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Hendrick RE, Monticciolo DL. Mammography Screening Should Begin at Age 40 Years. JOURNAL OF BREAST IMAGING 2024; 6:116-123. [PMID: 38280219 DOI: 10.1093/jbi/wbad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Indexed: 01/29/2024]
Abstract
The 2023 U.S. Preventive Services Task Force draft recommendation statement on screening for breast cancer recommends lowering the starting age for biennial screening with mammography to age 40 years from 50 years, the age of screening initiation that the Task Force had previously recommended since 2009. A recent Perspective article in the New England Journal of Medicine by Woloshin et al contends that this change will provide no additional benefit and is unjustified. This article reviews the main ideas presented by Woloshin et al and provides substantial evidence not considered by those authors in support of screening mammography in U.S. women starting at age 40 years.
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Affiliation(s)
- R Edward Hendrick
- Department of Radiology, University of Colorado Anschutz School of Medicine, Aurora, CO, USA
| | - Debra L Monticciolo
- Dartmouth Geisel School of Medicine, Lebanon, NH, USA
- Dartmouth Hitchcock Medical Center, Lebanon, NH, USA
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2
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van den Broek-Altenburg EM, Leslie AA, Benson JS, DeStigter KK. Disparities in Mammography Screening: Analyzing Barriers to Access Using Individual Patient Perspectives and the Health Belief Model. Cancer Control 2024; 31:10732748241248367. [PMID: 38752988 PMCID: PMC11100395 DOI: 10.1177/10732748241248367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Revised: 03/15/2024] [Accepted: 04/03/2024] [Indexed: 05/19/2024] Open
Abstract
OBJECTIVE The objective of our study is to explore Nepali women's beliefs about access to mammography screening, and motivations to get screened or not. This work was intended to be hypothesis generating for subsequent quantitative analysis and to inform policy and decision-making to improve access. METHODS We conducted structured qualitative interviews among nine Nepali women in the Northeast of the United States receiving care at a local community health center and among nine white women receiving mammography care at a large academic medical center in the Northeast. We analyzed the transcripts using a mixed deductive (content analysis) and inductive (grounded theory) approach. Deductive codes were generated from the Health Belief Model which states that a person's belief in the real threat of a disease with their belief in the effectiveness of the recommended health service or behavior or action will predict the likelihood the person will adopt the behavior. We compared and contrasted qualitative results from both groups. RESULTS We found that eligible Nepali women who had not received mammography screening had no knowledge of its availability and its importance. Primary care physicians emerged as a critical link in addressing this disparity: trust was found to be high among Nepali women with their established primary care provider. CONCLUSION The findings of this study suggest that the role of primary care practitioners in conversations around the importance and eligibility for mammography screening is of critical importance, especially for underserved groups with limited health knowledge of screening opportunities and potential health benefits. Follow-up research should focus on primary care practices.
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Affiliation(s)
| | - Abimbola A. Leslie
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Jamie S. Benson
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Kristen K. DeStigter
- Department of Radiology, Larner College of Medicine, University of Vermont, Burlington, VT, USA
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Wilkinson AN, Ellison LF, Billette JM, Seely JM. Impact of Breast Cancer Screening on 10-Year Net Survival in Canadian Women Age 40-49 Years. J Clin Oncol 2023; 41:4669-4677. [PMID: 37540825 PMCID: PMC10564321 DOI: 10.1200/jco.23.00348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/26/2023] [Accepted: 06/15/2023] [Indexed: 08/06/2023] Open
Abstract
PURPOSE In Canada, some provincial/territorial mammography screening programs include women age 40-49 years, whereas others do not. This study examines the impact of this dichotomy on the 10-year breast cancer (BC) net survival (NS) among women age 40-49 years and 50-59 years at diagnosis. METHODS Using the Canadian Cancer Registry data record linked to death information, we evaluated the cohort of Canadian women age 40-49 years and 50-59 years diagnosed with BC from 2002 to 2007. We compared 10-year NS estimates in the jurisdictions with organized screening programs that included women age 40-49 years, designated as screeners (Northwest Territories, British Columbia, Alberta, Nova Scotia, and Prince Edward Island), with comparator programs that did not (Yukon, Manitoba, Saskatchewan, Ontario, Quebec, New Brunswick, and Newfoundland and Labrador). RESULTS BC was the primary cause of 10-year mortality in women age 40-49 years diagnosed with BC (90.7% of deaths). Among these women, the 10-year NS for screeners (84.8%; 95% CI, 83.8 to 85.8) was 1.9 percentage points (pp) higher than that for comparators (82.9%; 95% CI, 82.3 to 83.5; P = .001). The difference in favor of screeners was significant among women age 45-49 years (2.6 pp; P = .001) but not among women age 40-44 years (0.9 pp; P = .328). Similarly, the incidence-based BC mortality rate was significantly lower in screener jurisdictions among women age 40-49 years and 45-49 years, but not for 40-44 years. Provincial/territorial NS increased significantly with higher mammography screening participation (P = .003). The BC incidence rate was virtually identical in screener and comparator jurisdictions among women age 40-49 years (P = .976) but was significantly higher for comparators among women age 50-59 years (P < .001). CONCLUSION Screening programs that included women in their 40s were associated with a significantly higher BC 10-year NS in women age 40-49 years, but not an increased rate of BC diagnosis. These results may inform screening guidelines for women age 40-49 years.
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Affiliation(s)
| | - Larry F. Ellison
- Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, Canada
| | - Jean-Michel Billette
- Centre for Population Health Data at Statistics Canada, Government of Canada, Ottawa, Canada
| | - Jean M. Seely
- University of Ottawa, Department of Radiology, Ottawa Hospital Research Institute, Ottawa, Canada
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Poterala JE, Stanley E, Narayan AK, Guevara AE, Naeger DM, Miles RC. Mammography Screening Outreach Through Non-Primary Care-Based Services. J Am Coll Radiol 2023; 20:1014-1021. [PMID: 37423346 DOI: 10.1016/j.jacr.2023.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/25/2023] [Accepted: 04/06/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVE To estimate the proportion of patients visiting urgent care centers or emergency departments or being hospitalized who were not up to date with recommended mammography screening to assess the potential impact of non-primary care-based cancer screening interventions. METHODS Adult participants from the 2019 National Health Interview Survey were included. Among participants not up to date with breast cancer screening guidelines based on ACR recommendations, the proportion of patients reporting an urgent care, emergency department visit, or hospitalization within the last year was estimated accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and mammography screening adherence. RESULTS The study included 9,139 women between the ages of 40 and 74 years without history of breast cancer. Of these respondents, 44.9% did not report mammography screening within the last year. Among participants who did not report mammography screening, 29.2% reported visiting an urgent care center, 21.8% reported visiting an emergency room, and 9.6% reported being hospitalized within the last year. The majority of patients receiving non-primary care-based services, who were not up to date with mammography screening, were from historically underserved groups including Black and Hispanic patients. CONCLUSION Nearly 10% to 30% of participants who have not obtained recommended breast cancer screening have visited non-primary care-based services including urgent care centers or emergency rooms or have been hospitalized within the last year.
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Affiliation(s)
- Johanna E Poterala
- School of Medicine and Public Health, University of Wisconsin, Madison, Wisconsin
| | - Edward Stanley
- School of Medicine, American University of the Caribbean, Pembroke Pines, Florida
| | - Anand K Narayan
- Vice Chair of Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - David M Naeger
- Director of Radiology; Vice Chair, Department of Radiology, Denver Health Medical Center, University of Colorado, Denver, Colorado
| | - Randy C Miles
- Chief of Breast Imaging; Associate Director of Radiology for Research, Denver Health Medical Center, Denver, Colorado.
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Funaro K, Niell B. Screening Mammography Utilization in the United States. JOURNAL OF BREAST IMAGING 2023; 5:384-392. [PMID: 38416907 DOI: 10.1093/jbi/wbad042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/01/2024]
Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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Hwong AR, Vittinghoff E, Thomas M, Hermida R, Walkup J, Crystal S, Olfson M, Mangurian C. Breast Cancer Screening Rates Among Medicaid Beneficiaries With Schizophrenia. Psychiatr Serv 2023; 74:497-504. [PMID: 36226372 PMCID: PMC10104476 DOI: 10.1176/appi.ps.20220163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Women with serious mental illness are more likely to be diagnosed as having late-stage breast cancer than women without serious mental illness, suggesting a disparity in screening mammography. This study aimed to compare screening mammography rates in a nationally representative sample of Medicaid beneficiaries with and without schizophrenia. METHODS Medicaid Analytic eXtract files, 2007-2012, were used to identify a cohort of women ages 40-64 with schizophrenia who were eligible for Medicaid but not Medicare (N=87,572 in 2007 and N=114,341 in 2012) and a cohort without schizophrenia, frequency-matched by age, race-ethnicity, and state (N=97,003 in 2007 and N=126,461 in 2012). Annual screening mammography rates were calculated and adjusted for demographic characteristics and comorbid conditions. Multivariable logistic regression was used to estimate the association between beneficiary characteristics and screening mammography rates. RESULTS In 2012, 27.2% of women with schizophrenia completed screening mammography, compared with 26.8% of the control cohort. In the schizophrenia cohort, American Indian/Alaskan Native women had significantly lower odds of receiving mammography (OR=0.82, p=0.02) than White women, whereas Hispanic/Latina women had higher odds (OR=1.16, p<0.001). Women with schizophrenia and a nonalcohol-related substance use disorder had lower odds of receiving mammography (OR=0.74, p<0.001) than women without a substance use disorder. Having at least one medical visit in the past year (vs. no visits) increased the odds of receiving screening mammography (OR=5.08, p<0.001). CONCLUSIONS Screening mammography rates were similar between Medicaid-insured women with and those without schizophrenia. Interventions to increase uptake may need to focus on improving socioeconomic conditions and primary care engagement for vulnerable populations, regardless of psychiatric condition.
