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Pleasant V. A Public Health Emergency: Breast Cancer Among Black Communities in the United States. Obstet Gynecol Clin North Am 2024; 51:69-103. [PMID: 38267132 DOI: 10.1016/j.ogc.2023.11.001] [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] [Indexed: 01/26/2024]
Abstract
While Black people have a similar incidence of breast cancer compared to White people, they have a 40% increased death rate. Black people are more likely to be diagnosed with aggressive subtypes such as triple-negative breast cancer. However, despite biological factors, systemic racism and social determinants of health create delays in care and barriers to treatment. While genetic testing holds incredible promise for Black people, uptake remains low and results may be challenging to interpret. There is a need for more robust, multidisciplinary, and antiracist interventions to reverse breast cancer-related racial disparities.
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Affiliation(s)
- Versha Pleasant
- Department of Obstetrics and Gynecology, Cancer Genetics & Breast Health Clinic, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA.
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Elmohr MM, Javed Z, Dubey P, Jordan JE, Shah L, Nasir K, Rohren EM, Lincoln CM. Social Determinants of Health Framework to Identify and Reduce Barriers to Imaging in Marginalized Communities. Radiology 2024; 310:e223097. [PMID: 38376404 PMCID: PMC10902599 DOI: 10.1148/radiol.223097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 09/20/2023] [Accepted: 09/25/2023] [Indexed: 02/21/2024]
Abstract
Social determinants of health (SDOH) are conditions influencing individuals' health based on their environment of birth, living, working, and aging. Addressing SDOH is crucial for promoting health equity and reducing health outcome disparities. For conditions such as stroke and cancer screening where imaging is central to diagnosis and management, access to high-quality medical imaging is necessary. This article applies a previously described structural framework characterizing the impact of SDOH on patients who require imaging for their clinical indications. SDOH factors can be broadly categorized into five sectors: economic stability, education access and quality, neighborhood and built environment, social and community context, and health care access and quality. As patients navigate the health care system, they experience barriers at each step, which are significantly influenced by SDOH factors. Marginalized communities are prone to disparities due to the inability to complete the required diagnostic or screening imaging work-up. This article highlights SDOH that disproportionately affect marginalized communities, using stroke and cancer as examples of disease processes where imaging is needed for care. Potential strategies to mitigate these disparities include dedicating resources for clinical care coordinators, transportation, language assistance, and financial hardship subsidies. Last, various national and international health initiatives are tackling SDOH and fostering health equity.
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Affiliation(s)
- Mohab M. Elmohr
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Zulqarnain Javed
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Prachi Dubey
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - John E. Jordan
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Lubdha Shah
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Khurram Nasir
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Eric M. Rohren
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
| | - Christie M. Lincoln
- From the Department of Radiology, Baylor College of Medicine, Houston, 1 Baylor Plaza, BCM 360, Houston, TX 77030 (M.M.E., E.M.R.); Division of Health Equity and Disparities Research, Center for Outcomes Research, Houston Methodist Hospital, Houston, Tex (Z.J., K.N.); Houston Radiology Associates, Houston Methodist Hospital, Houston, Tex (P.D.); ACR Commission on Neuroradiology, American College of Radiology, Reston, Va (J.E.J.); Department of Radiology, Division of Neuroimaging and Neurointervention, Stanford University School of Medicine, Stanford, Calif (J.E.J.); Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (L.S.); Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Tex (K.N.); Center for Cardiovascular Computational Health & Precision Medicine (C3-PH), Houston Methodist Hospital, Houston, Tex (K.N.); and Department of Neuroradiology, Division of Diagnostic Imaging, MD Anderson Cancer Center, Houston, Tex (C.M.L.)
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Liu Z, Shan Y, Kuo YF, Giordano SH. Rural racial disparities and barriers in mammography utilization among Medicare beneficiaries in Texas: A longitudinal study. Geriatr Nurs 2024; 55:14-20. [PMID: 37967477 PMCID: PMC10976317 DOI: 10.1016/j.gerinurse.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/17/2023]
Abstract
This study examined rural racial/ethnic disparities in long-term mammography screening practices among Medicare beneficiaries. A retrospective longitudinal study was conducted using 100% Texas Medicare data for women aged 65-74 who enrolled in Medicare between 2010-2013. Of the 114,939 eligible women, 21.2% of Hispanics, 33.3% of non-Hispanic Blacks (NHB), and 38.4% non-Hispanic Whites (NHW) in rural areas were regular users of mammography, compared to 33.5%, 44.9%, and 45.3% of their counterparts in urban areas, respectively. Stratification analyses showed rural Hispanics and NHB were 33% (95% CI, 25% - 40%) and 22% (95% CI, 6% - 36%) less likely to be regular users of mammography compared to their urban counterparts. Major barriers to routine mammography screening included the lack of a primary care provider, frequent hospitalization, and comorbidity. The findings of this study highlight the importance of addressing rural racial disparities in mammography utilization among older women to ensure equitable screening practices for all populations.
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Affiliation(s)
- Zhaoli Liu
- College of Nursing and Health Innovation, The University of Texas at Arlington, Texas, United States.
| | - Yong Shan
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Yong-Fang Kuo
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch, Galveston, Texas, United States
| | - Sharon H Giordano
- Departments of Health Services Research and Breast Medical Oncology, MD Anderson Cancer Center, The University of Texas, Houston, Texas, United States
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Zhang X, Elsaid MI, DeGraffinreid C, Champion VL, Paskett ED. Impact of the COVID-19 Pandemic on Cancer Screening Delays. J Clin Oncol 2023; 41:3194-3202. [PMID: 36735899 PMCID: PMC10256430 DOI: 10.1200/jco.22.01704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 11/29/2022] [Accepted: 01/06/2023] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To examine delays in cancer screenings during the COVID-19 pandemic. METHODS Participants from previous studies (N = 32,989) with permissions to be recontacted were invited to complete a survey between June and November 2020. Participants (n = 7,115) who met the age range for cancer screenings were included. Participants were asked if they planned to have and then if they postponed a scheduled mammogram, Pap test, stool blood test, colonoscopy, or human papillomavirus (HPV) test. Logistic regression was used to determine the factors associated with cancer screening delays for each planned test. RESULTS The average age was 57.3 years, 75% were female, 89% were non-Hispanic White, 14% had public insurance, and 34% lived in rural counties. Those who planned cancer screenings (n = 4,266, 60%) were younger, more likely to be female, with higher education, had private insurance, and lived in rural counties. Specifically, 24% delayed a mammogram (n = 732/2,986), 27% delayed a Pap test (n = 448/1,651), 27% delayed an HPV test (n = 59/220), 11% delayed a stool blood test (n = 44/388), and 36% delayed a colonoscopy (n = 304/840). Age, race/ethnicity, education, and health insurance were associated with delays in cancer screenings (all P < .05). Compared with non-Hispanic White women, non-Hispanic Black women had lower odds of delaying a mammogram (odds ratio [OR], 0.60; 95% CI, 0.39 to 0.94), Hispanic women had higher odds of delaying Pap test (OR, 2.46; 95% CI, 1.34 to 4.55), and women with other race/ethnicity had higher odds of delaying both Pap test (OR, 2.38; 95% CI, 1.41 to 4.02) and HPV test (OR, 5.37; 95% CI, 1.44 to 19.97). CONCLUSION Our findings highlighted the urgency for health care providers to address the significant delays in cancer screenings in those most likely to delay. Strategies and resources are needed to help those with barriers to receiving guideline-appropriate cancer screening.
