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Farivar D, Peterman NJ, Nilssen PK, Illingworth KD, Nuckols TK, Skaggs DL. Geographic Access to Pediatric Orthopedic Surgeons in the United States: An Analysis of Sociodemographic Factors. Orthopedics 2024:1-7. [PMID: 38690849 DOI: 10.3928/01477447-20240424-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
BACKGROUND It is unclear how pediatric orthopedic surgeons are geographically distributed relative to their patients. The purpose of this study was to evaluate the geographic distribution of pediatric orthopedic surgeons in the United States. MATERIALS AND METHODS County-level data of actively practicing pediatric orthopedic surgeons were identified by matching several registries and membership logs. Data were used to calculate the distance between counties and nearest surgeon. Counties were categorized as "surgeon clusters" or "surgeon deserts" if the distance to the nearest surgeon was less than or greater than the national average and the average of all neighboring counties, respectively. Cohorts were then compared for differences in population characteristics using data obtained from the 2020 American Community Survey. RESULTS A total of 1197 unique pediatric orthopedic surgeons were identified. The mean distance to the nearest pediatric orthopedic surgeon for a patient residing in a surgeon desert or a surgeon cluster was 141.9±53.8 miles and 30.9±16.0 miles, respectively. Surgeon deserts were found to have lower median household incomes (P<.001) and greater rates of children without health insurance (P<.001). Multivariate analyses showed that higher Rural-Urban Continuum codes (P<.001), Area Deprivation Index scores (P<.001), and percentage of patients without health insurance (P<.001) all independently required significantly greater travel distances to see a pediatric orthopedic surgeon. CONCLUSION Pediatric orthopedic surgeons are not equally distributed in the United States, and many counties are not optimally served. Additional studies are needed to identify the relationship between travel distances and patient outcomes and how geographic inequalities can be minimized. [Orthopedics. 202x;4x(x):xx-xx.].
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Siegel SD, Zhang Y, Lynch SM, Rowland J, Curriero FC. A Novel Approach for Conducting a Catchment Area Analysis of Breast Cancer by Age and Stage for a Community Cancer Center. Cancer Epidemiol Biomarkers Prev 2024; 33:646-653. [PMID: 38451180 PMCID: PMC11062816 DOI: 10.1158/1055-9965.epi-23-1125] [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: 09/14/2023] [Revised: 12/07/2023] [Accepted: 03/05/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND The U.S. Preventive Services Task Force recently issued an updated draft recommendation statement to initiate breast cancer screening at age 40, reflecting well-documented disparities in breast cancer-related mortality that disproportionately impact younger Black women. This study applied a novel approach to identify hotspots of breast cancer diagnosed before age 50 and/or at an advanced stage to improve breast cancer detection within these communities. METHODS Cancer registry data for 3,497 women with invasive breast cancer diagnosed or treated between 2012 and 2020 at the Helen F. Graham Cancer Center and Research Institute (HFGCCRI) and who resided in the HFGCCRI catchment area, defined as New Castle County, Delaware, were geocoded and analyzed with spatial intensity. Standardized incidence ratios stratified by age and race were calculated for each hotspot. RESULTS Four hotspots were identified, two for breast cancer diagnosed before age 50, one for advanced breast cancer, and one for advanced breast cancer diagnosed before age 50. Younger Black women were overrepresented in these hotspots relative to the full-catchment area. CONCLUSIONS The novel use of spatial methods to analyze a community cancer center catchment area identified geographic areas with higher rates of breast cancer with poor prognostic factors and evidence that these areas made an outsized contribution to racial disparities in breast cancer. IMPACT Identifying and prioritizing hotspot breast cancer communities for community outreach and engagement activities designed to improve breast cancer detection have the potential to reduce the overall burden of breast cancer and narrow racial disparities in breast cancer.