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Affiliation(s)
- Alison R Hwong
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Eric Vittinghoff
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Marilyn Thomas
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Richard Hermida
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - James Walkup
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Stephen Crystal
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Mark Olfson
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
| | - Christina Mangurian
- Department of Psychiatry and Behavioral Sciences (Hwong, Thomas, Mangurian) and Department of Epidemiology and Biostatistics (Vittinghoff, Thomas), University of California, San Francisco (UCSF), San Francisco; UCSF National Clinician Scholars Program, San Francisco Veterans Affairs Medical Center, San Francisco (Hwong); Institute for Health, Rutgers University, New Brunswick, New Jersey (Hermida, Walkup, Crystal); Department of Psychiatry, Columbia University Medical Center, New York City (Olfson); UCSF Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital, San Francisco (Mangurian)
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Callison K, Pesko MF, Phillips S, Sosa JA. Cancer Screening after the Adoption of Paid-Sick-Leave Mandates. N Engl J Med 2023; 388:824-832. [PMID: 36856618 PMCID: PMC10084522 DOI: 10.1056/nejmsa2209197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
BACKGROUND By the end of 2022, nearly 20 million workers in the United States have gained paid-sick-leave coverage from mandates that require employers to provide benefits to qualified workers, including paid time off for the use of preventive services. Although the lack of paid-sick-leave coverage may hinder access to preventive care, current evidence is insufficient to draw meaningful conclusions about its relationship to cancer screening. METHODS We examined the association between paid-sick-leave mandates and screening for breast and colorectal cancers by comparing changes in 12- and 24-month rates of colorectal-cancer screening and mammography between workers residing in metropolitan statistical areas (MSAs) that have been affected by paid-sick-leave mandates (exposed MSAs) and workers residing in unexposed MSAs. The comparisons were conducted with the use of administrative medical-claims data for approximately 2 million private-sector employees from 2012 through 2019. RESULTS Paid-sick-leave mandates were present in 61 MSAs in our sample. Screening rates were similar in the exposed and unexposed MSAs before mandate adoption. In the adjusted analysis, cancer-screening rates were higher among workers residing in exposed MSAs than among those in unexposed MSAs by 1.31 percentage points (95% confidence interval [CI], 0.28 to 2.34) for 12-month colorectal cancer screening, 1.56 percentage points (95% CI, 0.33 to 2.79) for 24-month colorectal cancer screening, 1.22 percentage points (95% CI, -0.20 to 2.64) for 12-month mammography, and 2.07 percentage points (95% CI, 0.15 to 3.99) for 24-month mammography. CONCLUSIONS In a sample of private-sector workers in the United States, cancer-screening rates were higher among those residing in MSAs exposed to paid-sick-leave mandates than among those residing in unexposed MSAs. Our results suggest that a lack of paid-sick-leave coverage presents a barrier to cancer screening. (Funded by the National Cancer Institute.).
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Affiliation(s)
- Kevin Callison
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Michael F Pesko
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Serena Phillips
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
| | - Julie A Sosa
- From the Department of Health Policy and Management, School of Public Health and Tropical Medicine, Murphy Institute of Political Economy, Tulane University, New Orleans (K.C.); the Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Atlanta (M.F.P., S.P.); and the Department of Surgery, School of Medicine, University of California at San Francisco, San Francisco (J.A.S.)
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DelaCourt A, Mehta A. Beyond glyco-proteomics-Understanding the role of genetics in cancer biomarkers. Adv Cancer Res 2023; 157:57-81. [PMID: 36725113 DOI: 10.1016/bs.acr.2022.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The development of robust cancer biomarkers is the most effective way to improve overall survival, as early detection and treatment leads to significantly better clinical outcomes. Many of the cancer biomarkers that have been identified and are clinically utilized are glycoproteins, oftentimes a specific glycoform. Aberrant glycosylation is a common theme in cancer, with dysregulated glycosylation driving tumor initiation and metastasis, and abnormal glycosylation can be detection both on the tissue surface and in serum. However, most cancer types are heterogeneous in regard to tumor genomics, and this heterogeneity extends to cancer glycomics. This limits the sensitivity of standalone glycan-based biomarkers, which has slowed their implementation clinically. However, if targeted biomarker development can take into account genomic tumor information, the development of complementary biomarkers that target unique cancer subgroups can be accomplished. This idea suggests the need for algorithm-based cancer biomarkers, which can utilize multiple biomarkers along with relevant demographic information. This concept has already been established in the detection of hepatocellular carcinoma with the GALAD score, and an algorithm-based approach would likely be effective in improving biomarker sensitivity for additional cancer types. In order to increase cancer diagnostic biomarker sensitivity, there must be more targeted biomarker development that considers tumor genomic, proteomic, metabolomic, and clinical data while identifying tumor biomarkers.
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Affiliation(s)
- Andrew DelaCourt
- Department of Cell & Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States
| | - Anand Mehta
- Department of Cell & Molecular Pharmacology & Experimental Therapeutics, Medical University of South Carolina, Charleston, SC, United States.
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Sohn YJ, Flores EJ, Narayan AK, Wang GX, Miles RC. Influence of Perceived Racial Stigma on Breast Cancer Screening Engagement. J Am Coll Radiol 2023; 20:151-155. [PMID: 36280212 DOI: 10.1016/j.jacr.2022.08.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/05/2022] [Accepted: 08/26/2022] [Indexed: 11/18/2022]
Affiliation(s)
- Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
| | - Gary X Wang
- Co-Chair, Diversity, Equity, and Inclusion Patient Experience Subcommittee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Randy C Miles
- Chief of Breast Imaging and Associate Director of Research in Radiology, Denver Health, Denver, Colorado.
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Breast, Colorectal, Lung, Prostate, and Cervical Cancer Screening Prevalence in a Large Commercial and Medicare Advantage Plan, 2008–2020. Prev Med Rep 2022; 30:102046. [DOI: 10.1016/j.pmedr.2022.102046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/09/2022] Open
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The Impact of Organised Screening Programs on Breast Cancer Stage at Diagnosis for Canadian Women Aged 40-49 and 50-59. Curr Oncol 2022; 29:5627-5643. [PMID: 36005182 PMCID: PMC9406663 DOI: 10.3390/curroncol29080444] [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: 06/23/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 12/02/2022] Open
Abstract
The relationship between Canadian mammography screening practices for women 40−49 and breast cancer (BC) stage at diagnosis in women 40−49 and 50−59 years was assessed using data from the Canadian Cancer Registry, provincial/territorial screening practices, and screening information from the Canadian Community Health Survey. For the 2010 to 2017 period, women aged 40−49 were diagnosed with lesser relative proportions of stage I BC (35.7 vs. 45.3%; p < 0.001), but greater proportions of stage II (42.6 vs. 36.7%, p < 0.001) and III (17.3 vs. 13.1%, p < 0.001) compared to women 50−59. Stage IV was lower among women 40−49 than 50−59 (4.4% vs. 4.8%, p = 0.005). Jurisdictions with organised screening programs for women 40−49 with annual recall (screeners) were compared with those without (comparators). Women aged 40−49 in comparator jurisdictions had higher proportions of stages II (43.7% vs. 40.7%, p < 0.001), III (18.3% vs. 15.6%, p < 0.001) and IV (4.6% vs. 3.9%, p = 0.001) compared to their peers in screener jurisdictions. Based on screening practices for women aged 40−49, women aged 50−59 had higher proportions of stages II (37.2% vs. 36.0%, p = 0.003) and III (13.6% vs. 12.3%, p < 0.001) in the comparator versus screener groups. The results of this study can be used to reassess the optimum lower age for BC screening in Canada.
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Regan C, Fehily C, Campbell E, Bowman J, Faulkner J, Oldmeadow C, Bartlem K. Clustering of chronic disease risks among people accessing community mental health services. Prev Med Rep 2022; 28:101870. [PMID: 35813396 PMCID: PMC9256721 DOI: 10.1016/j.pmedr.2022.101870] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 06/19/2022] [Accepted: 06/24/2022] [Indexed: 10/26/2022] Open
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Miles RC, Flores EJ, Carlos RC, Boakye-Ansa NK, Brown C, Sohn YJ, Narayan AK. Impact of Health Care-Associated Cost Concerns on Mammography Utilization: Cross-Sectional Survey Results From the National Health Interview Survey. J Am Coll Radiol 2022; 19:1081-1087. [PMID: 35879187 DOI: 10.1016/j.jacr.2022.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 05/26/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
PURPOSE Health care-related cost concerns and financial toxicity are increasingly recognized barriers along the breast cancer care continuum. The purpose of this study was to evaluate the association between patient-reported cost concerns and screening mammography utilization. METHODS Survey participants aged 40 to 74 years from the 2018 National Health Interview Survey without personal history of breast cancer were included (response rate: 64%). Respondents were queried if they had experienced specific access-related health care barriers. Multiple variable logistic regression analyses were performed to evaluate the association between barriers to care and patient-reported screening mammography utilization. RESULTS Of survey respondents, 7,511 women were included. Of this group, 68.9% reported receiving a screening mammogram within the last 2 years and 52.2% reported receiving a screening mammogram within the last year. Of all survey respondents, 48.4% reported worry paying medical bills. Patients who reported worry about paying medical bills (odds ratio [OR] 0.86; 95% confidence interval [CI]: 0.76-0.97; P = .01), challenges affording dental care (OR 0.65; 95% CI: 0.54-0.77; P < .01), and challenges affording eyeglasses (OR 0.67; 95% CI: 0.54-0.84; P < .01) were less likely to report screening mammography use than their respective counterparts. Patients who skipped medication doses (OR 0.69; 95% CI: 0.52-0.91; P < .01), took less medication, (OR 0.63; 95% CI: 0.48-0.82; P < .01), and delayed filling prescriptions (OR 0.71; 95% CI: 0.56-0.90; P < .01) to save money were also less likely to report receiving mammography screening. CONCLUSION Patient-reported cost-related barriers are associated with decreased utilization of routine mammography.
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Affiliation(s)
- Randy C Miles
- Chief, Breast Imaging and Associate Director, Research in Radiology, Denver Health, University of Colorado, Denver, Colorado.
| | - Efren J Flores
- Associate Chair, Equity, Inclusion and Community Health, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Ruth C Carlos
- Assistant Chair, Clinical Research, Department of Radiology, University of Michigan, Ann Arbor, Michigan; and Editor-in-Chief, JACR
| | | | - Corey Brown
- Meharry Medical College, Nashville, Tennessee
| | - Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Vice Chair, Equity, Department of Radiology, University of Wisconsin-Madison, Madison, Wisconsin
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Crown A, Ramiah K, Siegel B, Joseph KA. The Role of Safety-Net Hospitals in Reducing Disparities in Breast Cancer Care. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11576-3. [PMID: 35357616 DOI: 10.1245/s10434-022-11576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 02/27/2022] [Indexed: 12/22/2022]
Abstract
Advances in breast cancer screening and systemic therapies have been credited with profound improvements in breast cancer outcomes; indeed, 5-year relative survival rate approaches 91% in the USA (U.S. National Institutes of Health NCI. SEER Training Modules, Breast). While breast cancer mortality has been declining, oncologic outcomes have not improved equally among all races and ethnicities. Many factors have been implicated in breast cancer disparities; chief among them is limited access to care which contributes to lower rates of timely screening mammography and, once diagnosed with breast cancer, lower rates of receipt of guideline concordant care (Wu, Lund, Kimmick GG et al. in J Clin Oncol 30(2):142-150, 2012). Hospitals with a safety-net mission, such as the essential hospitals, historically have been dedicated to providing high-quality care to all populations and have eagerly embraced the role of caring for the most vulnerable and working to eliminate health disparities. In this article, we review landmark articles that have evaluated the role safety-net hospitals have played in providing equitable breast cancer care including to those patients who face significant social and economic challenges.
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Affiliation(s)
- Angelena Crown
- Breast Surgery, True Family Women's Cancer Center, Swedish Cancer Institute, Seattle, WA, USA
| | | | - Bruce Siegel
- America's Essential Hospitals, Washington, DC, USA
| | - Kathie-Ann Joseph
- Department of Surgery, New York University School of Medicine, NYC Health and Hospitals, Bellevue, New York, NY, USA.