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Affiliation(s)
- Xiaochen Zhang
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Mohamed I. Elsaid
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Cecilia DeGraffinreid
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
| | - Victoria L. Champion
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH
- Secondary Data Core, Center for Biostatistics, College of Medicine, The Ohio State University, Columbus, OH
| | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University, Columbus, OH
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Nguyen DL, Ambinder EB, Myers KS, Oluyemi E. Addressing Disparities Related to Access of Multimodality Breast Imaging Services Before and During the COVID-19 Pandemic. Acad Radiol 2022; 29:1852-1860. [PMID: 35562265 PMCID: PMC8947962 DOI: 10.1016/j.acra.2022.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 03/16/2022] [Accepted: 03/19/2022] [Indexed: 01/26/2023]
Abstract
Despite technological advancements focused on reducing breast cancer mortality through early detection, there have been reported disparities in the access to these imaging services with underserved patient populations (including racial minority groups and patients of low socioeconomic status) showing underutilization compared to other patient groups. These underserved populations tend to have more advanced breast cancer presentations, in part due to delays in diagnosis resulting in later stage of disease presentation. To make matters worse, the COVID-19 pandemic declared in March 2020 has resulted in significant healthcare disruptions leading to extensive delays in breast imaging services which are expected to negatively impact breast cancer mortality long-term. Given the worsening disparity in breast cancer mortality among racial/ethnic minorities and financially disadvantaged groups, it is vital to address these disparity gaps with the goal of reducing the barriers to timely breast cancer diagnosis and addressing breast cancer mortality differences among breast cancer patients. Therefore, this review aims to provide a discussion highlighting the disparities related to breast imaging access, the effects of the COVID-19 pandemic on these disparities, current targeted interventions implemented in breast imaging practices to reduce these disparities, and future directions on the journey to reducing disparity gaps for breast imaging patients. Tackling the root cause factors of the persistent breast cancer-related disparities is critical to meeting the needs of patients who are disadvantaged and can lead to continued improvement in the quality of individualized care for patients who have higher breast cancer morbidity and mortality risks.
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Carter BJ, Chen TA, Cho D, Connors SK, Siddiqi AD, McNeill LH, Reitzel LR. Examining Associations between Source of Cancer Information and Mammography Behavior among Black Church-Going Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13004. [PMID: 36293643 PMCID: PMC9602462 DOI: 10.3390/ijerph192013004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/07/2022] [Accepted: 10/09/2022] [Indexed: 06/16/2023]
Abstract
Black women have a slightly lower breast cancer incidence rate than White women, but breast cancer mortality is approximately 40% higher among Black women than among White women. Early detection by mammography may improve survival outcomes. Outlets providing information on cancer and cancer screening often present data, including mammography recommendations, that are unreliable, accessible, and/or inconsistent. We examined associations between sources of cancer information and mammography behavior among Black church-going women. A logistic regression model was used to examine associations between self-reported preferred source of cancer information (provider, cancer organization, social network, internet, or other media (e.g., books, magazines)) and self-reported most recent source of cancer information (same categories as preferred sources), respectively, and having received a mammogram within the prior 12 months. Participants were 832 Black women over 40 years old, recruited from three churches in Houston, Texas. Data were collected in 2012. Overall, 55.41% of participants indicated their preferred source of cancer information was a provider, 21.88% the internet, 11.54% other media, 10.22% a cancer organization, and 0.96% their social network. In contrast, 17.88% of participants indicated their most recent source of cancer information was a provider, 63.02% the internet, 12.04% other media, 4.50% a cancer organization, and 2.55% their social network. About 70% of participants indicated receiving a mammogram in the prior 12 months. Results indicated that women who most recently sought information from the internet had lower odds of having a mammogram than those who most recently sought information from a provider (aOR: 0.546, CI95%: 0.336-0.886, p = 0.014). These results reveal an opportunity to advance health equity by encouraging Black church-going women to obtain cancer information from providers rather than from the internet as a method to enhance mammography use. These results also reveal an opportunity to investigate what modifiable social determinants or other factors prevent Black church-going women from seeking cancer information from their preferred source, which was a provider for the majority of the sample, and designing interventions to better actualize this preference.
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Affiliation(s)
- Brian J. Carter
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
| | - Tzuan A. Chen
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- HEALTH Research Institute, University of Houston, 4349 Martin Luther King Boulevard, Houston, TX 77204, USA
| | - Dalnim Cho
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Ammar D. Siddiqi
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Biosciences, Rice University, 6100 Main St., Houston, TX 77005, USA
| | - Lorna H. McNeill
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Lorraine R. Reitzel
- Department of Health Disparities Research, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
- Department of Psychological, Health, and Learning Sciences, University of Houston, 491 Farish Hall, Houston, TX 77204, USA
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Platt S, Montgomery GH, Schnur JH, Margolies L. BI-RADS 0 Screening Mammography: Risk Factors That Prevent or Delay Follow-Up Time to Diagnostic Evaluation. J Am Coll Radiol 2022; 19:1262-1268. [PMID: 35985631 DOI: 10.1016/j.jacr.2022.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 10/15/2022]
Abstract
OBJECTIVE BI-RADS 0 screening mammograms require follow-up diagnostic imaging, optimally within 60 days. Our study aims to identify risk factors for delayed follow-up. METHODS We conducted a retrospective case-control study of individuals who had a nondiagnostic BI-RADS 0 screening mammogram between March 19, 2018, and March 19, 2020. Sociodemographic information was collected from self-reported questionnaire. We aimed to identify factors associated with <60-day follow-up, >60-day follow-up, or no follow-up outcomes. The χ2 test and univariate logistic regressions were performed. Significant variables were included in multinomial logistic regression. We also aimed to identify risk factors that lead to delayed follow-up times among individuals with follow-up. Spearman's correlation and Mann-Whitney Wilcoxon tests and Kruskal-Wallis tests were performed. RESULTS Review returned 5,034 screening mammograms. Of 4,552 individuals included, 904 (19.9%) had no follow-up. Of the 3,648 (80.1%) with follow-up, 2,797 (76.7%) had a follow-up <60 days (median 20 days) and 851 (23.3%) had follow-up >60 days (median 176 days). Multinomial regression found that Asian (P = .022), Black (P < .0001), and individuals who identified their race as other (P < .0001) were independently more likely to have no or >60-day follow-up. Individuals who did not report their race (P = .001) or completed the questionnaire in Spanish (P = .025) were more likely to have no or >60-day follow-up. Amongst individuals with follow-up, Black individuals (P < .0001), those who identified their race as other (P < .0001), Hispanic individuals (P = .04), and those who completed the questionnaire in Spanish (P < .0001) had follow-up delays. BRCA-positive individuals had shorter follow-up times (P = .021). DISCUSSION Follow-up time is affected by cancer risk factors such as BRCA status in addition to race, preferred language, and Hispanic ethnicity.
