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Zhang Z, Curran G, Xu K, Lim JY, Farris PE, Shannon J. Identify factors for insufficient (> 2 yr) mammogram screening among Oregonian women. Cancer Causes Control 2022; 33:293-301. [PMID: 34993663 DOI: 10.1007/s10552-021-01529-8] [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: 11/02/2020] [Accepted: 11/25/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE Women with breast cancer diagnosed from mammogram screenings have a lower mortality risk than women diagnosed from symptoms. Currently, the U.S Preventive Services Task Force recommends biannual screening for women aged 50-74 years old. In this study, we aimed to identify factors associated with inadequate screening defined as "no mammogram screening within past 2 years" to guide cancer prevention and early detection efforts. METHODS This study utilized area-based probabilistic sampling survey data, collected across Oregon in 2019. Dataset weights were calculated using a raking approach. Demographic and behavior information were collected with existing validated questionnaire items from national surveys. Weighted multivariable logistic regression analyses with missing-value imputations were conducted to identify factors associated with inadequate mammogram screening. RESULTS The study included 254 women 50-74 years old without previous breast or ovarian cancer history. 19.29% of the sample reported no mammogram within two years, including 1.57% with no previous mammograms. Following unadjusted analyses, the significant factors included education, occupation status, health insurance and smoking and were therefore included into the adjusted model. In the multivariate adjusted model education remained significant while occupation status, health insurance and smoking were no longer significant. Compared to women with a college graduate degree, women with less than college graduate degree were at higher risk of inadequate screening [OR (95% CI) = 3.23 (1.54, 6.74)]. CONCLUSIONS Lack of education was significantly associated with inadequate mammogram screening even after adjusting for occupation status, health insurance and smoking, which should prompt further outreach and education.
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Affiliation(s)
- Zhenzhen Zhang
- Division of Oncological Sciences, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA.
| | - Grace Curran
- Cancer Early Detection Advanced Research, Knight Cancer Institute, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Kenneth Xu
- Department of Psychology, Tulane University, 6400 Freret St., 2007 Percival Stern Hall, New Orleans, LA, 70118, USA
| | - Jeong Youn Lim
- Biostatistics Shared Resources, Knight Cancer Institute, Oregon Health & Science University, Portland, OR, 97239, USA
| | - Paige E Farris
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
| | - Jackilen Shannon
- OHSU-PSU School of Public Health, 3181 SW Sam Jackson Park Road, Portland, OR, 97239, USA
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Bao H, Wang L, Brown M, Zhang M, Hunt K, Di J, Zhao Z, Cong S, Fan J, Fang L, Wang L. A nationally quasi-experimental study to assess the impact of partial organized breast and cervical cancer screening programme on participation and inequalities. BMC Cancer 2020; 20:1191. [PMID: 33276761 PMCID: PMC7716588 DOI: 10.1186/s12885-020-07686-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 11/24/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Organized breast and cervical cancer screening programme could only provide services at no cost for a fraction of socioeconomic-deprived women in China and other low-resource countries, however, little evidence exists for whether such a programme effectively affect the participation and inequalities at the population level. METHODS We used individual-level data from a nationally cross-sectional survey in 2014-2015 for breast and cervical cancer screening participation. Data for intervention and comparison grouping were from 2009 to 2014 national breast and cervical cancer screening programme, and counties covered by the programme were divided into intervention group. We assessed the impact of the intervention on the participation rates and the magnitude of inequalities with two approaches: multivariable multilevel logistic regressions adjusting for individual- and region-level covariates; and a difference analysis combined with propensity score matching that estimated the average intervention effect. RESULTS Of 69,875 included women aged 35-64 years, 21,620 were classified into the intervention group and 43,669 into the comparison group for breast cancer screening; and 31,794 into the intervention group, and 33,682 into the comparison group for cervical cancer screening. Participation rate was higher in intervention group than comparison group for breast cancer screening (25.3, 95% confidential interval [CI], 22.8-27.7%, vs 19.1, 17.4-20.7%), and cervical cancer screening (25.7, 23.8-27.7%, vs 21.5, 19.6-23.5%), respectively. Intervention significantly increased the likelihood of participation for both breast cancer and cervical cancer screening in overall women, rural women and urban women, whereas the effect was significantly higher in rural women than urban women. The average intervention effect on the participation rate was an increase of 7.5% (6.7-8.2%) for breast cancer screening, and 6.8% (6.1-7.5%) for cervical cancer screening, respectively. The inequalities were significantly decreased by 37-41% (P < 0.001) between rural and urban, however, were slightly decreased or even increased in terms of age, education status, and household income. CONCLUSIONS Organized breast and cervical cancer screening programme targeting for a fraction of women could increase the participation rates at population level, however, it could not significantly affect socioeconomic-introduced inequalities. Further studies are need to conduct time-series analyses and strengthen the causal correlation.