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Affiliation(s)
- Scott D. Siegel
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Yuchen Zhang
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
- Center for Strategic Information Management, ChristianaCare, Newark, DE, United States
| | - Shannon M. Lynch
- Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, United States
| | - Jennifer Rowland
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, ChristianaCare, Newark, DE, United States
| | - Frank C. Curriero
- Johns Hopkins Spatial Science for Public Health Center, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health
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Edwards A, Monroe R, Amram O, Kumar A. Distance to endoscopy services amplifies racial inequities in colorectal cancer mortality in Washington state. Am J Surg 2024:S0002-9610(24)00198-3. [PMID: 38670835 DOI: 10.1016/j.amjsurg.2024.04.003] [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: 11/27/2023] [Revised: 03/12/2024] [Accepted: 04/02/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND This study evaluates relationships among race, access to endoscopy services, and colorectal cancer (CRC) mortality in Washington state (WA). METHODS We overlayed the locations of ambulatory endoscopy services with place of residence at time of death, using Department of Health data (2011-2018). We compared CRC mortality data within and outside a 10 km buffer from services. We used linear regression to assess the impact of distance and race on age at death while adjusting for gender and education level. RESULTS Age at death: median 72.9y vs. 68.2y for white vs. non-white (p < 0.001). The adjusted model showed that non-whites residing outside the buffer died 6.9y younger on average (p < 0.001). Non-whites residing inside the buffer died 5.2y younger on average (p < 0.001), and whites residing outside the buffer died 1.6y younger (p < 0.001). We used heatmaps to geolocate death density. CONCLUSIONS Results suggest that geographic access to endoscopy services disproportionately impacts non-whites in Washington. These data help identify communities which may benefit from improved access to alternative colorectal cancer screening methods.
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Affiliation(s)
- Ashley Edwards
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Rachel Monroe
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Providence Hood River Family Medicine Residency Program, Hood River, OR, USA
| | - Ofer Amram
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA; Community Health and Spatial Epidemiology Lab, Washington State University, Spokane, WA, USA
| | - Anjali Kumar
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA.
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Anderson RT, Hillemeier MM, Camacho FT, Harvey JA, Bonilla G, Batten GP, Robinson B, Safon CB, Louis C. The Breast-Imaging Operations, Practices and Systems Inventory: A framework to examine mammography facility effects on screening in rural communities. J Rural Health 2024; 40:282-291. [PMID: 37787554 DOI: 10.1111/jrh.12798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 08/10/2023] [Accepted: 09/14/2023] [Indexed: 10/04/2023]
Abstract
PURPOSE Develop and test a measurement framework of mammogram facility resources, policies, and practices in Appalachia. METHODS Survey items describing 7 domains of imaging facility qualities were developed and tested in the Appalachian regions of Kentucky, Ohio, Pennsylvania, Virginia, and West Virginia. Medicare claims data (2016-2018) were obtained on catchment area mammogram services. Construct validity was examined from associations with facility affiliation, community characteristics, mammogram screening uptake, and market reach. Analyses were performed with t-tests and ANOVA. RESULTS A total of 192 (of 377) sites completed the survey. Five factors were initially selected in exploratory factor analysis (FA) and refined in confirmatory FA: capacity, outreach & marketing, operational support, radiology review (NNFI = .94, GFI = 0.93), and diagnostic services (NNFI = 1.00, GFI = 0.99). Imaging capacity and diagnostic services were associated with screening uptake, with capacity strongly associated with catchment area demographic and economic characteristics. Imaging facilities in economically affluent versus poorer areas belong to larger health systems and have significantly more resources (P < .001). Facilities in economically distressed locations in Appalachia rely more heavily on outreach activities (P < .001). Higher facility capacity was significantly associated (P < .05) with larger catchment area size (median split: 48.5 vs 51.6), mammogram market share (47.4 vs 52.7), and screening uptake (47.6 vs 52.4). CONCLUSIONS A set of 18 items assessing breast imaging services and facility characteristics was obtained, representing policies and practices related to a facility's catchment area size, market share, and mammogram screening uptake.