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Affiliation(s)
- Samantha Platt
- Memorial Sloan Kettering Cancer Center, New York, New York.
| | - Guy H Montgomery
- Professor, Department of Population Health Science and Policy and Director, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Julie H Schnur
- Assistant Professor, Department of Population Health Science and Policy, Center for Behavioral Oncology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Laurie Margolies
- Professor of Diagnostic, Molecular and Interventional Radiology and Professor and Director, Dubin Breast Center, Icahn School of Medicine at Mount Sinai, New York, New York
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8
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Vang SS, Dunn A, Margolies LR, Jandorf L. Delays in Follow-up Care for Abnormal Mammograms in Mobile Mammography Versus Fixed-Clinic Patients. J Gen Intern Med 2022; 37:1619-1625. [PMID: 35212876 PMCID: PMC9130416 DOI: 10.1007/s11606-021-07189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Mobile mammographic services (MM) have been shown to increase breast cancer screening in medically underserved women. However, little is known about MM patients' adherence to follow-up of abnormal mammograms and how this compares with patients from traditional, fixed clinics. OBJECTIVES To assess delays in follow-up of abnormal mammograms in women screened using MM versus fixed clinics. DESIGN Electronic medical record review of abnormal screening mammograms. SUBJECTS Women screened on a MM van or at a fixed clinic with an abnormal radiographic result in 2019 (N = 1,337). MAIN MEASURES Our outcome was delay in follow-up of an abnormal mammogram of 60 days or greater. Guided by Andersen's Behavioral Model of Health Services Utilization, we assessed the following: predisposing (age, ethnicity, marital status, preferred language), enabling (insurance, provider referral, clinic site), and need (personal breast cancer history, family history of breast/ovarian cancer) factors. KEY RESULTS Only 45% of MM patients had obtained recommended follow-up within 60 days of an abnormal screening compared to 72% of fixed-site patients (p < .001). After adjusting for predisposing, enabling, and need factors, MM patients were 2.1 times more likely to experience follow-up delays than fixed-site patients (CI: 1.5-3.1; p < .001). African American (OR: 1.5; CI: 1.0-2.1; p < .05) and self-referred (OR: 1.8; CI: 1.2-2.8; p < .01) women were significantly more likely to experience delays compared to Non-Hispanic White women or women with a provider referral, respectively. Women who were married (OR: 0.63; CI: 0.5-0.9; p < .01), had breast cancer previously (OR: 0.37; CI: 0.2-0.8; p < .05), or had a family history of breast/ovarian cancer (OR: 0.76; CI: 0.6-0.9; p < .05) were less likely to experience delayed care compared to unmarried women, women with no breast cancer history, or women without a family history of breast/ovarian cancer, respectively. CONCLUSIONS A substantial proportion of women screened using MM had follow-up delays. Women who are African American, self-referred, or unmarried are particularly at risk of experiencing delays in care for an abnormal mammogram.
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Affiliation(s)
- Suzanne S Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA.
| | - Alexandra Dunn
- MD/MPH Program, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Laurie R Margolies
- Department of Diagnostic, Molecular and Interventional Radiology, Icahn School of Medicine at Mount Sinai, and The Dubin Breast Center, Mount Sinai Hospital, New York, NY, USA
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1077, New York, NY, 10029, USA
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9
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Trivedi U, Omofoye TS, Marquez C, Sullivan CR, Benson DM, Whitman GJ. Mobile Mammography Services and Underserved Women. Diagnostics (Basel) 2022; 12:902. [PMID: 35453950 PMCID: PMC9032638 DOI: 10.3390/diagnostics12040902] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023] Open
Abstract
Breast cancer, the second most common cause of cancer in women, affects people across different ages, ethnicities, and incomes. However, while all women have some risk of breast cancer, studies have found that some populations are more vulnerable to poor breast cancer outcomes. Specifically, women with lower socioeconomic status and of Black and Hispanic ethnicity have been found to have more advanced stages of cancer upon diagnosis. These findings correlate with studies that have found decreased use of screening mammography services in these underserved populations. To alleviate these healthcare disparities, mobile mammography units are well positioned to provide convenient screening services to enable earlier detection of breast cancer. Mobile mammography services have been operating since the 1970s, and, in the current pandemic, they may be extremely helpful. The COVID-19 pandemic has significantly disrupted necessary screening services, and reinstatement and implementation of accessible mobile screenings may help to alleviate the impact of missed screenings. This review discusses the history and benefits of mobile mammography, especially for underserved women.
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Affiliation(s)
- Usha Trivedi
- Rutgers New Jersey Medical School, 187 S W Orange, Newark, NJ 07103, USA;
| | - Toma S. Omofoye
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Cindy Marquez
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Callie R. Sullivan
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
| | - Diane M. Benson
- Office of Health Policy, The University of Texas MD Anderson Cancer Center, 7007 Bertner Avenue, Unit 1677, Houston, TX 77030, USA;
| | - Gary J. Whitman
- Department of Breast Imaging, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1350, Houston, TX 77030, USA; (T.S.O.); (C.M.); (C.R.S.)