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Affiliation(s)
- Heling Bao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Limin Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Matthew Brown
- Center for Global Health, China Office, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - Mei Zhang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Katherine Hunt
- Susan G. Komen, 5005 LBJ Freeway, Suite 526, Dallas, TX, 75244, USA
| | - Jiangli Di
- National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, 12 Dahuisi Road, Haidian District, Beijing, 100081, China
| | - Zhenping Zhao
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Shu Cong
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Jing Fan
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Liwen Fang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China
| | - Linhong Wang
- National Center for Chronic and Non-communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, 27 Nanwei Road, Xicheng District, Beijing, 100050, China.
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Richman AR, Torres E, Wu Q, Kampschroeder AP. Evaluating a Community-Based Breast Cancer Prevention Program for Rural Underserved Latina and Black Women. J Community Health 2020; 45:1205-1210. [PMID: 32529466 DOI: 10.1007/s10900-020-00856-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Persistent racial and ethnic disparities and rural-urban disparities in breast cancer mortality in North Carolina require attention. The Pitt County Breast Wellness Initiative-Education (PCBWI-E) provided culturally tailored breast cancer education and navigation to age-appropriate screening services (mammography and clinical breast exams) for uninsured and underinsured Black and Latina women age 25 and older in two rural counties in North Carolina (Pitt and Edgecombe Counties). Using a lay health model, the PCBWI-E trained 23 community members and public health undergraduate students as lay breast health educators. Breast health educators educated 735 women across the 2-year program. Baseline knowledge about breast health was low at year 1 and 2 (mean knowledge score = 59%, SD = 0.21 and 57%, SD = 0.22, respectively) and was higher at follow-up post-intervention for both years 1 and 2 (mean knowledge score = 78%, SD = 0.18 and 75%, SD = 0.19, respectively) (p < 0.001). In terms of navigation, almost three-quarters (72%) of those recommended to receive a mammogram, received one. Of the population served by the PCBWI-E who were aged 40 and above, 34% had never received a mammogram. Of those women who had never received a mammogram, 68% received one through the PCBWI-E program. The PCBWI-E was successful in increasing both breast health knowledge and access to age-appropriate breast cancer screening among uninsured and underserved Latina and Black women in rural eastern North Carolina. Future efforts should support the large-scale implementation of successful evidence-based culturally appropriate models like this one in the reduction of racial, ethnic, and rural breast cancer disparities.
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Affiliation(s)
- Alice R Richman
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA.
| | - Essie Torres
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA
| | - Qiang Wu
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Health Sciences Building, Greenville, NC, USA
| | - Amy P Kampschroeder
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 3107 Carol Belk Building, Greenville, NC, 27858, USA
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4
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Kurani SS, McCoy RG, Lampman MA, Doubeni CA, Finney Rutten LJ, Inselman JW, Giblon RE, Bunkers KS, Stroebel RJ, Rushlow D, Chawla SS, Shah ND. Association of Neighborhood Measures of Social Determinants of Health With Breast, Cervical, and Colorectal Cancer Screening Rates in the US Midwest. JAMA Netw Open 2020; 3:e200618. [PMID: 32150271 PMCID: PMC7063513 DOI: 10.1001/jamanetworkopen.2020.0618] [Citation(s) in RCA: 140] [Impact Index Per Article: 35.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 01/18/2020] [Indexed: 01/22/2023] Open
Abstract
Importance Despite advances in cancer treatment and cancer-related outcomes, disparities in cancer mortality remain. Lower rates of cancer prevention screening and consequent delays in diagnosis may exacerbate these disparities. Better understanding of the association between area-level social determinants of health and cancer screening may be helpful to increase screening rates. Objective To examine the association between area deprivation, rurality, and screening for breast, cervical, and colorectal cancer in patients from an integrated health care delivery system in 3 US Midwest states (Minnesota, Iowa, and Wisconsin). Design, Setting, and Participants In this cross-sectional study of adults receiving primary care at 75 primary care practices in Minnesota, Iowa, and Wisconsin, rates of recommended breast, cervical, and colorectal cancer screening completion were ascertained using electronic health records between July 1, 2016, and June 30, 2017. The area deprivation index (ADI) is a composite measure of social determinants of health composed of 17 US Census indicators and was calculated for all census block groups in Minnesota, Iowa, and Wisconsin (11 230 census block groups). Rurality was defined at the zip code level. Using multivariable logistic regression, this study examined the association between the ADI, rurality, and completion of cancer screening after adjusting for age, Charlson Comorbidity Index, race, and sex (for colorectal cancer only). Main Outcomes and Measures Completion of recommended breast, cervical, and colorectal cancer screening. Results The study cohorts were composed of 78 302 patients eligible for breast cancer screening (mean [SD] age, 61.8 [7.1] years), 126 731 patients eligible for cervical cancer screening (mean [SD] age, 42.6 [13.2] years), and 145 550 patients eligible for colorectal cancer screening (mean [SD] age, 62.4 [7.0] years; 52.9% [77 048 of 145 550] female). The odds of completing recommended screening were decreased for individuals living in the most deprived (highest ADI) census block group quintile compared with the least deprived (lowest ADI) quintile: the odds ratios were 0.51 (95% CI, 0.46-0.57) for breast cancer, 0.58 (95% CI, 0.54-0.62) for cervical cancer, and 0.57 (95% CI, 0.53-0.61) for colorectal cancer. Individuals living in rural areas compared with urban areas also had lower rates of cancer screening: the odds ratios were 0.76 (95% CI, 0.72-0.79) for breast cancer, 0.81 (95% CI, 0.79-0.83) for cervical cancer, and 0.93 (95% CI, 0.91-0.96) for colorectal cancer. Conclusions and Relevance Individuals living in areas of greater deprivation and rurality had lower rates of recommended cancer screening, signaling the need for effective intervention strategies that may include improved community partnerships and patient engagement to enhance access to screening in highest-risk populations.