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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16
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Ezema RN, Igbokwe CC, Iwuagwu TE, Agbaje OS, Ofuebe JI, Abugu LI, Eze DD, Wamanyi Y. Association of Sociodemographic Factors, Breast Cancer Fear, and Perceived Self-Efficacy With Breast Cancer Screening Behaviors Among Middle-Aged Nigerian Women. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2021; 15:11782234211043651. [PMID: 34616153 PMCID: PMC8488520 DOI: 10.1177/11782234211043651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 08/13/2021] [Indexed: 12/24/2022]
Abstract
Introduction: Breast cancer (BC) is a major public health problem among women. However, BC screening uptake is abysmally low among Nigerian women. This study evaluated the association of BC fear and perceived self-efficacy with BC screening (clinical breast exam [CBE] and mammography) among middle-aged Nigerian women. Methods: A community-based cross-sectional study was conducted among middle-aged women in Enugu State, southeast Nigeria. The data were collected between September 2019 and February 2020. The BC screening uptake, fear, and self-efficacy were assessed using the validated Breast Cancer Screening Questionnaire (BCSQ), Champion Breast Cancer Fear Scale (CBCFS), and Champion’s Mammography Self-Efficacy Scale (CMSES). Data were analyzed using frequencies and percentages, chi-square test, and univariate analysis of variance. Bivariate and multivariable logistic regression models were used to examine independent associations between selected sociodemographic factors, cancer fear, perceived self-efficacy, and BC screening. Results: The mean age of the participants was 55.3 years (SD: 5.75). More than half of the women (51%) reported having a BC screening in the past 12 months. However, only 12.5% and 16.9% reported having a CBE or mammogram in the past 12 months. The prevalence of a high, moderate, and low level of fear was 68%, 22.3%, and 9.8%, respectively. The prevalence of a high, moderate, and low self-efficacy level was 50.6%, 37.5%, and 12.0%, respectively. The multivariable logistics regression analysis showed that women aged 50-59 years and 60-64 years were 3.5 times (adjusted odds ratio [AOR] = 3.50, 95% confidence interval [CI]: 2.07-5.89, P < .0001), and 5.92 times (AOR = 5.92 95% CI: 2.63-13.35, P < .0001), respectively, more likely to perform mammogram than those aged 40-49 years. Women with a high level of self-efficacy were 2.68 times (AOR = 2.68, 95% CI: 1.15-6.26, P < .0001) more likely to use mammographic screening than those with low self-efficacy. Although not statistically significant, women with a moderate level of BC fear were 0.56 times less likely to use mammogram than women with a low level of BC fear. Conclusion: A low proportion of women underwent CBE or mammography. Women had a high level of BC fear and a moderate level of self-efficacy for BC screening. The findings emphasize the need for health educational and psychosocial interventions that improve self-efficacy and promote regular BC screening among middle-aged women.
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Affiliation(s)
- Rita Ngozi Ezema
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria.,College of Nursing Science and Health Technology, Nsukka, Nigeria
| | - Charles Chima Igbokwe
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Tochi Emmanuel Iwuagwu
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Olaoluwa Samson Agbaje
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Justina Ifeoma Ofuebe
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Lawretta Ijeoma Abugu
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Dorothy Doris Eze
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
| | - Yohanna Wamanyi
- Department of Human Kinetics and Health Education, Faculty of Education, University of Nigeria, Nsukka, Nsukka, Nigeria
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17
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Miller-Kleinhenz JM, Collin LJ, Seidel R, Reddy A, Nash R, Switchenko JM, McCullough LE. Racial Disparities in Diagnostic Delay Among Women With Breast Cancer. J Am Coll Radiol 2021; 18:1384-1393. [PMID: 34280379 DOI: 10.1016/j.jacr.2021.06.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE Early diagnosis is fundamental to reducing breast cancer (BC) mortality, and understanding potential barriers from initial screening to confirmed diagnosis is essential. The aim of this study was to evaluate patient characteristics that contribute to delay in diagnosis of screen-detected cancers and the contribution of delay to tumor characteristics and BC mortality. METHODS Three hundred sixty-two White and 368 Black women were identified who were screened and received subsequent BC diagnoses within Emory Healthcare, a part of Emory University health care system (2010-2014). Multivariable-adjusted logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) associating patient characteristics with delay to diagnostic evaluation (≥30 versus <30 days), delay to biopsy (≥15 versus <15 days), and total delay (≥45 versus <45 days). Additionally, the ORs and 95% CIs associating delay with tumor characteristics and BC mortality were computed. RESULTS Black women and women diagnosed at later stages, with larger tumor sizes, and with triple-negative tumors were more likely to experience ≥45 days to diagnosis. In multivariable-adjusted models, Black women had at least a two-fold increase in the odds of delay to diagnostic evaluation (OR, 1.98; 95% CI, 1.45-2.71), biopsy delays (OR, 2.41; 95% CI, 1.67-3.41), and total delays ≥45 days (OR, 2.22; 95% CI, 1.63-3.02) compared with White women. A 1.6-fold increased odds of BC mortality was observed among women who experienced total delays ≥45 days compared with women without delays in diagnosis (OR, 1.57, 95% CI, 0.96-2.58). CONCLUSIONS The study demonstrated racial disparities in delays in the diagnostic process for screen-detected malignancies. Total delay in diagnosis was associated with an increase in BC mortality.
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Affiliation(s)
| | - Lindsay J Collin
- Huntsman Cancer Institute, Department of Population Health Sciences, University of Utah, Salt Lake City, Utah
| | - Rebecca Seidel
- Department of Radiology and Imaging Services, Emory University School of Medicine, Atlanta, Georgia
| | - Arthi Reddy
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Jeffrey M Switchenko
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health of Emory University, Atlanta, Georgia
| | - Lauren E McCullough
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
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18
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Tummalapalli SL, Vittinghoff E, Hoggatt KJ, Keyhani S. Preventive Care Delivery After the Veterans Choice Program. Am J Prev Med 2021; 61:55-63. [PMID: 33820664 PMCID: PMC8217145 DOI: 10.1016/j.amepre.2021.01.029] [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: 09/25/2020] [Revised: 01/12/2021] [Accepted: 01/15/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The Veterans Choice Program expanded Veteran access to community care. The Veterans Choice Program may negatively impact the receipt of preventive care services owing to care fragmentation. This study assesses 10 measures of preventive care in Veterans with the Department of Veterans Affairs coverage before and after the Veterans Choice Program. METHODS The study population included Veterans who responded to the National Health Interview Survey during the 2 time periods before and after Veterans Choice Program implementation: January 2011-October 2014 and November 2015-December 2018. Outcomes were preventive care services categorized as cardiovascular risk reduction (cholesterol monitoring, blood pressure monitoring, aspirin use), infectious disease prevention (influenza vaccination and HIV testing), and diabetes care (fasting blood glucose monitoring, podiatry visits, ophthalmology visits, influenza vaccination, and pneumonia vaccination). Two different analyses were conducted: (1) unadjusted and multivariable-adjusted pre-post analysis and (2) difference-in-differences analyses. Analyses were conducted in 2019. RESULTS Measures of cardiovascular risk reduction and influenza vaccination were not statistically different before and after Veterans Choice Program implementation using the 2 different analytic approaches. In unadjusted pre-post analysis, after Veterans Choice Program implementation, Veterans with Veterans Affairs coverage had increased HIV testing (66.1%‒75.4%, p=0.008), podiatry visits (22.4%‒38.3%, p=0.01), and ophthalmology visits (62.2%‒77.2%, p=0.02). Using multivariable adjustment for participant sociodemographic factors, Veterans Choice Program implementation was associated with higher odds of podiatry visits (AOR=2.28, 95% CI=1.24, 4.20, p=0.009) and ophthalmology visits (AOR=2.11, 95% CI=1.13, 3.94, p=0.02) among Veterans with diabetes. In difference-in-differences analyses, Veterans Choice Program implementation was associated with increased podiatry visits (AOR=2.95, 95% CI=1.49, 5.83, p=0.002) among Veterans with diabetes and Veterans Affairs coverage compared with that among those with other coverage types, but no statistically significant effect was observed for ophthalmology visits. CONCLUSIONS Veterans with Veterans Affairs coverage and diabetes had an increase in podiatry visits after Veterans Choice Program implementation. There was no evidence that Veterans Choice Program implementation had a negative impact on the receipt of preventive care services among Veterans with Veterans Affairs coverage.
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Affiliation(s)
- Sri Lekha Tummalapalli
- Division of Healthcare Delivery Science & Innovation, Department of Population Health Sciences, Weill Cornell Medicine, New York, New York; Department of Medicine, University of California San Francisco, San Francisco, California.
| | - Eric Vittinghoff
- Department of Epidemiology & Biostatistics, University of California San Francisco, San Francisco, California
| | - Katherine J Hoggatt
- Department of Medicine, University of California San Francisco, San Francisco, California; San Francisco VA Health Care System, San Francisco, California
| | - Salomeh Keyhani
- Department of Medicine, University of California San Francisco, San Francisco, California; San Francisco VA Health Care System, San Francisco, California
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Figgatt M, Chen J, Capper G, Cohen S, Washington R. Chronic Disease Surveillance Using Electronic Health Records From Health Centers in a Large Urban Setting. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2021; 27:186-192. [PMID: 31688745 DOI: 10.1097/phh.0000000000001097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To assess the validity of electronic health records (EHRs) from a network of health centers for chronic disease surveillance among an underserved population in an urban setting. DESIGN EHRs from a network of health centers were used to calculate the prevalence of chronic disease among adult and child patient populations during 2016. Two population-based surveys with local estimates of chronic disease prevalence were compared with the EHR prevalences. SETTING A network of health centers that provides health care services to an underserved population in a large urban setting. PARTICIPANTS A total of 187 292 patients who had at least 1 health care visit recorded in the Philadelphia health center network. MAIN OUTCOME MEASURE Chronic disease indicator (CDI) prevalence of adult obesity, adult smoking, adult diabetes, adult hypertension, child obesity, and child asthma. Health center CDI proportions were compared with survey estimates. RESULTS Overall consistency between the health center estimates and surveys varied by CDI. With the exception of childhood obesity, all health center CDI proportions fell within the 95% CI for at least 1 comparison survey estimate. Statistically significant differences were observed and varied by CDI. CONCLUSIONS This analysis presents a novel use of existing EHR data to estimate chronic disease prevalence among underserved populations. With the increased use of EHRs in health centers, data from health center networks may supplement chronic disease surveillance efforts, if used appropriately.