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Psychosocial protective interventions associated with a better quality of life and psychological wellbeing for African American/Black female breast cancer survivors: an integrative review. Support Care Cancer 2022; 30:1093-1114. [PMID: 34417643 PMCID: PMC8787847 DOI: 10.1007/s00520-021-06425-0] [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: 03/16/2021] [Accepted: 07/08/2021] [Indexed: 02/03/2023]
Abstract
PURPOSE This integrative review provides an overview of current psychosocial interventions and qualitative studies exploring African American Breast Cancer Survivors (AABCS)' psychosocial wellbeing. METHODS We conducted a search of five databases: PubMed, Academic Search Ultimate, CINAHL, PsycINFO, and Web of Science. Peer-reviewed articles written in English and published from 2011 to May 26, 2021 were included. We critically appraised intervention studies and qualitative studies using established frameworks. RESULTS Of the 633 unique studies identified, seven interventions and twenty-one qualitative studies were included. Analysis of the interventions revealed the importance of alleviating structural barriers and facilitating peer support for AABCS. Analysis of the qualitative studies revealed seven themes: (1) spirituality/religion, (2) social support, (3) cultural perceptions of BC, (4) lack of representation, (5) negative impacts of treatment, (6) healthcare system experience, and (7) barriers to psychosocial care. CONCLUSIONS This review highlights the dearth of psychosocial interventions created specifically for AABCS. The qualitative literature in this review elucidates the unique psychosocial challenges that AABCS experience, providing rich data to inform the creation of future culturally competent interventions in this population. IMPLICATIONS FOR CANCER SURVIVORS This review found spirituality and social support to be protective factors for AABCS' psychosocial wellbeing. Further research using rigorous methodologies is needed to further evaluate how to most effectively alleviate structural barriers that AABCS face in obtaining long-term support.
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Spak DA, Foxhall L, Rieber A, Hess K, Helvie M, Whitman GJ. Retrospective Review of a Mobile Mammography Screening Program in an Underserved Population within a Large Metropolitan Area. Acad Radiol 2022; 29 Suppl 1:S173-S179. [PMID: 32763059 PMCID: PMC7855048 DOI: 10.1016/j.acra.2020.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Revised: 07/08/2020] [Accepted: 07/09/2020] [Indexed: 01/03/2023]
Abstract
RATIONALE AND OBJECTIVES Mobile mammography units provide preventive health care to patients facing barriers to annual screening. This study reviews the outcomes of a mobile mammography service during a recent 5-year period. MATERIALS AND METHODS This retrospective study analyzed the examinations by mobile mammography during a 5-year period (9327 examinations). The patients recalled, biopsies performed, and cancers detected were tallied. The race, age, breast cancer size, lymph node involvement, and metastases were recorded. The positive predictive value (PPV) and cancer detection rate metrics were calculated as outlined by the American College of Radiology Breast Imaging Reporting and Data System Atlas. RESULTS The program identified cancer in 14 cases (cancer detection rate = 1.5 per 1000 examinations [95% confidence interval [CI], 0.9-2.5]) with 11 being invasive. The majority of these cancers were small and of low stage. Lymph node status was determined in 11 of the 14 cases (1 as N1mi, 5 as N0, 4 as N1,1 as N2a). Abnormalities led to 1686 examinations recalled (Recall Rate = 17.8%; PPV 1 = 0.8% [95% CI, 0.5%-1.4%]). One hundred and one were recommended for biopsy (PPV 2 = 13.9% [95% CI, 8.4%-21.9%]), and 98 pursued biopsy (PPV 3 = 14.3% [95% CI, 8.7%-22.6%]). Patient age ranged from 41 to 67 years with an average of 50.6 years. CONCLUSION The program detected many cancers in an asymptomatic population facing barriers to breast cancer screening. These findings are underscored by the cancers detected at an early stage with a favorable prognosis and support the need for the development of similar programs.
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Affiliation(s)
- David A Spak
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030.
| | - Lewis Foxhall
- Department of Clinical Cancer Prevention, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Alyssa Rieber
- Department of General Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Kenneth Hess
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mark Helvie
- Department of Radiology, University of Michigan Health System, Ann Arbor, Michigan
| | - Gary J Whitman
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1350, Houston, TX 77030
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Guner AE, Surmeli A, Turan G, Kural K, Simsek EE, Maral I. A Large-scale Pilot Breast Cancer Screening Program: Findings and Recommendations for National Screening Programs. HASEKI TIP BÜLTENI 2022. [DOI: 10.4274/haseki.galenos.2021.7793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Gilmore D, Krantz M, Weaver L, Hand BN. Healthcare service use patterns among autistic adults: A systematic review with narrative synthesis. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2021; 26:317-331. [PMID: 34881676 DOI: 10.1177/13623613211060906] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
LAY ABSTRACT Autistic adults often have complex healthcare needs due to factors like having other health conditions, sensory sensitivities, and limited access to healthcare providers who are trained to provide care for them. All these factors may influence the healthcare services that autistic adults use. In this review, we searched six electronic research databases to gather the most recent evidence about how often autistic adults use five important healthcare services (the emergency department, hospitalization, outpatient mental health, preventive services, and primary care) compared to populations of non-autistic adults. A total of 16 articles were ultimately included in this review. Most articles found that autistic adults had equal or higher use of healthcare services than non-autistic adults. Autistic adults frequently used the emergency department and hospital. This may indicate that routine outpatient care in the community is not meeting their needs. Our findings show the importance of improving care at this level for autistic adults to reduce overuse of the emergency department (in this article referred to as ED) and hospital.
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Agrawal P, Chen TA, McNeill LH, Acquati C, Connors SK, Nitturi V, Robinson AS, Martinez Leal I, Reitzel LR. Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168494. [PMID: 34444241 PMCID: PMC8392666 DOI: 10.3390/ijerph18168494] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 08/07/2021] [Accepted: 08/09/2021] [Indexed: 11/16/2022]
Abstract
Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007-1.023)), having health insurance and ideal patient-provider communication (enabling: OR = 2.388 (1.597-3.570) and OR = 1.485 (1.080-2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058-4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient-provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.
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Affiliation(s)
- Pooja Agrawal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 77555, USA
| | - Tzuan A. Chen
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorna H. McNeill
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
| | - Chiara Acquati
- MD Anderson Cancer Center, Department of Health Disparities Research, Houston, TX 77230, USA; (L.H.M.); (C.A.)
- Graduate College of Social Work, University of Houston, Houston, TX 77204, USA
| | - Shahnjayla K. Connors
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Department of Social Sciences, University of Houston-Downtown, Houston, TX 77002, USA
| | - Vijay Nitturi
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Angelica S. Robinson
- Department of Radiology, University of Texas Medical Branch, Galveston, TX 77555, USA;
| | - Isabel Martinez Leal
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
| | - Lorraine R. Reitzel
- Department of Psychological, Health and Learning Sciences, University of Houston, Houston, TX 77204, USA; (P.A.); (T.A.C.); (S.K.C.); (V.N.); (I.M.L.)
