram in only 6.3%, but this rate varied significantly (all P < 0.05) by certain demographic factors (higher in younger and non-Hispanic patients) and was as high as 18.2%-18.9% of patients residing in regions with the most active expansion. CONCLUSIONS Health system mammography facility geographic expansion can improve average patient travel burden and reduce travel time variation among sociodemographic populations. Nonetheless, existing patients strongly tend to return to established facilities despite potentially shorter travel time locations, suggesting strong site loyalty. Variation in travel times likely relates to various factors other than facility proximity.
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30
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Badal K, Rampersad F, Warner WA, Toriola AT, Mohammed H, Scheffel HA, Ali R, Moosoodeen M, Konduru S, Russel A, Haraksingh R. A situational analysis of breast cancer early detection services in Trinidad and Tobago. Cancer Causes Control 2017; 29:33-42. [DOI: 10.1007/s10552-017-0937-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 08/01/2017] [Indexed: 02/07/2023]
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Variation in Patients' Travel Times among Imaging Examination Types at a Large Academic Health System. Acad Radiol 2017; 24:1008-1012. [PMID: 28356203 DOI: 10.1016/j.acra.2017.02.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Patients' willingness to travel farther distances for certain imaging services may reflect their perceptions of the degree of differentiation of such services. We compare patients' travel times for a range of imaging examinations performed across a large academic health system. MATERIALS AND METHODS We searched the NYU Langone Medical Center Enterprise Data Warehouse to identify 442,990 adult outpatient imaging examinations performed over a recent 3.5-year period. Geocoding software was used to estimate typical driving times from patients' residences to imaging facilities. Variation in travel times was assessed among examination types. RESULTS The mean expected travel time was 29.2 ± 20.6 minutes, but this varied significantly (p < 0.001) among examination types. By modality, travel times were shortest for ultrasound (26.8 ± 18.9) and longest for positron emission tomography-computed tomography (31.9 ± 21.5). For magnetic resonance imaging, travel times were shortest for musculoskeletal extremity (26.4 ± 19.2) and spine (28.6 ± 21.0) examinations and longest for prostate (35.9 ± 25.6) and breast (32.4 ± 22.3) examinations. For computed tomography, travel times were shortest for a range of screening examinations [colonography (25.5 ± 20.8), coronary artery calcium scoring (26.1 ± 19.2), and lung cancer screening (26.4 ± 14.9)] and longest for angiography (32.0 ± 22.6). For ultrasound, travel times were shortest for aortic aneurysm screening (22.3 ± 18.4) and longest for breast (30.1 ± 19.2) examinations. Overall, men (29.9 ± 21.6) had longer (p < 0.001) travel times than women (27.8 ± 20.3); this difference persisted for each modality individually (p ≤ 0.006). CONCLUSIONS Patients' willingness to travel longer times for certain imaging examination types (particularly breast and prostate imaging) supports the role of specialized services in combating potential commoditization of imaging services. Disparities in travel times by gender warrant further investigation.
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32
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Harada K, Lee S, Shimada H, Lee S, Bae S, Anan Y, Harada K, Suzuki T. Distance to screening site and older adults' participation in cognitive impairment screening. Geriatr Gerontol Int 2017; 18:146-153. [PMID: 28762614 DOI: 10.1111/ggi.13133] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 05/14/2017] [Accepted: 06/13/2017] [Indexed: 12/25/2022]
Abstract
AIM To develop intervention strategies that promote screening for cognitive impairment, it is essential to identify the modifiable predictors for participation in screening. The present study aimed to examine whether a shorter distance to the screening site predicted participation in screening for cognitive impairment, and whether interactive effects of the distance and psychological factors on the participation would be observed among community-dwelling older adults. METHODS The study used a prospective design. After a baseline questionnaire survey, participation in screening for cognitive impairment was followed for 6 months (n = 9616). The distance to the screening site was measured by road distance from each residential address and categorized into four groups (<1 km, 1-1.99 km, 2-2.99 km, ≥3 km). The questionnaire measured psychological factors (behavioral intention and perceived benefits of screening), driving status and demographic factors. RESULTS A logistic regression analysis showed that compared with the <1 km group, the 2-2.99 km (adjusted odds ratio 0.62, P = 0.040) and ≥3 km (adjusted odds ratio 0.54, P = 0.015) groups did not participate in screening after adjusting for psychological and demographic factors, and driving status. The interaction of the distances and psychological factors on participation were not significant. CONCLUSIONS The distance to the screening site predicted participation in cognitive impairment screening among older adults regardless of their psychological status. This finding shows that improving access to screening sites would be effective for promoting screening for cognitive impairments among both low and highly motivated older adults. Geriatr Gerontol Int 2018; 18: 146-153.