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Affiliation(s)
- Mary Figgatt
- Philadelphia Department of Public Health, Philadelphia, Pennsylvania (Mss Figgatt and Capper and Dr Washington); and Health Federation of Philadelphia, Philadelphia, Pennsylvania (Mss Chen and Cohen)
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20
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Berete F, der Heyden JV, Demarest S, Charafeddine R, Tafforeau J, Oyen HV, Bruyère O, Renard F. Validity of self-reported mammography uptake in the Belgian health interview survey: selection and reporting bias. Eur J Public Health 2021; 31:214-220. [PMID: 33226066 PMCID: PMC7851893 DOI: 10.1093/eurpub/ckaa217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The validity of self-reported mammography uptake is often questioned. We assessed the related selection and reporting biases among women aged 50-69 years in the Belgian Health Interview Survey (BHIS) using reimbursement data for mammography stemming from the Belgian Compulsory Health Insurance organizations (BCHI). METHODS Individual BHIS 2013 data (n = 1040) were linked to BCHI data 2010-13 (BHIS-BCHI sample). Being reimbursed for mammography within the last 2-years was used as the gold standard. Selection bias was assessed by comparing BHIS estimates reimbursement rates in BHIS-BCHI with similar estimates from the Echantillon Permanent/Permanente Steekproef (EPS), a random sample of BCHI data, while reporting bias was investigated by comparing self-reported versus reimbursement information in the BHIS-BCHI. Reporting bias was further explored through measures of agreement and logistic regression. RESULTS Mammography uptake rates based on self-reported information and reimbursement from the BHIS-BCHI were 75.5% and 69.8%, respectively. In the EPS, it was 64.1%. The validity is significantly affected by both selection bias {relative size = 8.93% [95% confidence interval (CI): 3.21-14.64]} and reporting bias [relative size = 8.22% (95% CI: 0.76-15.68)]. Sensitivity was excellent (93.7%), while the specificity was fair (66.4%). The agreement was moderate (kappa = 0.63). Women born in non-EU countries (OR = 2.81, 95% CI: 1.54-5.13), with high household income (OR = 1.27, 95% CI: 1.02-1.60) and those reporting poor perceived health (OR = 1.41, 95% CI: 1.14-1.73) were more likely to inaccurately report their mammography uptake. CONCLUSIONS The validity of self-reported mammography uptake in women aged 50-69 years is affected by both selection and reporting bias. Both administrative and survey data are complementary when assessing mammography uptake.
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Affiliation(s)
- Finaba Berete
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | | | - Stefaan Demarest
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Rana Charafeddine
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Jean Tafforeau
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Herman Van Oyen
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Ageing, University of Liege, Liège, Belgium
| | - Françoise Renard
- Department Epidemiology and Public Health, Sciensano, Brussels, Belgium
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21
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Miles RC, Flores EJ, Lopez DB, Sohn YJ, Gillis EA, Lehman CD, Narayan AK. Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence. J Am Coll Radiol 2021; 18:834-840. [PMID: 33497614 DOI: 10.1016/j.jacr.2020.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE We aimed to estimate the proportion of patients visiting the emergency department (ED) who were not up to date with cancer screening guidelines to assess the scope of need and potential impact of ED-based cancer screening interventions. METHODS Adult participants from the 2015 National Health Interview Survey were included. Among patients nonadherent to national breast, colorectal, or lung cancer screening guidelines, the proportion of patients reporting an ED visit within the last year was estimated, accounting for complex survey sampling design features. Multiple variable logistic regression analyses were then conducted to evaluate the association between sociodemographic characteristics and screening adherence. RESULTS Of screening eligible respondents, 17.2% of women nonadherent to mammography screening, 16.9% of patients nonadherent to colorectal cancer screening, and 25.0% of patients nonadherent to lung cancer screening reported at least one ED visit in the preceding year. Patients visiting the ED with postsecondary school education were more likely to be up to date with mammography screening than those without advanced education (odds ratio [OR] 1.45; 95% confidence interval [CI]: 1.21-1.74; P = .01). Patients without insurance were less likely than those with insurance to report being up to date with both mammography screening (OR 0.31; 95% CI: 0.21-0.48; P = .01) and colorectal cancer screening (OR 0.56; 95% CI: 0.34-0.93; P = .03). DISCUSSION Opportunities to improve cancer screening adherence exist through ED-based preventative care interventions, which leverage multidisciplinary partnerships, including radiologists, to reach large volumes of patients who are not engaged in cancer screening.
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Affiliation(s)
- Randy C Miles
- Education Director, Division of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J Flores
- Officer, Radiology Community Health Improvement, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Young-Jin Sohn
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Eleanor A Gillis
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D Lehman
- Division Chief of Breast Imaging, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K Narayan
- Co-chair, Radiology Diversity, Equity & Inclusion Committee, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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22
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Abdel-Rahman O. Patterns and Trends of Cancer Screening in Canada: Results From a Contemporary National Survey. J Natl Compr Canc Netw 2021; 19:68-76. [PMID: 33406489 DOI: 10.6004/jnccn.2020.7613] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/26/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to assess the patterns and trends of colorectal, breast, and cervical cancer screening within a contemporary cohort of Canadian adults. METHODS Canadian Community Health Survey datasets (2007-2016) were accessed and 3 cohorts were defined: (1) a colorectal cancer (CRC) screening cohort, defined as men and women aged 50 to 74 years with complete information about CRC screening tests and their timing; (2) a breast cancer screening cohort, defined as women aged 40 to 74 years with complete information about mammography and its timing; and (3) a cervical cancer screening cohort, defined as women aged 25 to 69 years with complete information about the Papanicolaou (Pap) test and its timing. Multivariable logistic regression analysis was then performed to evaluate factors associated with not having timely screening tests at the time of survey completion. RESULTS A total of 99,820 participants were considered eligible for the CRC screening cohort, 59,724 for the breast cancer screening cohort, and 46,767 for the cervical cancer screening cohort. Among eligible participants, 43% did not have timely recommended screening tests for CRC, 35% did not have timely mammography (this number decreased to 26% when limiting the eligible group to ages 50-74 years), and 25% did not have a timely Pap test. Lower income was associated with not having a timely recommended screening tests for all 3 cohorts (odds ratios [95% CI]: 1.86 [1.76-1.97], 1.89 [1.76-2.04], and 1.96 [1.79-2.14], respectively). Likewise, persons self-identifying as a visible minority were less likely to have timely recommended screening tests in all 3 cohorts (odds ratios for White race vs visible minority [95% CI]: 0.87 [0.83-0.92], 0.85 [0.80-0.91], and 0.66 [0.61-0.70], respectively). CONCLUSIONS More than one-third of eligible individuals are missing timely screening tests for CRC. Moreover, at least one-quarter of eligible women are missing their recommended breast and cervical cancer screening tests. More efforts from federal and provincial health authorities are needed to deal with socioeconomic disparities in access to cancer screening.
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Affiliation(s)
- Omar Abdel-Rahman
- Department of Oncology, University of Alberta and Cross Cancer Institute, Edmonton, Alberta, Canada
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23
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Nyrop KA, Damone EM, Deal AM, Carey LA, Lorentsen M, Shachar SS, Williams GW, Brenizer AT, Wheless A, Muss HB. Obesity, comorbidities, and treatment selection in Black and White women with early breast cancer. Cancer 2020; 127:922-930. [PMID: 33284988 DOI: 10.1002/cncr.33288] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND This study investigates obesity and comorbidity in Black and White women with early breast cancer (stages I-III) and their potential impact on treatment decisions for patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) tumors. METHODS In this retrospective chart review, comparisons of frequencies for Black and White patients were calculated with the Fisher exact test. Log binomial regression was used to estimate prevalence ratios (PRs) with 95% confidence intervals for total and individual comorbidities, and multivariable modeling was used to estimate PRs adjusted for age and body mass index (BMI). RESULTS In a sample of 548 patients, 26% were Black, and 74% were White. Sixty-two percent of Black patients and 32% of White patients were obese (BMI ≥ 30 kg/m2 ; P < .0001). Seventy-five percent of Black patients and 87% of White patients had HR+ tumors (P = .001). Significant intergroup differences were seen for 2 or more total comorbidities (62% of Blacks vs 47% of Whites; P = .001), 2 or more obesity-related comorbidities (33% vs 10%; P < .0001), hypertension (60% vs 32%; P < .0001), diabetes mellitus (23% vs 6%; P < .0001), hypercholesterolemia or hyperlipidemia (28% vs 18%; P = .02), and hypothyroidism (4% vs 11%; P = .012). In women with HR+/HER2- tumors, there were no intergroup differences in treatment decisions regarding the type of surgery, chemotherapy regimen, radiation, or endocrine treatment despite significant differences in the prevalence of obesity and comorbidities. CONCLUSIONS This study documents significant disparities between Black and White women with early breast cancer with regard to high rates of obesity, overall comorbidities, and obesity-related comorbidities, and it highlights the prevalence of competing risks that may complicate outcomes in breast cancer.
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Affiliation(s)
- Kirsten A Nyrop
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Emily M Damone
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lisa A Carey
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael Lorentsen
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | - Grant W Williams
- School of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Addison Tucker Brenizer
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amy Wheless
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hyman B Muss
- School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Einav L, Finkelstein A, Oostrom T, Ostriker A, Williams H. Screening and Selection: The Case of Mammograms. THE AMERICAN ECONOMIC REVIEW 2020; 110:3836-3870. [PMID: 34305149 PMCID: PMC8300583 DOI: 10.1257/aer.20191191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
We analyze selection into screening in the context of recommendations that breast cancer screening start at age 40. Combining medical claims with a clinical oncology model, we document that compliers with the recommendation are less likely to have cancer than younger women who select into screening or women who never screen. We show this selection is quantitatively important: shifting the recommendation from age 40 to 45 results in three times as many deaths if compliers were randomly selected than under the estimated patterns of selection. The results highlight the importance of considering characteristics of compliers when making and designing recommendations.
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Affiliation(s)
- Liran Einav
- Department of Economics, Stanford University, and the National Bureau of Economic Research
| | - Amy Finkelstein
- Department of Economics, Massachusetts Institute of Technology, and the National Bureau of Economic Research
| | | | | | - Heidi Williams
- Department of Economics, Stanford University, and the National Bureau of Economic Research
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25
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Sharma KP, Grosse SD, Maciosek MV, Joseph D, Roy K, Richardson LC, Jaffe H. Preventing Breast, Cervical, and Colorectal Cancer Deaths: Assessing the Impact of Increased Screening. Prev Chronic Dis 2020; 17:E123. [PMID: 33034556 PMCID: PMC7553223 DOI: 10.5888/pcd17.200039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Introduction The US Preventive Services Task Force (USPSTF) recommends select preventive clinical services, including cancer screening. However, screening for cancers remains underutilized in the United States. The Centers for Disease Control and Prevention leads initiatives to increase breast, cervical, and colorectal cancer (CRC) screening. We assessed the number of avoidable deaths from increased screening, according to USPSTF recommendations, for CRC and female breast and cervical cancers. Methods We used model-based estimates of avoidable deaths for the lifetime of single-year age cohorts under the current and increased use of screening scenarios (data year 2016; analysis, 2018). We calculated prevented cancer deaths for each 1% increase in screening uptake and extrapolated to current level of screening (2016), current level plus 10 percentage points, and increasing screening to 90% and 100% of the eligible population. Results Increased use of screening from current levels to 100% would prevent an additional 2,821 deaths from breast cancer, 6,834 deaths from cervical cancer, and 35,530 deaths from CRC over a lifetime of the respective single-year cohort. Increasing use of CRC screening would prevent approximately 8.5 times as many deaths as the equivalent increase in use of breast cancer screening (women only), although twice as many people (men and women) would have to be screened for CRC. Conclusions A large number of deaths could be avoided by increasing breast, cervical, and CRC screening. Public health programs incorporating strategies shown to be effective can help increase screening rates.