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Affiliation(s)
- Roger T Anderson
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Marianne M Hillemeier
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, USA
| | - Fabian T Camacho
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Jennifer A Harvey
- Department of Imaging Sciences, University of Rochester Medical Center, Rochester, New York, USA
| | - Gloribel Bonilla
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - George P Batten
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - Brenna Robinson
- University of Virginia Comprehensive Cancer Center, Charlottesville, Virginia, USA
| | - Cara B Safon
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Chris Louis
- Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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Farivar D, Peterman NJ, Narendran N, Illingworth KD, Nuckols TK, Bonda D, Skaggs DL. Geographic access to pediatric neurosurgeons in the USA: an analysis of sociodemographic factors. Childs Nerv Syst 2024; 40:905-912. [PMID: 37794171 PMCID: PMC10891277 DOI: 10.1007/s00381-023-06172-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 09/28/2023] [Indexed: 10/06/2023]
Abstract
PURPOSE Geographic access to physicians has been shown to be unevenly distributed in the USA, with those in closer proximity having superior outcomes. The purpose of this study was to describe how geographic access to pediatric neurosurgeons varies across socioeconomic and demographic factors. METHODS Actively practicing neurosurgeons were identified by matching several registries and membership logs. This data was used to find their primary practice locations and the distance the average person in a county must travel to visit a surgeon. Counties were categorized into "surgeon deserts" and "surgeon clusters," which were counties where providers were significantly further or closer to its residents, respectively, compared to the national average. These groups were also compared for differences in population characteristics using data obtained from the 2020 American Community Survey. RESULTS A total of 439 pediatric neurosurgeons were identified. The average person in a surgeon desert and cluster was found to be 189.2 ± 78.1 miles and 39.7 ± 19.6 miles away from the nearest pediatric neurosurgeon, respectively. Multivariate analyses showed that higher Rural-Urban Continuum (RUC) codes (p < 0.001), and higher percentages of American Indian (p < 0.001) and Hispanic (p < 0.001) residents were independently associated with counties where the average person traveled significantly further to surgeons. CONCLUSION Patients residing in counties with greater RUC codes and higher percentages of American Indian and Hispanic residents on average need to travel significantly greater distances to access pediatric neurosurgeons.
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Affiliation(s)
- Daniel Farivar
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nicholas J Peterman
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Nakul Narendran
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
| | - Kenneth D Illingworth
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Teryl K Nuckols
- Division of General Internal Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - David Bonda
- Department of Neurological Surgery, University of Washington Medical Center, Seattle, WA, USA
| | - David L Skaggs
- Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Bammert P, Schüttig W, Novelli A, Iashchenko I, Spallek J, Blume M, Diehl K, Moor I, Dragano N, Sundmacher L. The role of mesolevel characteristics of the health care system and socioeconomic factors on health care use - results of a scoping review. Int J Equity Health 2024; 23:37. [PMID: 38395914 PMCID: PMC10885500 DOI: 10.1186/s12939-024-02122-6] [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: 03/06/2023] [Accepted: 02/04/2024] [Indexed: 02/25/2024] Open
Abstract
BACKGROUND Besides macrolevel characteristics of a health care system, mesolevel access characteristics can exert influence on socioeconomic inequalities in healthcare use. These reflect access to healthcare, which is shaped on a smaller scale than the national level, by the institutions and establishments of a health system that individuals interact with on a regular basis. This scoping review maps the existing evidence about the influence of mesolevel access characteristics and socioeconomic position on healthcare use. Furthermore, it summarizes the evidence on the interaction between mesolevel access characteristics and socioeconomic inequalities in healthcare use. METHODS We used the databases MEDLINE (PubMed), Web of Science, Scopus, and PsycINFO and followed the 'Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols extension for scoping reviews (PRISMA-ScR)' recommendations. The included quantitative studies used a measure of socioeconomic position, a mesolevel access characteristic, and a measure of individual healthcare utilisation. Studies published between 2000 and 2020 in high income countries were considered. RESULTS Of the 9501 potentially eligible manuscripts, 158 studies were included after a two-stage screening process. The included studies contained a wide spectrum of outcomes and were thus summarised to the overarching categories: use of preventive services, use of curative services, and potentially avoidable service use. Exemplary outcomes were screening uptake, physician visits and avoidable hospitalisations. Access variables included healthcare system characteristics such as physician density or distance to physician. The effects of socioeconomic position on healthcare use as well as of mesolevel access characteristics were investigated by most studies. The results show that socioeconomic and access factors play a crucial role in healthcare use. However, the interaction between socioeconomic position and mesolevel access characteristics is addressed in only few studies. CONCLUSIONS Socioeconomic position and mesolevel access characteristics are important when examining variation in healthcare use. Additionally, studies provide initial evidence that moderation effects exist between the two factors, although research on this topic is sparse. Further research is needed to investigate whether adapting access characteristics at the mesolevel can reduce socioeconomic inequity in health care use.