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Affiliation(s)
- Kazuhiro Harada
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo, Japan.,Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Sangyoon Lee
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Hiroyuki Shimada
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Sungchul Lee
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Seongryu Bae
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan
| | - Yuya Anan
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Faculty of Wellness Studies, Kwassui Women's University, Nagasaki, Nagasaki, Japan
| | - Kenji Harada
- Department of Preventive Gerontology, National Center for Geriatrics and Gerontology, Obu, Aichi, Japan.,Graduate School of Health and Sport Sciences, Chukyo University, Toyota, Aichi, Japan
| | - Takao Suzuki
- Institute for Gerontology, J. F. Oberlin University, Machida, Tokyo, Japan
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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.
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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
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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.
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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
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Hong JL, Henderson LM, Jonsson Funk M, Lund JL, Buse JB, Pate V, Stürmer T. Differential Use of Screening Mammography in Older Women Initiating Metformin versus Sulfonylurea. Pharmacoepidemiol Drug Saf 2017; 26:666-675. [PMID: 28370798 DOI: 10.1002/pds.4195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2016] [Revised: 02/13/2017] [Accepted: 02/17/2017] [Indexed: 12/14/2022]
Abstract
PURPOSE Differential use of screening mammography may lead to biased detection of breast cancer. This study aimed to compare receipt of screening mammography and the incidence of screen-detected breast cancer between metformin and sulfonylurea initiators. METHODS We used 2006-2014 US Medicare claims to identify initiators of metformin or sulfonylurea aged 65+ years continuously enrolled in Parts A/B for ≥2 years pre-initiation and ≥2 years post-initiation. We reported frequencies of screening mammograms and screen-detected breast cancer in 1 year pre-initiation among all cohort members and in 1 year post-initiation among cancer-free cohort members. Weighted screening risk differences (RDs) were estimated comparing metformin to sulfonylurea group. RESULTS We identified 41,436 and 13,367 initiators of metformin and sulfonylurea, 35% and 24% of which had ≥1 screening mammogram in 1 year pre-initiation (weighted RD: 6 percentage points; 95% CI: 5 to 7), respectively. The weighted RD for screen-detected breast cancer associated with metformin was 0.00 percentage points (95% CI: -0.09 to 0.09). Among cancer-free cohort members, metformin initiators had 5 percentage points (95% CI: 4 to 6) and 0.11 percentage points (95% CI: -0.02 to 0.23) absolute risk excess of screening mammography and screen-detected breast cancer in 1 year post-initiation, compared with sulfonylurea initiators, respectively. CONCLUSIONS Metformin initiators were more likely to receive screening mammograms than sulfonylurea initiators pre- and post-initiation, indicating possible detection bias due to differential screening mammography. Researchers should be aware of the potential for more screening mammograms pre- and post-initiation when interpreting the findings of metformin on breast cancer incidence. Copyright © 2017 John Wiley & Sons, Ltd.