- Health Research Institute, University of Houston, Houston, TX 77204, USA
- Correspondence: ; Tel.: +1-713-743-6679
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Amornsiripanitch N, Chikarmane SA, Cochon LR, Khorasani R, Giess CS. Electronic Worklist Improves Timeliness of Screening Mammogram Interpretation in an Urban Underserved Population. Curr Probl Diagn Radiol 2021; 51:323-327. [PMID: 34266693 DOI: 10.1067/j.cpradiol.2021.06.001] [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: 04/04/2021] [Accepted: 06/09/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To evaluate the impact of an electronic workflow update on screening mammography turnaround time and time to diagnostic imaging for mammography performed on our urban mobile mammography van and at an urban community health center. METHOD Prior to 10/15/2019, screening exams for the mammography van and urban community health center were made available for interpretation to a single designated radiologist via a manually generated paper list. On 10/15/2019, screening exams were routed electronically onto PACS for any breast radiologist across our Network to interpret. Screening mammogram turnaround time (defined as time form image acquisition to report finalization), time to diagnostic imaging, and time to tissue sampling were collected for pre- and post-implementation periods (6/1-9/30/2019 and 11/1/2019-2/29/2020, respectively) and compared via student t-test and statistical process control analyses. RESULTS The number of screening exams in the pre- and post-implementation periods were 851 and 728 exams, respectively. Patients were predominately Black and/or African American (400/1579, 25%), non-English speaking (858/1579, 54%) and insured by Medicaid (751/1579, 48%). After implementation of the electronic workflow, turnaround time decreased from 101.0 to 36.4 hours (63.9%, P <0.001) and statistical process control analyses showed sustained decrease in mean turnaround time. However, mean time to diagnostic imaging and tissue sampling were unchanged after implementation (39 vs 45, days; P = 0.330 and 43 vs 59; P = 0.187, respectively). CONCLUSION Electronic workflow management can reduce screening mammography turnaround time for underserved populations, but additional efforts are warranted to improve time to imaging follow-up for abnormal screening mammograms.
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Affiliation(s)
| | | | - Laila R Cochon
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
| | - Ramin Khorasani
- Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115
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Tsapatsaris A, Reichman M. Project ScanVan: Mobile mammography services to decrease socioeconomic barriers and racial disparities among medically underserved women in NYC. Clin Imaging 2021; 78:60-63. [PMID: 33770557 DOI: 10.1016/j.clinimag.2021.02.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/22/2021] [Accepted: 02/28/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To evaluate whether, with access to free screening services, uninsured minority women in NYC are able to successfully manage existing barriers to breast cancer screening. METHODS This is a retrospective cohort study, with permission to use de-identified data received from Project Renewal's ScanVan in 2019. Project Renewal ScanVan provides clinical breast exams, mammograms, and health education to low-income women. The screening mammograms were conducted in the ScanVan and read by a board-certified radiologist. The electronic medical records were reviewed with respect to the patients' BI-RADS category, insurance status, race, and age. Descriptive statistics were performed and cancer detection rate, recall rate, and positive predictive values (PPV1, PPV2, PPV3) were calculated. RESULTS In 2019, 66% (2499 of 3745) of patients who used the ScanVan were Hispanic & African American. 43% (1627 of 3745) of the women were uninsured, 15% (579 of 3745) of the women had Medicare, and 18% (676 of 3745) classified as other. 17 out of 3745 patients screened received a new diagnosis of breast cancer, corresponding to a cancer detection rate of 4.5/1000 screened. 258 were recalled, corresponding with a recall rate of 7%. The PPV1 was 6.5% (17/258); PPV2 was 29.8% (17/57); and PPV3 was 34% (17/50). CONCLUSION Barriers to breast cancer screening include lack of medical insurance, limited access to care, and the absence of a primary care physician. The mobile mammography screening van successfully overcame such barriers, providing uninsured women from racial minority groups with vital breast cancer screening and follow up care.
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Affiliation(s)
- Ava Tsapatsaris
- Eastchester High School, Student, 2 Stewart Pl, Eastchester, New York, 10709, USA.
| | - Melissa Reichman
- Weill Cornell Medicine, Department of Radiology, 525 East 68th street, New York, NY, 10065, USA.
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Aleshire ME, Adegboyega A, Escontrías OA, Edward J, Hatcher J. Access to Care as a Barrier to Mammography for Black Women. Policy Polit Nurs Pract 2021; 22:28-40. [PMID: 33076774 PMCID: PMC8175007 DOI: 10.1177/1527154420965537] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.
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Affiliation(s)
- Mollie E. Aleshire
- School of Nursing, University of Louisville, Louisville, Kentucky, United States
| | | | - Omar A. Escontrías
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
| | - Jean Edward
- College of Nursing, University of Kentucky, Lexington, United States
| | - Jennifer Hatcher
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
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Bertucci M, Bonnet E, Satger L, Kreiche A, Chappert JL, Loy-Morel S, Segondy M, Daurès JP, Boulle N. Acceptability of vaginal self-sampling with high-risk human papillomavirus testing for cervical cancer screening: a French questionnaire-based study. Women Health 2020; 61:83-94. [PMID: 33106125 DOI: 10.1080/03630242.2020.1831683] [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] [Indexed: 10/23/2022]
Abstract
In France, cervical cancer screening based on cervical smear has a participation rate of around 60%. New screening strategies are encouraged to increase the participation of under-screened women, including vaginal self-sampling with high-risk human papillomavirus (HR-HPV) testing. This study was based on the distribution of an anonymous self-administered questionnaire to assess the acceptability of vaginal self-sampling with HR-HPV testing by women aged 25 to 65 years in two French Departments of the South of France, Aude, and Hérault, showing low participation in cervical cancer screening. Factors influencing this acceptability were also analyzed. From May to July 2017, 349 completed questionnaires were collected. Women declared high acceptability for vaginal self-sampling (81%) preferably at home (82.6%). Acceptability was statistically higher in the Department of Herault (p = .001) and for women older than 50 years (p = .018). There was no difference according to educational level or attendance to cervical cancer screening. Knowledge about cervical cancer and cervical cancer screening was significantly influenced by educational level. This study confirmed that vaginal self-sampling with HR-HPV testing was highly accepted, including by under-screened women, encouraging further interventional studies. Education about cervical cancer and cervical cancer screening should be part of these programs, especially for women with lower educational level.