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Affiliation(s)
- Shaheen S. Kurani
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rozalina G. McCoy
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Michelle A. Lampman
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Chyke A. Doubeni
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
- Center for Health Equity and Community Engagement Research, Mayo Clinic, Rochester, Minnesota
| | - Lila J. Finney Rutten
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Jonathan W. Inselman
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Rachel E. Giblon
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Kari S. Bunkers
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle
| | - Robert J. Stroebel
- Division of Community Internal Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - David Rushlow
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota
| | - Sagar S. Chawla
- Department of Orthopaedics and Sports Medicine, University of Washington, Seattle
| | - Nilay D. Shah
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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Justice MF, King KA, Vidourek RA, Merianos AL. Breast Cancer Knowledge Among College Students: Influencing Factors and Resultant Behaviors. AMERICAN JOURNAL OF HEALTH EDUCATION 2018. [DOI: 10.1080/19325037.2017.1414645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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6
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Preventing premature deaths from breast and cervical cancer among underserved women in the United States: insights gained from a national cancer screening program. Cancer Causes Control 2015; 26:805-9. [PMID: 25783456 DOI: 10.1007/s10552-015-0541-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Accepted: 02/20/2015] [Indexed: 02/05/2023]
Abstract
This commentary highlights some of the valuable insights gained from a special collection of papers that utilized data from the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and appear in this special issue. The data and experiences of the NBCCEDP can inform the identification of new opportunities and directions for meeting the cancer screening needs of underserved women in a complex and changing health care environment.
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Documet P, Bear TM, Flatt JD, Macia L, Trauth J, Ricci EM. The association of social support and education with breast and cervical cancer screening. HEALTH EDUCATION & BEHAVIOR 2015; 42:55-64. [PMID: 25394824 PMCID: PMC4526257 DOI: 10.1177/1090198114557124] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Disparities in breast and cervical cancer screening by socioeconomic status persist in the United States. It has been suggested that social support may facilitate screening, especially among women of low socioeconomic status. However, at present, it is unclear whether social support enables mammogram and Pap test compliance. PURPOSE This study examines the association between social support and compliance with mammogram and Pap test screening guidelines, and whether social support provides added value for women of low education. METHOD Data were from a countywide 2009-2010 population-based survey, which included records of 2,588 women 40 years and older (mammogram) and 2,123 women 21 to 65 years old (Pap test). Compliance was determined using the guidelines in effect at the time of data collection. RESULTS Social support was significantly related to mammogram (adjusted odds ratio = 1.43; 95% confidence interval [1.16, 1.77]) and Pap test (adjusted odds ratio = 1.71; 95% confidence interval [1.27, 2.29]) compliance after controlling for age, race, having a regular health care provider, and insurance status. The interaction between social support and education had a significant effect on Pap test compliance only among women younger than 40; the effect was not significant for mammogram compliance. CONCLUSION Social support is associated with breast and cervical cancer screening compliance. The association between education and cancer screening behavior may be moderated by social support; however, results hold only for Pap tests among younger women. Practitioners and researchers should focus on interventions that activate social support networks as they may help increase both breast and cervical cancer screening compliance among women with low educational attainment.