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Affiliation(s)
- Jin-Liern Hong
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Louise M Henderson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,Department of Radiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Michele Jonsson Funk
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer L Lund
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - John B Buse
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Virginia Pate
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Til Stürmer
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Racial Disparities in Screening Mammography in the United States: A Systematic Review and Meta-analysis. J Am Coll Radiol 2016; 14:157-165.e9. [PMID: 27993485 DOI: 10.1016/j.jacr.2016.07.034] [Citation(s) in RCA: 122] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/27/2016] [Accepted: 07/29/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE Many studies have suggested that disparities exist in the use of medical screening tests. The purpose of this study was to assess racial disparities in screening mammography in the United States via a systematic review and meta-analysis. METHODS We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus for comparative studies published between 1946 and 2015 comparing utilization of mammography among various racial groups. Two independent reviewers extracted data and appraised study. Meta-analysis was conducted when appropriate using the random-effects model. RESULTS A total of 5,818,380 patients were included across 39 relevant studies; 43.1% of patients were white, 33.3% were black, 17.4% were Hispanic, and 6.2% were Asian/Pacific Islander. Black and Hispanic populations had lower odds of utilizing screening mammography when compared with the white population (odds ratio [OR] = 0.81; 95% confidence interval [CI], 0.72-0.91; I2 = 89.4% and OR = 0.83; 95% CI, 0.74-0.93, respectively). For African Americans, these disparities were present in both the 40 to 65 age group and the >65 age group; for Hispanics, these differences were present only in the 40 to 65 age group. There was no difference in mammography utilization between Asians/Pacific Islanders and whites (OR = 1.82; 95% CI, 0.09-38.41). CONCLUSIONS Racial disparities in utilization of screening mammography are evident in black and Hispanic populations in the United States. Further studies are needed to understand reasons for disparities, trends over time, and the effectiveness of interventions targeting these disparities.
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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.
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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
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Caplin DA, Smith KR, Ness KK, Hanson HA, Smith SM, Nathan PC, Hudson MM, Leisenring WM, Robison LL, Oeffinger KC. Effect of Population Socioeconomic and Health System Factors on Medical Care of Childhood Cancer Survivors: A Report from the Childhood Cancer Survivor Study. J Adolesc Young Adult Oncol 2016; 6:74-82. [PMID: 27754726 DOI: 10.1089/jayao.2016.0016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
PURPOSE To determine the independent contribution of population socioeconomic and health system factors on childhood cancer survivors' medical care and screening. METHODS 7899 childhood cancer survivors in the United States and Canada enrolled in the Childhood Cancer Survivor Study (CCSS). Population-level factors were derived from U.S. Area Health Resource File or 201 Canadian Census. Health service utilization and individual-level factors were self-reported. Multivariable logistic regression was used to calculate the effect of population factors on medical care (any care vs. no care; risk-based care vs. general care) and indicated echocardiogram or mammogram, adjusting for individual sociodemographic and health status. RESULTS After adjusting for individual factors, population factors had a nominal impact on childhood cancer survivors' medical care and screening. Higher population median income was associated with risk-based survivor-focused care versus general care (odds ratio [OR] 1.05, 95% confidence interval [CI], 1.01-1.09) among all participants, but not among U.S. residents only (OR 1.03, 95% CI, 0.99-1.07). For U.S. residents, the number of CCSS centers within the geographic area was associated with greater odds of receiving risk-based survivor-focused medical care (OR 1.12, 95% CI, 1.04-1.20). Areas with higher median income had higher rates of echocardiogram screening among survivors at risk of cardiomyopathy (for every $10,000 increase in median income, there is a 12% increase in odds of echocardiogram screening; 95% CI 1.05-1.20). A positive relationship was identified between greater number of physicians and surgeons in the county of residence and recommended echocardiogram (for every additional 1000 physicians and surgeons: OR 1.12, 95% CI, 1.01-1.23). We found no association between population-level factors and mammography screening. CONCLUSIONS Population socioeconomic disparities moderately affect childhood cancer survivors' risk-based medical care and screening after accounting for individual sociodemographic and health factors.