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Affiliation(s)
- Martina Bertucci
- Department of Midwifery Studies, University of Montpellier , Montpellier, France
| | - Emmanuel Bonnet
- UPRES EA2415 Clinical Research University Institute, University of Montpellier , Montpellier, France
| | - Laura Satger
- Department of Gynecology and Obstetrics, CHU Montpellier , Montpellier, France
| | - Antoine Kreiche
- Department of Aude, Regional Coordinating Center for Cancer Screening, Occitanie , Carcassonne, France
| | - Jean-Loup Chappert
- Department of Hérault, Regional Coordinating Center for Cancer Screening, Occitanie , Montpellier, France
| | - Silvia Loy-Morel
- Department of Herault, Association for Breast Cancer Screening in Montpellier-Hérault (AMHDCS) , Montpellier, France
| | - Michel Segondy
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier , Montpellier, France
| | - Jean Pierre Daurès
- UPRES EA2415 Clinical Research University Institute, University of Montpellier , Montpellier, France
| | - Nathalie Boulle
- Pathogenesis and Control of Chronic Infections, University of Montpellier, INSERM, EFS, CHU Montpellier , Montpellier, France.,Department of Pathology and Oncobiology, Laboratory of Solid Tumors, CHU Montpellier , Montpellier, France
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Ginsburg O, Yip CH, Brooks A, Cabanes A, Caleffi M, Dunstan Y. J, Gyawali B, McCormack V, de Anderson MM, Mehrotra R, Mohar A, Murillo R, Pace LE, Paskett ED, Romanoff A, Rositch AF, Scheel J, Schneidman M, Unger-Saldana K, Vanderpuye V, Wu TY, Yuma S, Dvaladze A, Duggan C, Anderson BO. Breast cancer early detection: A phased approach to implementation. Cancer 2020; 126 Suppl 10:2379-2393. [PMID: 32348566 PMCID: PMC7237065 DOI: 10.1002/cncr.32887] [Citation(s) in RCA: 203] [Impact Index Per Article: 50.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 02/24/2020] [Accepted: 02/25/2020] [Indexed: 12/16/2022]
Abstract
When breast cancer is detected and treated early, the chances of survival are very high. However, women in many settings face complex barriers to early detection, including social, economic, geographic, and other interrelated factors, which can limit their access to timely, affordable, and effective breast health care services. Previously, the Breast Health Global Initiative (BHGI) developed resource-stratified guidelines for the early detection and diagnosis of breast cancer. In this consensus article from the sixth BHGI Global Summit held in October 2018, the authors describe phases of early detection program development, beginning with management strategies required for the diagnosis of clinically detectable disease based on awareness education and technical training, history and physical examination, and accurate tissue diagnosis. The core issues address include finance and governance, which pertain to successful planning, implementation, and the iterative process of program improvement and are needed for a breast cancer early detection program to succeed in any resource setting. Examples are presented of implementation, process, and clinical outcome metrics that assist in program implementation monitoring. Country case examples are presented to highlight the challenges and opportunities of implementing successful breast cancer early detection programs, and the complex interplay of barriers and facilitators to achieving early detection for breast cancer in real-world settings are considered.
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Affiliation(s)
- Ophira Ginsburg
- Perlmutter Cancer Center, Section for Global Health, Division of Health and Behavior, Department of Population Health, New York University Langone Health, NY, USA
| | - Cheng-Har Yip
- University of Malaya, Kuala Lumpur, Malaysia
- Ramsay Sime Darby Health Care Kuala Lumpur, Malaysia
| | - Ari Brooks
- Dept. of Surgery, University of Pennsylvania, PA, USA
| | | | - Maira Caleffi
- Breast Center Hospital Moinhos de Vento Porto Alegre, Brazil
| | - Jorge Dunstan Y.
- Department of Breast, Skin and Soft Tissue Sarcomas Surgery Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru
| | - Bishal Gyawali
- Department of Oncology, Department of Public Health Sciences and Division of Cancer Care and Epidemiology, Queen’s University, Kingston, Ontario, Canada
| | | | | | | | - Alejandro Mohar
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Raul Murillo
- Centro Javeriano de Oncología – Hospital Universitario San Ignacio. Colombia
- Facultad de Medicina – Pontificia Universidad Javeriana, Colombia
| | - Lydia E. Pace
- Division of Women’s Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, USA
| | - Electra D. Paskett
- Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, OH
| | - Anya Romanoff
- Department of Surgery, Division of Surgical Oncology, Breast Surgery, The Icahn School of Medicine at The Mount Sinai Hospital, New York, NY, USA
| | - Anne F. Rositch
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - John Scheel
- Dept. of Radiology, University of Washington, Seattle, WA, USA
- Department of Global Health, University of Washington Seattle, WA, USA
| | - Miriam Schneidman
- Health, Nutrition and Population Global Practice, The World Bank Group
| | - Karla Unger-Saldana
- Unidad de Investigación Biomédica en Cáncer, Instituto Nacional de Cancerología, UNAM, Mexico
| | - Verna Vanderpuye
- National Center for Oncology, Radiotherapy and Nuclear Medicine, Accra, Ghana
| | - Tsu-Yin Wu
- Center for Health Disparities Innovation and Studies, Eastern Michigan University, MI, USA
| | - Safina Yuma
- Dept. of Reproductive and Child Health, Ministry of Health, Community Development, Gender, Elderly & Children, Dodoma, Tanzania
| | - Allison Dvaladze
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- University of Washington, Seattle, WA, USA
| | - Catherine Duggan
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
| | - Benjamin O. Anderson
- Breast Health Global Initiative, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, Washington, USA
- Departments of Surgery and Global Health Medicine, University of Washington, Seattle, Washington, USA
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Zuwasti U, Abbey G, Pollack E, Scheel J, Chong A. Breast Imaging in Global Health: Serving the Underserved. CURRENT RADIOLOGY REPORTS 2020. [DOI: 10.1007/s40134-020-00349-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Image Quality and Performance Benchmarks in Vehicle and Hospital Mammography. Clin Breast Cancer 2020; 20:e358-e365. [PMID: 32171703 DOI: 10.1016/j.clbc.2019.12.003] [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: 07/19/2019] [Revised: 11/29/2019] [Accepted: 12/11/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Whether the quality and clinical performance of mammograms obtained in vehicles and those obtained in fixed facilities are equal remains unknown. We compared the characteristics of examinees screened in hospital and vehicle settings. PATIENTS AND METHODS Data from women who had undergone mammography at Shuang Ho Hospital from January 1, 2013, to December 31, 2016, were obtained from the Women's Breast Screening Database and used for analysis. The records revealed that 43,807 and 11,955 women had undergone mammography in vehicle and hospital settings, respectively. The performance benchmarks, including recall rate, cancer detection rate, and positive predictive value, in the 2 settings were compared. In addition, the image quality was compared by reviewing 110 records from each setting. RESULTS The hospital mammograms had greater subtotal mean scores (189.2 ± 5.9) compared with the vehicle mammograms (185.5 ± 7.7; P < .0001) in the mediolateral oblique view. Mobile mammography contributed to a lower odds ratio of classification in the Breast Imaging Reporting and Data System categories of 0, 4, and 5. In general, all performance benchmarks, including the cancer detection rate and positive predictive value of mobile and hospital mammography, were satisfactory. However, the recall rate with the hospital mammography service was slightly greater than the acceptable benchmark. CONCLUSION Mobile mammography services should be continued with improvements in image quality. The reduction in the number of patients with a category of 0 in the classification system in both mammography service settings and the enhancement of data linking to previous mammograms warrants additional attention.