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Affiliation(s)
| | - Todd M Bear
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Laura Macia
- University of Pittsburgh, Pittsburgh, PA, USA
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Kamdje AHN, Etet PFS, Vecchio L, Tagne RS, Amvene JM, Muller JM, Krampera M, Lukong KE. New targeted therapies for breast cancer: A focus on tumor microenvironmental signals and chemoresistant breast cancers. World J Clin Cases 2014; 2:769-86. [PMID: 25516852 PMCID: PMC4266825 DOI: 10.12998/wjcc.v2.i12.769] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 07/12/2014] [Accepted: 09/23/2014] [Indexed: 02/05/2023] Open
Abstract
Breast cancer is the most frequent female malignancy worldwide. Current strategies in breast cancer therapy, including classical chemotherapy, hormone therapy, and targeted therapies, are usually associated with chemoresistance and serious adverse effects. Advances in our understanding of changes affecting the interactome in advanced and chemoresistant breast tumors have provided novel therapeutic targets, including, cyclin dependent kinases, mammalian target of rapamycin, Notch, Wnt and Shh. Inhibitors of these molecules recently entered clinical trials in mono- and combination therapy in metastatic and chemo-resistant breast cancers. Anticancer epigenetic drugs, mainly histone deacetylase inhibitors and DNA methyltransferase inhibitors, also entered clinical trials. Because of the complexity and heterogeneity of breast cancer, the future in therapy lies in the application of individualized tailored regimens. Emerging therapeutic targets and the implications for personalized-based therapy development in breast cancer are herein discussed.
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Plescia M, Wong F, Pieters J, Joseph D. The National Breast and Cervical Cancer Early Detection Program in the era of health reform: a vision forward. Cancer 2014; 120 Suppl 16:2620-4. [PMID: 25099907 DOI: 10.1002/cncr.28826] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 03/10/2014] [Indexed: 11/12/2022]
Abstract
For the last 22 years, the Centers for Disease Control and Prevention (CDC) National Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided high quality breast and cervical cancer screening to women who do not have health insurance or who have inadequate insurance. As the health care landscape changes, it is time for CDC to address new identified needs and opportunities to increase cancer screening and to further explore new or expanded roles for the program looking to the future. The NBCCEDP is well positioned to build upon its experience, established clinical and community partnerships, and success in serving disadvantaged and diverse populations to address important barriers to cancer screening that will persist as health reform is implemented. Additionally, the program can adapt its extensive experience with establishing and managing an organized system of delivering cancer screening and apply it to promote a more organized approach to screening through health care systems on a population level. Emphasis is placed on the implementation of evidenced-based interventions proven effective in increasing cancer screening rates, promising practices and other organizational policy and health systems interventions.
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Affiliation(s)
- Marcus Plescia
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Smith JL. Capsule commentary on Davis et al., Improving mammography screening among the medically underserved. J Gen Intern Med 2014; 29:652. [PMID: 24464284 PMCID: PMC3965729 DOI: 10.1007/s11606-013-2761-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Judith Lee Smith
- Centers for Disease Control and Prevention, Atlanta, GA, 30341, USA,
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Brown ML, Klabunde CN, Cronin KA, White MC, Richardson LC, McNeel TS. Challenges in meeting Healthy People 2020 objectives for cancer-related preventive services, National Health Interview Survey, 2008 and 2010. Prev Chronic Dis 2014; 11:E29. [PMID: 24576396 PMCID: PMC3938963 DOI: 10.5888/pcd11.130174] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Introduction Healthy People (HP) is the US program that formulates and tracks national health objectives for the nation. The National Health Interview Survey (NHIS) is a designated data source for setting and evaluating several HP targets in cancer. We used data from the 2008 and 2010 NHIS to provide a benchmark for national performance toward meeting HP 2020 cancer-related objectives. Methods HP 2020 cancer screening, provider counseling, and health care access objectives were selected. For each objective, NHIS measures for the overall population and several sociodemographic subgroups were calculated; the findings were compared with established HP 2020 targets. Results From 2008 to 2010, rates of breast and cervical cancer screening declined slightly while colorectal cancer screening rates increased by 7 percentage points. Rates of cancer screening and provider counseling were below HP targets. Meeting HP targets seems less likely for subgroups characterized by low income, no health insurance, or no usual source of care. Meeting HP targets for access to health services will require an increase of 18 percentage points in the proportion of persons under age 65 with health insurance coverage and an increase of 10 percentage points in the proportion aged 18 to 64 with a usual source of care. Conclusion Whether HP objectives for cancer screening and health care access are met may depend on implementation of health care reform measures that improve access to and coordination of care. Better integration of clinical health care and community-based efforts for delivering high-quality screening and treatment services and elimination of health disparities are also needed.
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Affiliation(s)
| | | | | | - Mary C White
- Centers for Disease Control and Prevention, Atlanta, Georgia
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