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Affiliation(s)
| | - Ken R Smith
- 1 University of Utah School of Medicine , Salt Lake City, Utah
| | - Kirsten K Ness
- 2 St. Jude Children's Research Hospital , Memphis, Tennessee
| | - Heidi A Hanson
- 1 University of Utah School of Medicine , Salt Lake City, Utah
| | - Stephanie M Smith
- 3 Department of Medicine, Hospital of the University of Pennsylvania , Philadelphia, Pennsylvania
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Xavier DR, Oliveira RADD, Matos VPD, Viacava F, Carvalho CDC. Cobertura de mamografias, alocação e uso de equipamentos nas Regiões de Saúde. SAÚDE EM DEBATE 2016. [DOI: 10.1590/0103-1104201611002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
RESUMO O rastreamento por intermédio da mamografia é o principal meio de detecção da neoplasia maligna da mama. Considera-se relevante compreender como este tem se dado nas Regiões de Saúde brasileiras, unidade espacial fundamental na atual política de saúde. A análise de indicadores relacionados à cobertura de mamografia das mulheres de 40 a 69 anos, número, distribuição e grau de utilização dos mamógrafos demonstra grandes problemas, que não podem ser simplesmente atribuídos à falta de equipamentos. Destaca-se também a diversidade de situações das Regiões de Saúde e das unidades da federação, caracterizada especialmente pelas melhores condições no Sul e Sudeste e piores nas outras regiões.
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Onega T, Lee CI, Benkeser D, Alford-Teaster J, Haas JS, Tosteson ANA, Hill D, Shi X, Henderson LM, Hubbard RA. Travel Burden to Breast MRI and Utilization: Are Risk and Sociodemographics Related? J Am Coll Radiol 2016; 13:611-9. [PMID: 27026577 DOI: 10.1016/j.jacr.2016.01.022] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/27/2016] [Accepted: 01/28/2016] [Indexed: 11/26/2022]
Abstract
PURPOSE Mammography, unlike MRI, is relatively geographically accessible. Additional travel time is often required to access breast MRI. However, the amount of additional travel time and whether it varies on the basis of sociodemographic or breast cancer risk factors is unknown. METHODS The investigators examined screening mammography and MRI between 2005 and 2012 in the Breast Cancer Surveillance Consortium by (1) travel time to the closest and actual mammography facility used and the difference between the two, (2) women's breast cancer risk factors, and (3) sociodemographic characteristics. Logistic regression was used to examine the odds of traveling farther than the closest facility in relation to women's characteristics. RESULTS Among 821,683 screening mammographic examinations, 76.6% occurred at the closest facility, compared with 51.9% of screening MRI studies (n = 3,687). The median differential travel time among women not using the closest facility for mammography was 14 min (interquartile range, 8-25 min) versus 20 min (interquartile range, 11-40 min) for breast MRI. Differential travel time for both imaging modalities did not vary notably by breast cancer risk factors but was significantly longer for nonurban residents. For non-Hispanic black compared with non-Hispanic white women, the adjusted odds of traveling farther than the closest facility were 9% lower for mammography (odds ratio, 0.91; 95% confidence interval, 0.87-0.95) but more than two times higher for MRI (odds ratio, 2.64; 95% confidence interval, 1.36-5.13). CONCLUSIONS Breast cancer risk factors were not related to excess travel time for screening MRI, but sociodemographic factors were, suggesting the possibility that geographic distribution of advanced imaging may exacerbated disparities for some vulnerable populations.