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Affiliation(s)
- Krishna P Sharma
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, MS-MF76, Atlanta, GA 30341.
| | - Scott D Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Djenaba Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kakoli Roy
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lisa C Richardson
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Harold Jaffe
- Office of the Associate Director for Science, Centers for Disease Control and Prevention, Atlanta, Georgia
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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: 7] [Impact Index Per Article: 1.8] [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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57% decline in Rhode Island invasive breast cancer mortality between 1987 and 2017: mammography predominates in preventing mortality. Breast Cancer Res Treat 2020; 184:135-147. [PMID: 32779036 DOI: 10.1007/s10549-020-05834-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Controversy exists regarding proportional contributions of mammographic screening versus systemic therapy to declining disease-specific mortality of female invasive breast cancer (IBC) in the United States. Understanding relative contributions may help address allocation of medical resources. METHODS A 31-year (1987-2017) review of Rhode Island (RI) Cancer Registry data of female IBC was carried out in a state with high rates of mammographic screening. RESULTS Over 31 years in RI, statistically significant improvements occurred at initial diagnosis of IBC: mean and median maximum cancer diameters decreased by 21% and 30% respectively. Despite 1997 introduction of more accurate sentinel lymph node biopsy, the proportion of patients with axillary lymph node metastases (LNM) decreased by 27%. Extent of LNM also decreased as patients with over three node metastases decreased 67%. By 2017, 53% of all patients with LNM had only one. Poorly differentiated cancers decreased 50%. Disease-specific mortality decreased 57%. DISCUSSION Improvements in initial presentation of IBC are consistent with most having progressive growth, from cellular origin to palpable mass, the currently accepted biological model. Breast cancers identified earlier at initial diagnosis through screening mammography are characterized by smaller size, fewer axillary LNMs, better grade differentiation, and decreased mortality. Statistical analysis from these improved diagnostic parameters indicate that the majority of mortality decline from invasive breast cancer in RI can be attributed to earlier detection. Thus, mammography predominates in preventing mortality.
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Lowry KP, Trentham-Dietz A, Schechter CB, Alagoz O, Barlow WE, Burnside ES, Conant EF, Hampton JM, Huang H, Kerlikowske K, Lee SJ, Miglioretti DL, Sprague BL, Tosteson ANA, Yaffe MJ, Stout NK. Long-Term Outcomes and Cost-Effectiveness of Breast Cancer Screening With Digital Breast Tomosynthesis in the United States. J Natl Cancer Inst 2020; 112:582-589. [PMID: 31503283 PMCID: PMC7301096 DOI: 10.1093/jnci/djz184] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 08/01/2019] [Accepted: 09/05/2019] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Digital breast tomosynthesis (DBT) is increasingly being used for routine breast cancer screening. We projected the long-term impact and cost-effectiveness of DBT compared to conventional digital mammography (DM) for breast cancer screening in the United States. METHODS Three Cancer Intervention and Surveillance Modeling Network breast cancer models simulated US women ages 40 years and older undergoing breast cancer screening with either DBT or DM starting in 2011 and continuing for the lifetime of the cohort. Screening performance estimates were based on observational data; in an alternative scenario, we assumed 4% higher sensitivity for DBT. Analyses used federal payer perspective; costs and utilities were discounted at 3% annually. Outcomes included breast cancer deaths, quality-adjusted life-years (QALYs), false-positive examinations, costs, and incremental cost-effectiveness ratios (ICERs). RESULTS Compared to DM, DBT screening resulted in a slight reduction in breast cancer deaths (range across models 0-0.21 per 1000 women), small increase in QALYs (1.97-3.27 per 1000 women), and a 24-28% reduction in false-positive exams (237-268 per 1000 women) relative to DM. ICERs ranged from $195 026 to $270 135 per QALY for DBT relative to DM. When assuming 4% higher DBT sensitivity, ICERs decreased to $130 533-$156 624 per QALY. ICERs were sensitive to DBT costs, decreasing to $78 731 to $168 883 and $52 918 to $118 048 when the additional cost of DBT was reduced to $36 and $26 (from baseline of $56), respectively. CONCLUSION DBT reduces false-positive exams while achieving similar or slightly improved health benefits. At current reimbursement rates, the additional costs of DBT screening are likely high relative to the benefits gained; however, DBT could be cost-effective at lower screening costs.
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Affiliation(s)
- Kathryn P Lowry
- Department of Radiology, University of Washington, Seattle Cancer Care Alliance, Seattle, WA
| | | | - Clyde B Schechter
- University of Wisconsin-Madison, Madison, WI; Department of Family and Social Medicine, Albert Einstein College of Medicine, Bronx, NY
| | - Oguzhan Alagoz
- Carbone Cancer Center and Department of Population Health Sciences
- School of Medicine and Public Health, and Department of Industrial and Systems Engineering
| | - William E Barlow
- Cancer Research and Biostatistics, University of Washington, Seattle, WA
| | | | - Emily F Conant
- Department of Radiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - John M Hampton
- Carbone Cancer Center and Department of Population Health Sciences
| | - Hui Huang
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, MA
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics, University of California, San Francisco, CA
| | - Sandra J Lee
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Diana L Miglioretti
- Division of Biostatistics, Department of Public Health Sciences, University of California Davis, Davis, CA
- Kaiser Permanente Washington Health Research Institute, Seattle, WA
| | - Brian L Sprague
- Departments of Surgery and Radiology, University of Vermont Cancer Center, University of Vermont Larner College of Medicine, Burlington, VT
| | - Anna N A Tosteson
- The Dartmouth Institute for Health Policy and Clinical Practice and Norris Cotton Cancer Center, Geisel School of Medicine at Dartmouth, Lebanon, NH
| | - Martin J Yaffe
- Departments of Medical Biophysics and Medical Imaging, University of Toronto, Toronto, Canada
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
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Rai A, Doria-Rose VP, Silvestri GA, Yabroff KR. Evaluating Lung Cancer Screening Uptake, Outcomes, and Costs in the United States: Challenges With Existing Data and Recommendations for Improvement. J Natl Cancer Inst 2020; 111:342-349. [PMID: 30698792 DOI: 10.1093/jnci/djy228] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/14/2018] [Accepted: 12/10/2018] [Indexed: 12/17/2022] Open
Abstract
The National Lung Screening Trial (NLST) reported substantial reduction in lung cancer mortality among high-risk individuals screened annually with low-dose helical computed tomography (LDCT). As a result, the US Preventive Services Task Force issued a B recommendation for annual LDCT in high-risk individuals, which requires private insurers to cover it without cost-sharing. The Medicare program also covers LDCT for high-risk beneficiaries without cost-sharing. However, the NLST findings may not be generalizable to the community setting because of differences in patients, providers, and practices participating in the NLST. Thus, examining uptake of LDCT screening in community practice is critical, as is evaluating the immediate and downstream outcomes of screening, including false-positive scans, follow-up examinations and adverse events, costs, stage of disease at diagnosis, and survival. This commentary presents an overview of the landscape of the data resources currently available to evaluate the uptake, outcomes, and costs of LDCT screening in the United States. We describe the strengths and limitations of existing data sources, including administrative databases, surveys, and registries. Thereafter, we provide recommendations for improving the data infrastructure pertaining to three overarching research areas: receipt of guideline-consistent screening and follow-up, weighing benefits and harms of screening, and costs of screening.
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Affiliation(s)
- Ashish Rai
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (AR, KRY)
| | - V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, NCI, Bethesda, MD (VPDR)
| | - Gerard A Silvestri
- Thoracic Oncology Research Group, Division of Pulmonary, Critical Care, Allergy and Sleep Medicine, Medical University of South Carolina, Charleston, SC (GAS)
| | - K Robin Yabroff
- Surveillance and Health Services Research Program, Department of Intramural Research, American Cancer Society, Atlanta, GA (AR, KRY)
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Lipscomb J, Escoffery C, Gillespie TW, Henley SJ, Smith RA, Chociemski T, Almon L, Jiang R, Sheng X, Goodman M, Ward KC. Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030977. [PMID: 32033227 PMCID: PMC7037204 DOI: 10.3390/ijerph17030977] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/20/2020] [Accepted: 01/24/2020] [Indexed: 11/24/2022]
Abstract
Women diagnosed with breast cancer at a relatively early age (≤45 years) or with bilateral disease at any age are at elevated risk for additional breast cancer, as are their female first-degree relatives (FDRs). We report on a randomized trial to increase adherence to mammography screening guidelines among survivors and FDRs. From the Georgia Cancer Registry, breast cancer survivors diagnosed during 2000–2009 at six Georgia cancer centers underwent phone interviews about their breast cancer screening behaviors and their FDRs. Nonadherent survivors and FDRs meeting all inclusion criteria were randomized to high-intensity (evidence-based brochure, phone counseling, mailed reminders, and communications with primary care providers) or low-intensity interventions (brochure only). Three and 12-month follow-up questionnaires were completed. Data analyses used standard statistical approaches. Among 1055 survivors and 287 FDRs who were located, contacted, and agreed to participate, 59.5% and 62.7%, respectively, reported breast cancer screening in the past 12 months and were thus ineligible. For survivors enrolled at baseline (N = 95), the proportion reporting adherence to guideline screening by 12 months post-enrollment was similar in the high and low-intensity arms (66.7% vs. 79.2%, p = 0.31). Among FDRs enrolled at baseline (N = 83), screening was significantly higher in the high-intensity arm at 12 months (60.9% vs. 32.4%, p = 0.03). Overall, about 72% of study-eligible survivors (all of whom were screening nonadherent at baseline) reported screening within 12 months of study enrollment. For enrolled FDRs receiving the high-intensity intervention, over 60% reported guideline screening by 12 months. A major conclusion is that using high-quality central cancer registries to identify high-risk breast cancer survivors and then working closely with these survivors to identify their FDRs represents a feasible and effective strategy to promote guideline cancer screening.
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Affiliation(s)
- Joseph Lipscomb
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Correspondence: ; Tel.: +404-727-4513; Fax: +404-727-9198
| | - Cam Escoffery
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Theresa W. Gillespie
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
- Department of Surgery and Department of Hematology and Medical Oncology, Emory University School of Medicine; Atlanta, GA 30322, USA
| | - S. Jane Henley
- Division of Cancer Prevention and Control, U.S. Centers for Disease Control and Prevention; Atlanta, GA 30341, USA;
| | - Robert A. Smith
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Cancer Control Program, American Cancer Society; Atlanta, GA 30303, USA
| | - Toni Chociemski
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Lyn Almon
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Renjian Jiang
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Xi Sheng
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
| | - Michael Goodman
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
| | - Kevin C. Ward
- Rollins School of Public Health, Emory University; Atlanta, GA 30322, USA; (C.E.); (R.A.S.); (T.C.); (L.A.); (R.J.); (X.S.); (M.G.); (K.C.W.)