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De Mil R, Guillaume E, Launay L, Guittet L, Dejardin O, Bouvier V, Notari A, Launoy G, Berchi C. Cost-Effectiveness Analysis of a Mobile Mammography Unit for Breast Cancer Screening to Reduce Geographic and Social Health Inequalities. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1111-1118. [PMID: 31563253 DOI: 10.1016/j.jval.2019.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 05/02/2019] [Accepted: 06/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Breast cancer is the leading cancer in terms of incidence and mortality among women in France. Effective organized screening does exist, however, the participation rate is low, and negatively associated with a low socioeconomic status and remoteness. OBJECTIVES To determine the cost-effectiveness of a mobile mammography (MM) program to increase participation in breast cancer screening and reduce geographic and social inequalities. METHODS A cost-effectiveness analysis from retrospective data was conducted from the payer perspective, comparing an invitation to a mobile mammography unit (MMU) or to a radiologist's office (MM or RO group) with an invitation to a radiologist's office only (RO group) (n = 37 461). Medical and nonmedical direct costs were estimated. Outcome was screening participation. The mean incremental cost and effect, the incremental cost-effectiveness ratio, and the cost-effectiveness acceptability curve were estimated. RESULTS The mean incremental cost for invitation to MM or RO was estimated to be €23.21 (95% CI, 22.64-23.78) compared with RO only, and with a point of participation gain of 3.8% (95% CI, 2.8-4.8), resulting in an incremental cost per additional screen of €610.69 (95% CI, 492.11-821.01). The gain of participation was more important in women living in deprived areas and for distances exceeding 15 km from an RO. CONCLUSION Screening involving a MMU can increase participation in breast cancer screening and reduce geographic and social inequalities while being more cost-effective in remote areas and in deprived areas. Because of the retrospective design, further research is needed to provide more evidence of the effectiveness and cost-effectiveness of using a MMU for organized breast cancer screening and to determine the optimal conditions for implementing it.
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Affiliation(s)
- Rémy De Mil
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France.
| | | | | | - Lydia Guittet
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
| | | | | | | | - Guy Launoy
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
| | - Célia Berchi
- Normandie Univ, UNICAEN, INSERM, Anticipe, Caen, France
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Tran L, Tran P. US urban-rural disparities in breast cancer-screening practices at the national, regional, and state level, 2012-2016. Cancer Causes Control 2019; 30:1045-1055. [PMID: 31428890 DOI: 10.1007/s10552-019-01217-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 08/09/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Previous studies suggesting that rural US women may be less likely to have a recent mammogram than urban women are limited in either scope or granularity. This study explored urban-rural disparities in US breast cancer-screening practices at the national, regional, and state levels. METHODS We used data from the 2012, 2014, and 2016 Behavioral Risk Factor Surveillance Systems surveys. Logistic models were utilized to examine the impact of living in an urban/rural area on mammogram screening at three geographic levels while adjusting for covariates. We then calculated average adjusted predictions (AAPs) and average marginal effects (AMEs) to isolate the association between breast cancer screening and the urban/rural factor. RESULTS At all geographic levels, AAPs of breast cancer screening were similar among urban, suburban, and rural residents. Regarding "ever having a mammogram" and "having a recent mammogram," urban women had small but significantly higher adjusted probabilities (AAP: 94.6%, 81.1%) compared to rural women (AAP: 93.5%, 80.2%). CONCLUSIONS While urban-rural differences in breast cancer screening are small, they can translate into tens of thousands of rural women not receiving mammograms. Hence, there is a need to continue screening initiatives in these areas to reduce the number of breast cancer deaths.
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Affiliation(s)
- Lam Tran
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, New Haven, CT, USA
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Availability of Common Pediatric Radiology Studies: Are Rural Patients at a Disadvantage? J Surg Res 2018; 234:26-32. [PMID: 30527482 DOI: 10.1016/j.jss.2018.08.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2018] [Revised: 08/24/2018] [Accepted: 08/24/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Many families wish to have radiologic tests performed locally, especially when obtaining these tests in specialized pediatric centers would require long-distance travel with associated costs and inconveniences. The differential availability of specialized and common pediatric uroradiographic tests in rural and urban areas has not been described. We undertook this study to describe the availability of common radiographic tests ordered by pediatric urologists, and to identify disparities in the availability of radiographic tests between urban and rural locations. MATERIALS AND METHODS We surveyed all freestanding hospitals in Washington State on the availability of flat-plate abdominal radiograph (AXR), renal-bladder ultrasounds (RBUS), voiding cystourethrograms (VCUG), MAG-3 renal scans, and nuclear cystograms (NC) for children, as well as testing restrictions, availability of sedation for urology tests, and presence of onsite radiologists. Rural and urban hospitals were compared on these characteristics. RESULTS The survey was completed by 74 of 88 institutions (84.1%); 17 (23.0%) were rural (population <2500), 32 (43.2%) were in urban clusters (population 2500-50,000), and 25 (33.8%) were in urban areas (population >50,000). Seventy-three (98.6%) institutions offered AXR, 68 (91.9%) offered RBUS, 44 (59.5%) offered VCUG, 26 (35.1%) offered MAG-3, and 15 (20.3%) offered NC to children. All urban and most (16/17; 94.1%) rural institutions had shareable digital imaging capability. AXR (100% versus 96%, P = 0.88) and RBUS (70.6% versus 96%, P = 0.15) availability was similar in rural and urban settings, whereas VCUG (11.8% versus 72%, P = 0.001), MAG-3 (5.9% versus 60%, P = 0.006), and NC (0% versus 44%, P = 0.017) were more commonly available in urban settings. Fewer rural hospitals employed full-time, in-house radiologists (35.3% versus 96%, P < 0.0001) or offered sedation (6.3% versus 36%, P = 0.01) for testing, but an equal proportion had age restrictions on the tests offered (40% versus 17.6%, P = 0.50). Fellowship-trained pediatric radiologists (0% versus 16%, P = 0.39) and child life specialists (0% versus 20%, P = 0.28) worked exclusively in urban settings. Most hospitals offering specialized radiographic tests (VCUG: 90.9%; P < 0.0001 and MAG-3: 92.3%; P = 0.002) had onsite radiologists. CONCLUSIONS The geographically widespread availability of AXR and RBUS may represent an opportunity to offer families care closer to home, realizing cost and time savings. Anxious children and those requiring more specialized studies may benefit from referral to urban centers. The lack of rural radiologists may be an actionable barrier to availability of specialized radiology testing.