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Affiliation(s)
- Tracy Onega
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Services, University of Washington School of Public Health, Seattle, Washington; Fred Hutchinson Institute for Cancer Outcomes Research, Seattle, Washington
| | - David Benkeser
- Group Health Research Institute, Seattle, Washington; Department of Biostatistics, University of Washington School of Public Health, Seattle, Washington
| | - Jennifer Alford-Teaster
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire; The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
| | - Deirdre Hill
- Department of Internal Medicine, University of New Mexico, Albuquerque, New Mexico
| | - Xun Shi
- The Geography Department, Dartmouth College, Hanover, New Hampshire
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, North Carolina
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Alford-Teaster J, Lange JM, Hubbard RA, Lee CI, Haas JS, Shi X, Carlos HA, Henderson L, Hill D, Tosteson ANA, Onega T. Is the closest facility the one actually used? An assessment of travel time estimation based on mammography facilities. Int J Health Geogr 2016; 15:8. [PMID: 26892310 PMCID: PMC4757990 DOI: 10.1186/s12942-016-0039-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 02/08/2016] [Indexed: 11/25/2022] Open
Abstract
Background Characterizing geographic access depends on a broad range of methods available to researchers and the healthcare context to which the method is applied. Globally, travel time is one frequently used measure of geographic access with known limitations associated with data availability. Specifically, due to lack of available utilization data, many travel time studies assume that patients use the closest facility. To examine this assumption, an example using mammography screening data, which is considered a geographically abundant health care service in the United States, is explored. This work makes an important methodological contribution to measuring access—which is a critical component of health care planning and equity almost everywhere.
Method We analyzed one mammogram from each of 646,553 women participating in the US based Breast Cancer Surveillance Consortium for years 2005–2012. We geocoded each record to street level address data in order to calculate travel time to the closest and to the actually used mammography facility. Travel time between the closest and the actual facility used was explored by woman-level and facility characteristics. Results Only 35 % of women in the study population used their closest facility, but nearly three-quarters of women not using their closest facility used a facility within 5 min of the closest facility. Individuals that by-passed the closest facility tended to live in an urban core, within higher income neighborhoods, or in areas where the average travel times to work was longer. Those living in small towns or isolated rural areas had longer closer and actual median drive times. Conclusion Since the majority of US women accessed a facility within a few minutes of their closest facility this suggests that distance to the closest facility may serve as an adequate proxy for utilization studies of geographically abundant services like mammography in areas where the transportation networks are well established.
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Affiliation(s)
- Jennifer Alford-Teaster
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Jane M Lange
- Group Health Research Institute, Seattle, WA, USA.
| | - Rebecca A Hubbard
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, 19104, USA.
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA. .,Department of Health Services, University of Washington School of Public Health, Seattle, WA, USA.
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, MA, USA.
| | - Xun Shi
- The Geography Department, Dartmouth College, Hanover, NH, USA.
| | - Heather A Carlos
- Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Louise Henderson
- Department of Radiology, The University of North Carolina, Chapel Hill, NC, USA.
| | | | - Anna N A Tosteson
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
| | - Tracy Onega
- Department of Biomedical Science, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Department of Epidemiology, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA. .,The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, NH, USA.
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Non-attendance of mammographic screening: the roles of age and municipality in a population-based Swedish sample. Int J Equity Health 2015; 14:157. [PMID: 26715453 PMCID: PMC4696103 DOI: 10.1186/s12939-015-0291-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2015] [Accepted: 12/18/2015] [Indexed: 11/13/2022] Open
Abstract
Background Inequality in health and health care is increasing in Sweden. Contributing to widening gaps are various factors that can be assessed by determinants, such as age, educational level, occupation, living area and country of birth. A health care service that can be used as an indicator of health inequality in Sweden is mammographic screening. The non-attendance rate is between 13 and 31 %, while the average is about 20 %. This study aims to shed light on three associations: between municipality and non-attendance, between age and non-attendance, and the interaction of municipality of residence and age in relation to non-attendance. Methods The study is based on data from the register that identifies attenders and non-attenders of mammographic screening in a Swedish county, namely the Radiological Information System (RIS). Further, in order to provide a socio-demographic profile of the county’s municipalities, aggregated data for women in the age range 40–74 in 2012 were retrieved from Statistics Sweden (SCB), the Public Health Agency of Sweden, the National Board of Health and Welfare, and the Swedish Social Insurance Agency. The sample consisted of 52,541 women. Analysis conducted of the individual data were multivariate logistic regressions, and pairwise chi-square tests. Results The results show that age and municipality of residence associated with non-attendance of mammographic screening. Municipality of residence has a greater impact on non-attendance among women in the age group 70 to 74. For most of the age categories there were differences between the municipalities in regard to non-attendance to mammographic screening. Conclusions Age and municipality of residence affect attendance of mammographic screening. Since there is one sole and pre-selected mammographic screening facility in the county, distance to the screening facility may serve as one explanation to non-attendance which is a determinant of inequity. From an equity perspective, lack of equal access to health and health care influences facility utilization.