- Winship Cancer Institute of Emory University; Atlanta, GA 30322, USA;
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Grimley CE, Kato PM, Grunfeld EA. Health and health belief factors associated with screening and help-seeking behaviours for breast cancer: A systematic review and meta-analysis of the European evidence. Br J Health Psychol 2019; 25:107-128. [PMID: 31876992 DOI: 10.1111/bjhp.12397] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/28/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE The aim of this systematic review was to identify health or health belief factors associated with mammography attendance or with self-initiated medical help-seeking for breast cancer symptoms among women in Europe. METHODS Five databases were searched for articles published between 2005 and 2018. Meta-analyses were conducted for 13 factors related to screening attendance and two factors associated with help-seeking behaviour. Where there were too few studies to include in the meta-analysis, a narrative synthesis was undertaken. RESULTS Sixty-five studies were included. Never having had cervical screening (d = -.72, p < .001) and higher perceived barriers to mammography (d = -.40, p < .001) were associated with lower levels of screening attendance. Possessing health insurance (d = .49, p < .001), greater perceived benefits (d = .31, p < .001) and motivation (d = .36, p = .003) towards screening, and higher perceived seriousness (d = .24, p = .019) and susceptibility (d = .20, p = .024) towards breast cancer were associated with a higher level of screening attendance. Presenting with a non-lump symptom was associated with a longer time to presentation (d = .32, p < .001). The narrative synthesis revealed that previous benign breast disease was associated with a higher level of screening attendance but with a longer time to presentation. CONCLUSIONS The review identified key similarities in factors associated with screening and help-seeking behaviours which offer scope for combined interventions aimed at women that target both behaviours. Furthermore, the review highlighted that fewer studies have focused on help-seeking behaviour, despite two thirds of breast cancer cases being self-detected. Future research should further examine predictors of help-seeking behaviour including a focus on modifiable factors, such as BMI, and physical activity.
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Affiliation(s)
| | - Pamela M Kato
- P. M. Kato Consulting, Mountain View, California, USA
| | - Elizabeth A Grunfeld
- Department of Psychological Sciences, Birkbeck College, University of London, UK
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Uptake of Gynecological Cancer Screening and Performance of Breast Self-Examination Among 50-Year-Old Migrant and Non-migrant Women in Germany: Results of a Cross-Sectional Study (InEMa). J Immigr Minor Health 2019; 21:674-677. [PMID: 29987640 DOI: 10.1007/s10903-018-0785-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Our aim was to provide data regarding uptake of gynecological early detection measures and performance of breast self-examinations among migrant women in Germany. Cross-sectional self-reported data were collected using paper-and-pencil questionnaires. Descriptive analyses, Chi square-tests, and logistic regression were applied. Results were adjusted for educational level. Of 5387 women, 89.9% were autochthonous, 4.1% German resettlers, 2.8% Turkish, 3.1% other migrants. Participation rates regarding cancer screening differed significantly, with the lowest proportion in Turkish migrants (65.0%), resettlers (67.8%), other migrants (68.2%) and autochthonous population (78.2%). No differences in performance of breast self-examinations were detected. When adjusted for education, results indicated only slight changes in the odds to participate in screening irregularly or not at all. Results support existing evidence by showing lower participation rates in cancer screening among migrant women, but there were no differences regarding breast self-examinations. Migrant women form a potential high-risk group for late-stage diagnosis of cervical or breast cancer.
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Kriaucioniene V, Petkeviciene J. Predictors and Trend in Attendance for Breast Cancer Screening in Lithuania, 2006-2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16224535. [PMID: 31744058 PMCID: PMC6887946 DOI: 10.3390/ijerph16224535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 11/08/2019] [Accepted: 11/14/2019] [Indexed: 12/24/2022]
Abstract
In Lithuania, a Nationwide Breast Cancer (BC) Screening Program was launched in 2005, offering mammography for women aged 50 to 69 years, every other year. This study aimed to determine the trend in the attendance for mammography screening during 2006–2014 and to identify the factors that are predictive for participation in it. The study sample consisted of 1941 women aged 50–64 years, who participated in five cross-sectional biennial postal surveys of Lithuanian Health Behavior Monitoring, carried out in independent national random samples. The attendance for screening was identified if women reported having had a mammogram within the last two years. The proportion of women attending the screening was continuously increasing from 20.0% in 2006 up to 65.8% in 2014. The attendance for BC screening was associated with the participation in cervical cancer screening. A higher level of education, living in a city, frequent contact with a doctor, and healthy behaviors (fresh-vegetable consumption, physical activity, and absence of alcohol abuse) were associated with higher participation rates in BC screening. To increase BC screening uptake and to reduce inequalities in attendance, new strategies of organized BC screening program using systematic personal invitations are required in Lithuania.
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Bonafede MM, Miller JD, Pohlman SK, Troeger KA, Sprague BL, Herschorn SD, Winer IH. Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance. Am J Prev Med 2019; 57:394-402. [PMID: 31377088 PMCID: PMC7433028 DOI: 10.1016/j.amepre.2019.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.
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Affiliation(s)
| | | | - Scott K Pohlman
- Outcomes Research, Hologic, Inc., Marlborough, Massachusetts
| | | | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont; Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
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Ryser MD, Hendrix LH, Worni M, Liu Y, Hyslop T, Hwang ES. Incidence of Ductal Carcinoma In Situ in the United States, 2000-2014. Cancer Epidemiol Biomarkers Prev 2019; 28:1316-1323. [PMID: 31186262 PMCID: PMC6679771 DOI: 10.1158/1055-9965.epi-18-1262] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 03/01/2019] [Accepted: 06/03/2019] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND In absence of definitive molecular risk markers, clinical management of patients diagnosed with ductal carcinoma in situ (DCIS) remains largely guided by patient and tumor characteristics. In this study, we analyzed recent trends in DCIS incidence and compared them against trends in mammography use. METHODS The Surveillance, Epidemiology, and End Results registry was queried for patients diagnosed with DCIS from 2000 to 2014 (18 registries). Joinpoint regression analyses were used to compute age- and race-stratified trends in age-adjusted incidence of DCIS. The patterns of DCIS incidence were compared against mammography utilization data from the National Health Interview Survey. RESULTS Between 2000 and 2014, overall DCIS incidence in the U.S. population was stable (P = 0.24). Among age groups 20 to 44 years and 45 to 55 years, DCIS incidence increased by 1.3% (P = 0.001) and 0.6% (P = 0.02) per year, respectively. Although stable among white women, DCIS incidence increased among black women and women of other races by 1.6% (P < 0.001) and 1.0% (P = 0.002) per year, respectively. Mammography uptake correlated well with DCIS incidence, with the exception of women ages 40 to 49 years and black women who experienced an increase in DCIS incidence despite stagnating and decreasing mammography uptake, respectively. CONCLUSIONS Overall DCIS incidence rates have remained stable between 2000 and 2014. However, subgroup analyses revealed an increase in incidence among both younger women and black women. IMPACT DCIS incidence trends did not correlate with the mammography uptake patterns, suggesting that etiologic factors other than screening may be leading to an increased DCIS incidence in these groups.
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MESH Headings
- Adult
- Black or African American/statistics & numerical data
- Age Factors
- Aged
- Breast Neoplasms/epidemiology
- Breast Neoplasms/ethnology
- Breast Neoplasms/pathology
- Carcinoma, Ductal, Breast/epidemiology
- Carcinoma, Ductal, Breast/ethnology
- Carcinoma, Ductal, Breast/pathology
- Carcinoma, Intraductal, Noninfiltrating/epidemiology
- Carcinoma, Intraductal, Noninfiltrating/pathology
- Female
- Humans
- Incidence
- Mammography/statistics & numerical data
- Middle Aged
- SEER Program
- United States/epidemiology
- White People/statistics & numerical data
- Young Adult
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Affiliation(s)
- Marc D Ryser
- Department of Population Health Sciences, Duke University Medical Center, Durham, North Carolina.
- Department of Mathematics, Duke University, Durham, North Carolina
| | - Laura H Hendrix
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - Mathias Worni
- Department of Visceral Surgery and Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yiling Liu
- Duke Center for Applied Genomics & Precision Medicine, Duke University Medical Center, Durham, North Carolina
| | - Terry Hyslop
- Department of Biostatistics & Bioinformatics, Duke University Medical Center, Durham, North Carolina
| | - E Shelley Hwang
- Department of Surgery, Division of Advanced Oncologic and GI Surgery, Duke University Medical Center, Durham, North Carolina
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Oeffinger KC, Ford JS, Moskowitz CS, Chou JF, Henderson TO, Hudson MM, Diller L, McDonald A, Ford J, Mubdi NZ, Rinehart D, Vukadinovich C, Gibson TM, Anderson N, Elkin EB, Garrett K, Rebull M, Leisenring W, Robison LL, Armstrong GT. Promoting Breast Cancer Surveillance: The EMPOWER Study, a Randomized Clinical Trial in the Childhood Cancer Survivor Study. J Clin Oncol 2019; 37:2131-2140. [PMID: 31260642 PMCID: PMC6698920 DOI: 10.1200/jco.19.00547] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The aim of the current study was to increase the uptake of screening mammography among high-risk women who were treated for a childhood cancer with chest radiotherapy. PATIENTS AND METHODS Two hundred four female survivors in the Childhood Cancer Survivor Study who were treated with chest radiotherapy with 20 Gy or greater, age 25 to 50 years, and without breast imaging in the past 24 months were randomly assigned 2:1 to receive a mailed informational packet followed by a tailored telephone-delivered brief motivational interview (intervention) versus an attention control. Primary outcome was the difference in the proportion of participants who completed a screening mammogram by 12 months as evaluated in an intent-to-treat analysis. Stratum-adjusted relative risk (RR) and 95% CI were estimated using the Cochran-Mantel-Haenszel method. Secondary outcomes included the completion of screening breast magnetic resonance imaging (MRI) and barriers to screening and moderating factors. RESULTS Women in the intervention group were significantly more likely than those in the control group to report a mammogram (45 [33.1%] of 136 v 12 [17.6%] of 68; RR, 1.9; 95% CI, 1.1 to 3.3). The intervention was more successful among women age 25 to 39 years (RR, 2.2; 95% CI, 1.1 to 4.7) than among those age 40 to 50 years (RR, 1.4; 95% CI, 0.6 to 3.2). The proportion of women who reported a breast MRI at 12 months was similar between the two groups: 16.2% (intervention) compared with 13.2% (control; RR, 1.2; 95% CI, 0.6 to 2.5). Primary barriers to completing a screening mammogram and/or breast MRI included lack of physician recommendation, deferred action by survivor, cost, and absence of symptoms. CONCLUSION Use of mailed materials followed by telephone-delivered counseling increased mammography screening rates in survivors at high risk for breast cancer; however, this approach did not increase the rate of breast MRI. Cost of imaging and physician recommendation were important barriers that should be addressed in future studies.
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Affiliation(s)
| | - Jennifer S Ford
- 2Hunter College, City University of New York, New York, NY.,3The Graduate Center of the City University of New York, New York, NY
| | | | - Joanne F Chou
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Lisa Diller
- 7Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | | | - James Ford
- 6St Jude Children's Research Hospital, Memphis, TN
| | - Nidha Z Mubdi
- 4Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | - Elena B Elkin
- 4Memorial Sloan Kettering Cancer Center, New York, NY
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Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2019; 69:184-210. [PMID: 30875085 DOI: 10.3322/caac.21557] [Citation(s) in RCA: 355] [Impact Index Per Article: 71.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, the current American Cancer Society cancer screening guidelines are summarized, and the most current data from the National Health Interview Survey are provided on the utilization of cancer screening for men and women and on the adherence of men and women to multiple recommended screening tests.