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Affiliation(s)
- Philip Bammert
- Chair of Health Economics, Technical University of Munich, Munich, Germany.
| | - Wiebke Schüttig
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Anna Novelli
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Iryna Iashchenko
- Chair of Health Economics, Technical University of Munich, Munich, Germany
| | - Jacob Spallek
- Department of Public Health, Brandenburg University of Technology Cottbus-Senftenberg, Senftenberg, Germany
- Lausitz Center for Digital Public Health, Brandenburg University of Technology, Senftenberg, Germany
| | - Miriam Blume
- Department of Epidemiology and Health Monitoring, Robert-Koch-Institute, Berlin, Germany
| | - Katharina Diehl
- Department of Medical Informatics, Biometry and Epidemiology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Irene Moor
- Institute of Medical Sociology, Interdisciplinary Center for Health Sciences, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Nico Dragano
- Institute of Medical Sociology, Centre for Health and Society, University Hospital and Medical Faculty, University of Duesseldorf, Duesseldorf, Germany
| | - Leonie Sundmacher
- Chair of Health Economics, Technical University of Munich, Munich, Germany
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Wilkerson AD, Gentle CK, Ortega C, Al-Hilli Z. Disparities in Breast Cancer Care-How Factors Related to Prevention, Diagnosis, and Treatment Drive Inequity. Healthcare (Basel) 2024; 12:462. [PMID: 38391837 PMCID: PMC10887556 DOI: 10.3390/healthcare12040462] [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: 12/16/2023] [Revised: 02/05/2024] [Accepted: 02/07/2024] [Indexed: 02/24/2024] Open
Abstract
Breast cancer survival has increased significantly over the last few decades due to more effective strategies for prevention and risk modification, advancements in imaging detection, screening, and multimodal treatment algorithms. However, many have observed disparities in benefits derived from such improvements across populations and demographic groups. This review summarizes published works that contextualize modern disparities in breast cancer prevention, diagnosis, and treatment and presents potential strategies for reducing disparities. We conducted searches for studies that directly investigated and/or reported disparities in breast cancer prevention, detection, or treatment. Demographic factors, social determinants of health, and inequitable healthcare delivery may impede the ability of individuals and communities to employ risk-mitigating behaviors and prevention strategies. The disparate access to quality screening and timely diagnosis experienced by various groups poses significant hurdles to optimal care and survival. Finally, barriers to access and inequitable healthcare delivery patterns reinforce inequitable application of standards of care. Cumulatively, these disparities underlie notable differences in the incidence, severity, and survival of breast cancers. Efforts toward mitigation will require collaborative approaches and partnerships between communities, governments, and healthcare organizations, which must be considered equal stakeholders in the fight for equity in breast cancer care and outcomes.
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Affiliation(s)
- Avia D Wilkerson
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Corey K Gentle
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Camila Ortega
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Zahraa Al-Hilli
- Department of General Surgery, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, OH 44195, USA
- Breast Center, Integrated Surgical Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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Portero de la Cruz S, Béjar LM, Cebrino J. Temporal Evolution and Associated Factors of Adherence to Mammography Screening among Women in Spain: Results from Two National Health Surveys (2017-2020). Healthcare (Basel) 2023; 11:2934. [PMID: 37998426 PMCID: PMC10671473 DOI: 10.3390/healthcare11222934] [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: 10/14/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/25/2023] Open
Abstract
Ensuring equity in cancer screening is recommended by the European Commission. Despite the fact that breast cancer screening is a free population-based program in Spain, there remains considerable variation in the adherence to screening rate among population groups. This study was designed to describe the adherence of breast cancer screening in women in Spain, to evaluate the evolution in the period from 2017 to 2020, and to determine the variables that influence choosing to undergo breast cancer screening. A nationwide cross-sectional study with 7220 females aged 50-69 years from the 2017 Spanish National Health Survey and the 2020 European Health Survey for Spain was performed. We investigated mammography uptake rates, with socio-demographic factors, lifestyle habits, and health-related characteristics as independent variables. Multivariable logistic regression was used to identify the associated factors of mammography adherence. Of the women, 78% had undergone mammography in the previous two years, and there was a significant decrease in the uptake rate for breast cancer screening from 2017 (81.23%) to 2020 (74.68%) (p < 0.001). Educational level, marital status, residential location, nationality, smoking status, alcohol consumption, and leisure-time physical activity were all associated factors of mammography uptake.