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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
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Tatalovich Z, Zhu L, Rolin A, Lewis DR, Harlan LC, Winn DM. Geographic disparities in late stage breast cancer incidence: results from eight states in the United States. Int J Health Geogr 2015; 14:31. [PMID: 26497363 PMCID: PMC4619382 DOI: 10.1186/s12942-015-0025-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 10/12/2015] [Indexed: 12/20/2022] Open
Abstract
Background Late stage of cancer at diagnosis is an important predictor of cancer mortality. In many areas worldwide, cancer registry systems, available data and mapping technologies can provide information about late stage cancer by geographical regions, offering valuable opportunities to identify areas where further investigation and interventions are needed. The current study examined geographical variation in late stage breast cancer incidence across eight states in the United States with the objective to identify areas that might benefit from targeted interventions. Methods Data from the Surveillance Epidemiology and End Results Program on late stage breast cancer incidence was used as dependent variable in regression analysis and certain factors known to contribute to high rates of late stage cancer (socioeconomic characteristics, health insurance characteristics, and the availability and utilization of cancer screening) as covariates. Geographic information systems were used to map and highlight areas that have any combination of high late stage breast cancer incidence and significantly associated risk factors. Results The differences in mean rates of late stage breast cancer between eight states considered in this analysis are statistically significant. Factors that have statistically negative association with late stage breast cancer incidence across the eight states include: density of mammography facilities, percent population with Bachelor’s degree and English literacy while percent black population has statistically significant positive association with late stage breast cancer incidence. Conclusions This study describes geographic disparities in late stage breast cancer incidence and identifies areas that might benefit from targeted interventions. The results suggest that in the eight US states examined, higher rates of late stage breast cancer are more common in areas with predominantly black population, where English literacy, percentage of population with college degree and screening availability are low. The approach described in this work may be utilized both within and outside US, wherever cancer registry systems and technologies offer the same opportunity to identify places where further investigation and interventions for reducing cancer burden are needed.
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Affiliation(s)
- Zaria Tatalovich
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA. .,Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9609 Medical Center Dr. Suite 4E 446, Rockville, MD, 20850, USA.
| | - Li Zhu
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Alicia Rolin
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Denise R Lewis
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Linda C Harlan
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
| | - Deborah M Winn
- Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD, 20892, USA.
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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.
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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
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Lee CI, Bogart A, Hubbard RA, Obadina ET, Hill DA, Haas JS, Tosteson ANA, Alford-Teaster JA, Sprague BL, DeMartini WB, Lehman CD, Onega TL. Advanced Breast Imaging Availability by Screening Facility Characteristics. Acad Radiol 2015; 22:846-52. [PMID: 25851643 PMCID: PMC4465038 DOI: 10.1016/j.acra.2015.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2014] [Revised: 02/12/2015] [Accepted: 02/13/2015] [Indexed: 01/07/2023]
Abstract
RATIONALE AND OBJECTIVES To determine the relationship between screening mammography facility characteristics and on-site availability of advanced breast imaging services required for supplemental screening and the diagnostic evaluation of abnormal screening findings. MATERIALS AND METHODS We analyzed data from all active imaging facilities across six regional registries of the National Cancer Institute-funded Breast Cancer Surveillance Consortium offering screening mammography in calendar years 2011-2012 (n = 105). We used generalized estimating equations regression models to identify associations between facility characteristics (eg, academic affiliation, practice type) and availability of on-site advanced breast imaging (eg, ultrasound [US], magnetic resonance imaging [MRI]) and image-guided biopsy services. RESULTS Breast MRI was not available at any nonradiology or breast imaging-only facilities. A combination of breast US, breast MRI, and imaging-guided breast biopsy services was available at 76.0% of multispecialty breast centers compared to 22.2% of full diagnostic radiology practices (P = .0047) and 75.0% of facilities with academic affiliations compared to 29.0% of those without academic affiliations (P = .04). Both supplemental screening breast US and screening breast MRI were available at 28.0% of multispecialty breast centers compared to 4.7% of full diagnostic radiology practices (P < .01) and 25.0% of academic facilities compared to 8.5% of nonacademic facilities (P = .02). CONCLUSIONS Screening facility characteristics are strongly associated with the availability of on-site advanced breast imaging and image-guided biopsy service. Therefore, the type of imaging facility a woman attends for screening may have important implications on her timely access to supplemental screening and diagnostic breast imaging services.