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Vang S, Margolies LR, Jandorf L. Mobile Mammography Participation Among Medically Underserved Women: A Systematic Review. Prev Chronic Dis 2018; 15:E140. [PMID: 30447104 PMCID: PMC6266518 DOI: 10.5888/pcd15.180291] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction Although breast cancer deaths have declined, the mortality rate among women from medically underserved communities is disproportionally high. Screening mammography is the most effective tool for detecting breast cancer in its early stages, yet many women from medically underserved communities do not have adequate access to screening mammograms. Mobile mammography may be able to bridge this gap by providing screening mammograms at no cost or low cost and delivering services to women in their own neighborhoods, thus eliminating cost and transportation barriers. The objective of this systematic review was to describe the scope and impact of mobile mammography programs in promoting mammographic screening participation among medically underserved women. Methods We searched electronic databases for English-language articles published in the United States from January 2010 through March 2018 by using the terms “mobile health unit,” “mammogram,” “mammography,” and “breast cancer screening.” Of the 93 articles initially identified, we screened 55; 16 were eligible to be assessed and 10 qualified for full text review and data extraction. Each study was coded for study purpose, research design, data collection, population targeted, location, sample size, outcomes, predictors, analytical methods, and findings. Results Of the 10 studies that qualified for review, 4 compared mobile mammography users with users of fixed units, and the other 6 characterized mobile mammography users only. All the mobile mammography units included reached underserved women. Most of the women screened in mobile units were African American or Latina, low income, and/or uninsured. Mobile mammography users reported low adherence to 1-year (12%–34%) and 2-year (40%–48%) screening guidelines. Some difficulties faced by mobile clinics were patient retention, patient follow-up of abnormal or inconclusive findings, and women inaccurately perceiving their breast cancer risk. Conclusion Mobile mammography clinics may be effective at reaching medically underserved women. Adding patient navigation to mobile mammography programs may promote attendance at mobile sites and increase follow-up adherence. Efforts to promote mammographic screening should target women from racial/ethnic minority groups, women from low-income households, and uninsured women. Future research is needed to understand how to best improve visits to mobile mammography clinics.
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Affiliation(s)
- Suzanne Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, Box 1077, New York, NY 10029.
| | - Laurie R Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, New York
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Roubidoux MA, Shih-Pei Wu P, Nolte ELR, Begay JA, Joe AI. Availability of prior mammograms affects incomplete report rates in mobile screening mammography. Breast Cancer Res Treat 2018; 171:667-673. [PMID: 29951970 DOI: 10.1007/s10549-018-4861-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 06/20/2018] [Indexed: 02/03/2023]
Abstract
PURPOSE Mobile mammography can improve access to screening mammography in rural areas and underserved populations. We evaluated the frequency of incomplete reports in mobile mammography screening and the relationships between prior mammograms and recall rates. METHODS The frequency of incomplete mammogram reports, the subgroups of those needing prior comparison mammograms, recalls for additional imaging, and availability of prior mammograms of a mobile screening mammography unit were compared with fixed site mammography from January 1, 2007 through December 31, 2009. All mobile unit mammograms were full field digital mammography (FFDM). Differences between rates of recall, incomplete reports, and availability of prior mammograms were calculated using the Chi-Square statistic. RESULTS Of 2640 mobile mammography cases, 21.9% (578) reports were incomplete, versus 15.2% (7653) (p ≤ 0.001) of 50325 fixed site reports. Of incomplete cases, recall for additional imaging occurred among 8.3% (218) of mobile mammography reports versus 11.3% (5708) (p ≤ 0.001) of fixed site reports. Prior mammograms were needed among 13.6% (360) of mobile mammography versus 3.9% (1945) (p ≤ 0.001) of fixed site reports. Mobile mammography recall rate varied with availability of prior mammograms: 16.0% (54) when no prior mammograms, 7.6% (127) when prior mammograms were elsewhere but unavailable and 5.9% (37) when prior FFDM were immediately available (p ≤ 0.001). CONCLUSIONS Incomplete reports were more frequent in mobile mammography than the fixed site. The availability of prior comparison mammograms at time of interpretation decreased the rate of incomplete mammogram reports. Recall rates were higher without prior comparison mammograms and lowest when comparison FFDM mammograms were available.
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Affiliation(s)
- Marilyn A Roubidoux
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA.
| | - Peggy Shih-Pei Wu
- Kaiser Permanente, South Sacramento Medical Group, 6600 Bruceville Rd, 1st Floor, Sacramento, CA, 95823, USA
| | - Emily L Roen Nolte
- Rosalind Franklin University of Medicine and Science, 3333 Greenbay Rd, North Chicago, IL, 60064, USA
| | - Joel A Begay
- University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Annette I Joe
- Division of Breast Imaging, Department of Radiology, Michigan Medicine - University of Michigan, University of Michigan Health System, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, 2902TC, Ann Arbor, MI, 48109, USA
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Trepka MJ, Sheehan DM, Fennie KP, Mauck DE, Lieb S, Maddox LM, Niyonsenga T. Racial/Ethnic Disparities in Failure to Initiate HIV Care: Role of HIV Testing Site, Individual Factors, and Neighborhood Factors, Florida, 2014-2015. J Health Care Poor Underserved 2018; 29:1153-1175. [PMID: 30122689 PMCID: PMC6292206 DOI: 10.1353/hpu.2018.0085] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Delayed initiation of human immunodeficiency virus (HIV) care affects disease progression. To determine the role of HIV testing site and neighborhood- and individual-level factors in racial/ethnic disparities in initiation of care, we examined Florida population-based HIV/AIDS surveillance system records. We performed multilevel Poisson regression to calculate adjusted prevalence ratios (APR) for non-initiation of care by race/ethnicity adjusting for HIV testing site type and individual- and neighborhood-level characteristics. Of 8,913 people diagnosed with HIV during 2014-2015 in the final dataset, 18.3% were not in care within three months of diagnosis. The APR for non-initiation of care for non-Hispanic Blacks relative to non-Hispanic Whites was 1.57 (95% confidence interval [CI] 1.38-1.78) and for those tested in plasma/donation centers relative to outpatient clinics was 2.45 (95% CI 2.19-2.74). Testing site and individual variables contribute to racial/ethnic disparities in non-initiation of HIV care. Linkage procedures, particularly at plasma/blood donation centers, warrant improvement.
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