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Affiliation(s)
- Robert A Smith
- Vice-President, Cancer Screening, and Director, Center for Quality Cancer Screening and Research, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Kimberly S Andrews
- Director, Guidelines Process, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Debbie Saslow
- Senior Director, Human Papillomavirus-Related and Women's Cancers, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
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DeSantis CE, Miller KD, Goding Sauer A, Jemal A, Siegel RL. Cancer statistics for African Americans, 2019. CA Cancer J Clin 2019; 69:211-233. [PMID: 30762872 DOI: 10.3322/caac.21555] [Citation(s) in RCA: 480] [Impact Index Per Article: 96.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
In the United States, African American/black individuals bear a disproportionate share of the cancer burden, having the highest death rate and the lowest survival rate of any racial or ethnic group for most cancers. To monitor progress in reducing these inequalities, every 3 years the American Cancer Society provides the estimated number of new cancer cases and deaths for blacks in the United States and the most recent data on cancer incidence, mortality, survival, screening, and risk factors using data from the National Cancer Institute, the North American Association of Central Cancer Registries, and the National Center for Health Statistics. In 2019, approximately 202,260 new cases of cancer and 73,030 cancer deaths are expected to occur among blacks in the United States. During 2006 through 2015, the overall cancer incidence rate decreased faster in black men than in white men (2.4% vs 1.7% per year), largely due to the more rapid decline in lung cancer. In contrast, the overall cancer incidence rate was stable in black women (compared with a slight increase in white women), reflecting increasing rates for cancers of the breast, uterine corpus, and pancreas juxtaposed with declining trends for cancers of the lung and colorectum. Overall cancer death rates declined faster in blacks than whites among both males (2.6% vs 1.6% per year) and females (1.5% vs 1.3% per year), largely driven by greater declines for cancers of the lung, colorectum, and prostate. Consequently, the excess risk of overall cancer death in blacks compared with whites dropped from 47% in 1990 to 19% in 2016 in men and from 19% in 1990 to 13% in 2016 in women. Moreover, the black-white cancer disparity has been nearly eliminated in men <50 years and women ≥70 years. Twenty-five years of continuous declines in the cancer death rate among black individuals translates to more than 462,000 fewer cancer deaths. Continued progress in reducing disparities will require expanding access to high-quality prevention, early detection, and treatment for all Americans.
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Affiliation(s)
- Carol E DeSantis
- Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Kimberly D Miller
- Senior Associate Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Ann Goding Sauer
- Senior Associate Scientist, Surveillance and Health Services Research, Intramural Research, American Cancer Society, Atlanta, GA
| | - Ahmedin Jemal
- Vice President, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | - Rebecca L Siegel
- Scientific Director, Surveillance Research, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
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Hendrick RE, Baker JA, Helvie MA. Breast cancer deaths averted over 3 decades. Cancer 2019; 125:1482-1488. [DOI: 10.1002/cncr.31954] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 11/23/2018] [Accepted: 11/28/2018] [Indexed: 01/08/2023]
Affiliation(s)
- R. Edward Hendrick
- Department of Radiology University of Colorado School of Medicine Aurora Colorado
| | - Jay A. Baker
- Department of Radiology Duke University Medical Center Durham North Carolina
| | - Mark A. Helvie
- Department of Radiology and Rogel Cancer Center University of Michigan Health System Ann Arbor Michigan
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Zuley M. Author's Reply. J Am Coll Radiol 2019; 16:136-138. [PMID: 30717833 DOI: 10.1016/j.jacr.2018.12.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 12/20/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Margarita Zuley
- Department of Radiology, Division of Breast Imaging, University of Pittsburgh Medical Center, Magee Womens Hospital, 300 Halket St, Pittsburgh PA 15213.
| | -
- Department of Radiology, Division of Breast Imaging, University of Pittsburgh Medical Center, Magee Womens Hospital, 300 Halket St, Pittsburgh PA 15213
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Levine RS, Kilbourne BJ, Sanderson M, Fadden MK, Pisu M, Salemi JL, Mejia de Grubb MC, O’Hara H, Husaini BA, Zoorob RJ, Hennekens CH. Lack of validity of self-reported mammography data. Fam Med Community Health 2019; 7:e000096. [PMID: 32148699 PMCID: PMC6910732 DOI: 10.1136/fmch-2018-000096] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 01/06/2019] [Indexed: 11/04/2022] Open
Abstract
This qualitative literature review aimed to describe the totality of peer-reviewed scientific evidence from 1990 to 2017 concerning validity of self-reported mammography. This review included articles about mammography containing the words accuracy, validity, specificity, sensitivity, reliability or reproducibility; titles containing self-report, recall or patient reports, and breast or 'mammo'; and references of identified citations focusing on evaluation of 2-year self-reports. Of 45 publications meeting the eligibility criteria, 2 conducted in 1993 and 1995 at health maintenance organisations in Western USA which primarily served highly educated whites provided support for self-reports of mammography over 2 years. Methodological concerns about validity of self-reports included (1) telescoping, (2) biased overestimates particularly among black women, (3) failure to distinguish screening and diagnostic mammography, and (4) failure to address episodic versus consistent mammography use. The current totality of evidence supports the need for research to reconsider the validity of self-reported mammography data as well as the feasibility of alternative surveillance data sources to achieve the goals of the Healthy People Initiative.
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Affiliation(s)
- Robert S Levine
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Barbara J Kilbourne
- Department of Sociology, Tennessee State University, Nashville, Tennessee, USA
| | - Maureen Sanderson
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Mary K Fadden
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Maria Pisu
- University of Alabama School of Medicine at Birmingham, Birmingham, Alabama, USA
| | - Jason L Salemi
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | | | - Heather O’Hara
- Department of Family and Community Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Baqar A Husaini
- Department of Sociology, Tennessee State University, Nashville, Tennessee, USA
| | - Roget J Zoorob
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Charles H Hennekens
- Charles E Schmidt School of Medicine, Florida Atlantic University, Boca Raton, Florida, USA
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Wender RC, Brawley OW, Fedewa SA, Gansler T, Smith RA. A blueprint for cancer screening and early detection: Advancing screening's contribution to cancer control. CA Cancer J Clin 2019; 69:50-79. [PMID: 30452086 DOI: 10.3322/caac.21550] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.
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Affiliation(s)
- Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Department of Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Strategic Director of Pathology Research, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice-President, Cancer Screening, Cancer Control Department, and Director, Center for Quality Cancer Screening and Research, American Cancer Society Atlanta, GA
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Bhargava S, Moen K, Qureshi SA, Hofvind S. Mammographic screening attendance among immigrant and minority women: a systematic review and meta-analysis. Acta Radiol 2018; 59:1285-1291. [PMID: 29451023 DOI: 10.1177/0284185118758132] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Groups of immigrant and minority women are more often diagnosed with advanced stage breast cancer than other women. Mammographic screening aims to reduce mortality from breast cancer through early detection in asymptomatic women. Purpose To compare mammographic screening attendance among immigrant and minority women to that of other women. Material and Methods A literature search of PubMed, Embase, Google Scholar, and Cochrane identified 1369 papers published between January 1995 and March 2016. In the review, we included 33 studies investigating mammographic screening attendance among immigrant and/or minority women. In a meta-analysis, we included 19 of the studies that compared attendance among immigrant and/or minority women with that among other women, using a random effects model. Results The review included studies from Europe, North America, and Oceania, with 42,666,093 observations of opportunities for mammographic screening. Attendance was generally lower among immigrant and minority women compared to other women (46.2% vs. 55.0%; odds ratio = 0.64, 95% confidence interval = 0.56-0.73; P < 0.05, I2 = 99.9%). Non-Western immigrants had lower attendance rates than other immigrants. Conclusion Immigrant and minority women had lower mammographic screening attendance than other women, which could potentially put them at increased risk for more advanced breast cancer. This review emphasizes the importance of continued efforts to engage with the preventative health needs of diverse populations in attempts to achieve equality in access to, and use of, care.
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Affiliation(s)
- Sameer Bhargava
- Cancer Registry of Norway, Oslo, Norway
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Kåre Moen
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Samera Azeem Qureshi
- Norwegian Centre for Minority and Migrant Health Research, Oslo University Hospital, Oslo, Norway
| | - Solveig Hofvind
- Cancer Registry of Norway, Oslo, Norway
- Department of Life Sciences and Health, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Oslo, Norway
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Pappadis MR, Volk RJ, Krishnan S, Weller SC, Jaramillo E, Hoover DS, Giordano SH, Tan A, Sheffield KM, Housten AJ, Goodwin JS. Perceptions of overdetection of breast cancer among women 70 years of age and older in the USA: a mixed-methods analysis. BMJ Open 2018; 8:e022138. [PMID: 29903800 PMCID: PMC6009543 DOI: 10.1136/bmjopen-2018-022138] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES Current research on the perceptions of overdiagnosis or overdetection of breast cancer has largely been conducted outside of the USA and with women younger than 70 years.Therefore, we explored older women's perceptions about the concept of overdetection of breast cancer and its influence on future screening intentions. DESIGN Mixed-methods analysis using purposive sampling based on race/ethnicity, age and educational level. Semistructured interviews, including two hypothetical scenarios illustrating benefits and harms of screening and overdetection, were analysed using inductive and deductive thematic approaches. An inferential clustering technique was used to assess overall patterns in narrative content by sociodemographic characteristics, personal screening preferences or understanding of overdetection. SETTING Houston/Galveston, Texas, USA. PARTICIPANTS 59 English-speaking women aged 70 years and older with no prior history of breast cancer. RESULTS Very few women were familiar with the concept of overdetection and overtreatment. After the scenarios were presented, half of the women still demonstrated a lack of understanding of the concept of overdetection. Many women expressed suspicion of the concept, equating it to rationing. Women who showed understanding of overdetection were more likely to express an intent to discontinue screening, although 86% of the women stated that hearing about overdetection did not influence their screening decision. Themes identified did not differ by race/ethnicity, education, age or screening preferences. Differences were identified between women who understood overdetection and women who did not (r=0.23, p<0.001). CONCLUSIONS Many older women did not understand the concept of overdetection, in addition to being suspicious of or resistant to the concept. Providing older women with descriptions of overdetection may not be sufficient to influence screening intentions.