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Affiliation(s)
- Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109; Department of Health Services, University of Washington School of Public Health, Seattle, Washington.
| | - Andy Bogart
- Group Health Research Institute, Seattle, Washington
| | | | - Eniola T Obadina
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Deirdre A Hill
- Department of Internal Medicine, Cancer Research and Treatment Center, University of New Mexico, Albuquerque, New Mexico
| | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts; Department of Medicine, Harvard Medical School, Dana Farber Harvard Cancer Institute, Boston, Massachusetts; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, Massachusetts
| | - Anna N A Tosteson
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Jennifer A Alford-Teaster
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
| | - Brian L Sprague
- Department of Surgery and Office of Health Promotion Research, University of Vermont, Burlington, Vermont
| | - Wendy B DeMartini
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Constance D Lehman
- Department of Radiology, University of Washington School of Medicine, 825 Eastlake Ave East, Seattle, WA 98109
| | - Tracy L Onega
- Department of Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire; Department of Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Norris Cotton Cancer Center, Geisel School of Medicine, Lebanon, New Hampshire
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Kaplan HG, Malmgren JA, Atwood MK, Calip GS. Effect of treatment and mammography detection on breast cancer survival over time: 1990-2007. Cancer 2015; 121:2553-61. [PMID: 25872471 DOI: 10.1002/cncr.29371] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 01/14/2015] [Accepted: 03/04/2015] [Indexed: 11/09/2022]
Abstract
BACKGROUND The extent to which improvements over time in breast cancer survival are related to earlier detection by mammography or to more effective treatments is not known. METHODS At a comprehensive cancer care center, the authors conducted a retrospective cohort study of women ages 50 to 69 years who were diagnosed with invasive breast cancer (stages I through III) and were followed over 3 periods (1990-1994, 1995-1999, and 2000-2007). Data were abstracted from patient charts and included detection method, diagnosis, treatment, and follow-up for vital status in the institutional breast cancer registry (n = 2998). The method of detection was categorized as patient or physician detected or mammography detected. Cox proportional hazards models were used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (CIs) for 5-year disease-specific survival in relation to detection method and treatment factors, and differences in survival were analyzed using the Kaplan-Meier method. RESULTS Fifty-eight percent of breast cancers were mammography detected, and 42% were patient or physician detected; 56% of tumors were stage I, 31% were stage II, and 13% were stage III. The average length of follow-up was 10.71 years. The combined 5-year disease-specific survival rate was 89% from 1990 to 1994, 94% from 1995 to 1999, and 96% from 2000 to 2007 (P < .001). In an adjusted model, mammography detection (HR, 0.43; 95% CI, 0.27-0.70), hormone therapy (HR, 0.47; 95% CI, 0.30-0.75), and taxane-containing chemotherapy (HR, 0.61; 95% CI, 0.37-0.99) were significantly associated with a decreased risk of disease-specific mortality. CONCLUSIONS Better breast cancer survival over time was related to mammography detection, hormone therapy, and taxane-containing chemotherapy. Treatment improvements alone are not sufficient to explain the observed survival improvements over time.
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Affiliation(s)
- Henry G Kaplan
- Department of Oncology, Swedish Cancer Institute, Seattle, Washington
| | - Judith A Malmgren
- HealthStat Consulting, Seattle, Washington.,Department of Epidemiology, University of Washington School of Public Health, Seattle, Washington
| | - Mary K Atwood
- Department of Oncology, Swedish Cancer Institute, Seattle, Washington
| | - Gregory S Calip
- Center for Pharmacoepidemiology and Pharmacoeconomic Research, University of Illinois at Chicago, Chicago, Illinois
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Disparities in receipt of breast and cervical cancer screening for rural women age 18 to 64 with disabilities. Womens Health Issues 2015; 25:246-53. [PMID: 25864023 DOI: 10.1016/j.whi.2015.02.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 01/26/2015] [Accepted: 02/09/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND Previous research has found breast and cervical cancer screening disparities between women with and without disabilities, and between women living in rural versus urban areas. Living in a rural area may add to the barriers women with disabilities experience when attempting to obtain screening for breast and cervical cancer. The purpose of this study was to examine the combination of disability status and rurality in association with receipt of breast and cervical cancer screening among women age 18 to 64 in the United States. METHODS We conducted cross-sectional analyses of data from the Medical Expenditure Panel Survey, using pooled annual data files from 2002 through 2008. We compared recent receipt of breast and cervical cancer screening among four groups: 1) urban women without disabilities, 2) urban women with disabilities, 3) rural women without disabilities, and 4) rural women with disabilities. FINDINGS Overall, women with disabilities were less likely to be up to date with mammograms and Pap tests compared with women with no disabilities. Similarly, women in rural areas were less likely to have received breast or cervical cancer screening within recommended timeframes. Women who both had a disability and lived in a rural area were the least likely to be current with screening. CONCLUSIONS Our findings suggest that living in rural regions compounds disparities in receipt of cancer screening among women with disabilities. Increased attention is needed to improve receipt of cancer screening among rural women with disabilities.
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Akinyemiju TF, Genkinger JM, Farhat M, Wilson A, Gary-Webb TL, Tehranifar P. Residential environment and breast cancer incidence and mortality: a systematic review and meta-analysis. BMC Cancer 2015; 15:191. [PMID: 25885593 PMCID: PMC4396806 DOI: 10.1186/s12885-015-1098-z] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 02/20/2015] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Factors beyond the individual level such as those characterizing the residential environment may be important to breast cancer outcomes. We provide a systematic review and results of meta-analysis of the published empirical literature on the associations between breast cancer risk and mortality and features of the residential environment. METHODS Using PRISMA guidelines, we searched four electronic databases and manually searched the references of selected articles for studies that were published before June 2013. We selected English language articles that presented data on adult breast cancer incidence or mortality in relation to at least one area-based residential (ABR) independent variable. RESULTS We reviewed 31 eligible studies, and observed variations in ABR construct definition and measurement, study design, and analytic approach. The most common ABR measures were indicators of socioeconomic status (SES) (e.g., income, education, summary measures of several SES indicators or composite SES). We observed positive associations between breast cancer incidence and urbanization (Pooled RR for urban vs. rural: 1.09. 95% CI: 1.01, 1.19), ABR income (Pooled RR for highest vs. lowest ABR income: 1.17, 95% CI: 1.15, 1.19) and ABR composite SES (Pooled RR for highest vs. lowest ABR composite SES: 1.25, 95% CI: 1.08, 1.44). We did not observe consistent associations between any ABR measures and breast cancer mortality. CONCLUSIONS The findings suggest modest positive associations between urbanization and residential area socioeconomic environment and breast cancer incidence. Further studies should address conceptual and methodological gaps in the current publications to enable inference regarding the influence of the residential environment on breast cancer.
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Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Jeanine M Genkinger
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
| | - Maggie Farhat
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Adrienne Wilson
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Tiffany L Gary-Webb
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Departments of Community and Behavioral Sciences and Epidemiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.
| | - Parisa Tehranifar
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA.
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
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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.
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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
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