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Affiliation(s)
- Monique R Pappadis
- Division of Rehabilitation Sciences, School of Health Professions, The University of Texas Medical Branch, Galveston, Texas, USA
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Robert J Volk
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Shilpa Krishnan
- Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Susan C Weller
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Preventive Medicine and Community Health, The University of Texas Medical Branch, Galveston, USA
- Department of Family Medicine, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Elizabeth Jaramillo
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Internal Medicine and Division of Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
| | - Diana Stewart Hoover
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Sharon H Giordano
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
- Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Alai Tan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Kristin M Sheffield
- Global Patient Outcomes and Real World Evidence, Eli Lilly and Company, Indianapolis, Indiana, USA
| | - Ashley J Housten
- Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - James S Goodwin
- Sealy Center on Aging, The University of Texas Medical Branch, Galveston, Texas, USA
- Department of Internal Medicine and Division of Geriatrics, The University of Texas Medical Branch, Galveston, Texas, USA
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Alagoz O, Ergun MA, Cevik M, Sprague BL, Fryback DG, Gangnon RE, Hampton JM, Stout NK, Trentham-Dietz A. The University of Wisconsin Breast Cancer Epidemiology Simulation Model: An Update. Med Decis Making 2018; 38:99S-111S. [PMID: 29554470 PMCID: PMC5862066 DOI: 10.1177/0272989x17711927] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The University of Wisconsin Breast Cancer Epidemiology Simulation Model (UWBCS), also referred to as Model W, is a discrete-event microsimulation model that uses a systems engineering approach to replicate breast cancer epidemiology in the US over time. This population-based model simulates the lifetimes of individual women through 4 main model components: breast cancer natural history, detection, treatment, and mortality. A key feature of the UWBCS is that, in addition to specifying a population distribution in tumor growth rates, the model allows for heterogeneity in tumor behavior, with some tumors having limited malignant potential (i.e., would never become fatal in a woman's lifetime if left untreated) and some tumors being very aggressive based on metastatic spread early in their onset. The model is calibrated to Surveillance, Epidemiology, and End Results (SEER) breast cancer incidence and mortality data from 1975 to 2010, and cross-validated against data from the Wisconsin cancer reporting system. The UWBCS model generates detailed outputs including underlying disease states and observed clinical outcomes by age and calendar year, as well as costs, resource usage, and quality of life associated with screening and treatment. The UWBCS has been recently updated to account for differences in breast cancer detection, treatment, and survival by molecular subtypes (defined by ER/HER2 status), to reflect the recent advances in screening and treatment, and to consider a range of breast cancer risk factors, including breast density, race, body-mass-index, and the use of postmenopausal hormone therapy. Therefore, the model can evaluate novel screening strategies, such as risk-based screening, and can assess breast cancer outcomes by breast cancer molecular subtype. In this article, we describe the most up-to-date version of the UWBCS.
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Affiliation(s)
- Oguzhan Alagoz
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI
| | - Mehmet Ali Ergun
- Department of Industrial and Systems Engineering, University of Wisconsin-Madison, Madison, WI
| | | | - Brian L Sprague
- Department of Surgery and University of Vermont Cancer Center, University of Vermont, Burlington, VT
| | - Dennis G Fryback
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI
| | - Ronald E Gangnon
- Department of Population Health Sciences and Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI
| | - John M Hampton
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
| | - Natasha K Stout
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA
| | - Amy Trentham-Dietz
- Department of Population Health Sciences and Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI
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Nandam N, Gaebler-Spira D, Byrne R, Wolfman J, Reis JP, Hung CW, Todd A, Durkin J, Marciniak C. Breast cancer screening in women with cerebral palsy: Could care delivery be improved? Disabil Health J 2018; 11:435-441. [PMID: 29500093 DOI: 10.1016/j.dhjo.2018.02.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 02/09/2018] [Accepted: 02/14/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with disabilities (WWD) have reported lower mammography rates than the general population, however rates for women with cerebral palsy (CP) have not been specifically studied. OBJECTIVE To evaluate mammography rates in women with CP and to identify strengths and barriers with their screening experience. METHODS Women with CP 40 years or older (n = 118) participating in a prospective cross-sectional survey were queried regarding screening status, imaging modality, and accommodation needs and availability. Categorical variables were summarized and Chi-square testing used to assess factors contributing to screening compliance. The effect of functional factors on screening was evaluated using logistic regression. RESULTS 77 women (65.3%) had mammograms within the past two years; 56 (47.5%) were screening mammograms. Severity of fine motor deficits was associated with lack of screening (OR 0.559, p = 0.019). 85 (72.0%) experienced positive staff attitudes. Facilities most often met needs for ramps, elevators, and/or wide doorways (92.9%), exam explanations (84.4%), and accessible parking (82.5%). Needs least often met included accommodations for standing (59.3%) or for difficulties with arm/shoulder positioning (57.1%), and wheelchair-accessible mammogram machines (59.1%). CONCLUSIONS The screening compliance rate for women with CP is low, although the 2-year mammography rate is comparable to that reported for WWD and the general female U.S. POPULATION Women were usually offered respectful care. Adequate physical accommodations during the procedure were reported less often than overall facility environmental accommodations. These findings demonstrate the need for improved screening rates in women with CP, and highlight areas for improving their screening experience.
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Affiliation(s)
- Neeharika Nandam
- Northwestern University Feinberg School of Medicine, 420 E. Superior St., Chicago, IL 60611, USA
| | - Deborah Gaebler-Spira
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E. Chicago Avenue #86, Chicago, IL 606111, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Rachel Byrne
- Cerebral Palsy Foundation, 3 Columbus Circle, 15th Floor, New York, NY 10019, USA; Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Judith Wolfman
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., Suite 800, Chicago, IL 60611, USA; Lynn Sage Breast Center, 250 E. Superior St., Chicago, IL 60611, USA
| | - Judy Panko Reis
- Access Living, 115 West Chicago Avenue, Chicago, IL 60654, USA
| | - Chun Wai Hung
- Division of Pediatric Orthopedics, Columbia University Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital, 3959 Broadway, Room 800N, New York, NY 10032, USA
| | - Allison Todd
- Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA
| | - Jordyn Durkin
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, 676 N. St. Clair St., 14th Floor, Chicago, IL 60611, USA
| | - Christina Marciniak
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, 710 North Lake Shore Drive, #1022, Chicago, IL 60611, USA; Shirley Ryan AbilityLab, 355 East Erie Street, Chicago, IL 60611, USA; Department of Neurology, Northwestern University Feinberg School of Medicine, 303 East Chicago Avenue, Ward 12-140, Chicago, IL 60611, USA.
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Current Issues in the Overdiagnosis and Overtreatment of Breast Cancer. AJR Am J Roentgenol 2018; 210:285-291. [DOI: 10.2214/ajr.17.18629] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Wagaw F, Okoro CA, Kim S, Park J, Rachman F. Linking Data From Health Surveys and Electronic Health Records: A Demonstration Project in Two Chicago Health Center Clinics. Prev Chronic Dis 2018; 15:E09. [PMID: 29346063 PMCID: PMC5774304 DOI: 10.5888/pcd15.170085] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Introduction Monitoring and understanding population health requires conducting health-related surveys and surveillance. The objective of our study was to assess whether data from self-administered surveys could be collected electronically from patients in urban, primary-care, safety-net clinics and subsequently linked and compared with the same patients’ electronic health records (EHRs). Methods Data from self-administered surveys were collected electronically from a convenience sample of 527 patients at 2 Chicago health centers from September through November, 2014. Survey data were linked to EHRs. Results A total of 251 (47.6%) patients who completed the survey consented to having their responses linked to their EHRs. Consenting participants were older, more likely to report fair or poor health, and took longer to complete the survey than those who did not consent. For 8 of 18 categorical variables, overall percentage of agreement between survey data and EHR data exceeded 80% (sex, race/ethnicity, pneumococcal vaccination, self-reported body mass index [BMI], diabetes, high blood pressure, medication for high blood pressure, and hyperlipidemia), and of these, the level of agreement was good or excellent (κ ≥0.64) except for pneumococcal vaccination (κ = 0.40) and hyperlipidemia (κ = 0.47). Of 7 continuous variables, agreement was substantial for age and weight (concordance coefficients ≥0.95); however, with the exception of calculated survey BMI and EHR–BMI (concordance coefficient = 0.88), all other continuous variables had poor agreement. Conclusions Self-administered and web-based surveys can be completed in urban, primary-care, safety-net clinics and linked to EHRs. Linking survey and EHR data can enhance public health surveillance by validating self-reported data, completing gaps in patient data, and extending sample sizes obtained through current methods. This approach will require promoting and sustaining patient involvement.
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Affiliation(s)
- Fikirte Wagaw
- Alliance of Chicago Community Health Services, Chicago, Illinois.,Chicago Department of Public Health, 333 S. State St, 2nd Floor, Chicago, IL 60604.
| | - Catherine A Okoro
- Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jessica Park
- Alliance of Chicago Community Health Services, Chicago, Illinois
| | - Fred Rachman
- Alliance of Chicago Community Health Services, Chicago, Illinois
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Jemal A, Robbins AS, Lin CC, Flanders WD, DeSantis CE, Ward EM, Freedman RA. Factors That Contributed to Black-White Disparities in Survival Among Nonelderly Women With Breast Cancer Between 2004 and 2013. J Clin Oncol 2018; 36:14-24. [DOI: 10.1200/jco.2017.73.7932] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Purpose To estimate the contribution of differences in demographics, comorbidity, insurance, tumor characteristics, and treatment to the overall mortality disparity between nonelderly black and white women diagnosed with early-stage breast cancer. Patients and Methods Excess relative risk of all-cause death in black versus white women diagnosed with stage I to III breast cancer, expressed as a percentage and stratified by hormone receptor status for each variable (demographics, comorbidity, insurance, tumor characteristics, and treatment) in sequentially, propensity-scored, optimally matched patients by using multivariable hazard ratios (HRs). Results We identified 563,497 white and black women 18 to 64 years of age diagnosed with stage I to III breast cancer from 2004 to 2013 in the National Cancer Data Base. Among women with hormone receptor–positive disease, who represented 78.5% of all patients, the HR for death in black versus white women in the demographics-matched model was 2.05 (95% CI, 1.94 to 2.17). The HR decreased to 1.93 (95% CI, 1.83 to 2.04), 1.54 (95% CI, 1.47 to 1.62), 1.30 (95% CI, 1.24 to 1.36), and 1.25 (95% CI, 1.19 to 1.31) when sequentially matched for comorbidity, insurance, tumor characteristics, and treatment, respectively. These factors combined accounted for 76.3% of the total excess risk of death in black patients; insurance accounted for 37.0% of the total excess, followed by tumor characteristics (23.2%), comorbidities (11.3%), and treatment (4.8%). Results generally were similar among women with hormone receptor–negative disease, although the HRs were substantially smaller. Conclusion Matching by insurance explained one third of the excess risk of death among nonelderly black versus white women diagnosed with early-stage breast cancer; matching by tumor characteristics explained approximately one fifth of the excess risk. Efforts to focus on equalization of access to care could substantially reduce ethnic/racial disparities in overall survival among nonelderly women diagnosed with breast cancer.
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Affiliation(s)
- Ahmedin Jemal
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - Anthony S. Robbins
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - Chun Chieh Lin
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - W. Dana Flanders
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - Carol E. DeSantis
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - Elizabeth M. Ward
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
| | - Rachel A. Freedman
- Ahmedin Jemal, Anthony S. Robbins, Chun Chieh Lin, Carol E. DeSantis, and Elizabeth M. Ward, American Cancer Society; W. Dana Flanders, Emory University, Atlanta, GA; and Rachel A. Freedman, Dana-Farber Cancer Institute, Boston, MA
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