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Affiliation(s)
- Silvia Portero de la Cruz
- Department of Nursing, Pharmacology and Physiotherapy, Faculty of Medicine and Nursing, University of Córdoba, Avda. Menéndez Pidal, S/N, 14071 Córdoba, Spain
- Research Group GE10 Clinical and Epidemiological Research in Primary Care, Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Hospital Universitario Reina Sofía, 14071 Córdoba, Spain
| | - Luis M. Béjar
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
| | - Jesús Cebrino
- Department of Preventive Medicine and Public Health, Faculty of Medicine, University of Seville, Avda. Doctor Fedriani, S/N, 41009 Seville, Spain; (L.M.B.); (J.C.)
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Webster JL, Goldstein ND, Rowland JP, Tuite CM, Siegel SD. A catchment and location-allocation analysis of mammography access in Delaware, US: implications for disparities in geographic access to breast cancer screening. Breast Cancer Res 2023; 25:137. [PMID: 37941020 PMCID: PMC10631173 DOI: 10.1186/s13058-023-01738-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 10/30/2023] [Indexed: 11/10/2023] Open
Abstract
BACKGROUND Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. Access to breast cancer screening was evaluated in Delaware, a state that experiences an elevated burden from breast cancer but is otherwise representative of the US in terms of race and urban-rural characteristics. We first conducted a catchment analysis of mammography facilities. Finding evidence of disparities by race and rurality, we next conducted a location-allocation analysis to identify candidate locations for the establishment of new mammography facilities to optimize equitable access. METHODS A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines. RESULTS The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 68% (95% CI 38-85%) fewer mammography units and 89% (95% CI 60-98%) fewer BICOEs. The more rural counties in the state accounted for 41% of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas. CONCLUSIONS The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.
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Affiliation(s)
- Jessica L Webster
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Neal D Goldstein
- Department of Epidemiology and Biostatistics, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA
| | - Jennifer P Rowland
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Catherine M Tuite
- Department of Radiology, Breast Imaging Section, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, Newark, DE, USA
| | - Scott D Siegel
- Cawley Center for Translational Cancer Research, Helen F. Graham Cancer Center & Research Institute, Christiana Care Health System, 4701 Ogletown-Stanton Road, Newark, DE, 19713, USA.
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Omisore AD, Sutton EJ, Akinola RA, Towoju AG, Akhigbe A, Ebubedike UR, Tansley G, Olasehinde O, Goyal A, Akinde AO, Alatise OI, Mango VL, Kingham TP, Knapp GC. Population-Level Access to Breast Cancer Early Detection and Diagnosis in Nigeria. JCO Glob Oncol 2023; 9:e2300093. [PMID: 38096465 PMCID: PMC10730078 DOI: 10.1200/go.23.00093] [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: 03/29/2023] [Revised: 09/08/2023] [Accepted: 10/26/2023] [Indexed: 12/18/2023] Open
Abstract
PURPOSE Mammography, breast ultrasound (US), and US-guided breast biopsy are essential services for breast cancer early detection and diagnosis. This study undertook a comprehensive evaluation to determine population-level access to these services for breast cancer early detection and diagnosis in Nigeria using a previously validated geographic information system (GIS) model. METHODS A comprehensive list of public and private facilities offering mammography, breast US, and US-guided breast biopsy was compiled using publicly available facility data and a survey administered nationally to Nigerian radiologists. All facilities were geolocated. A cost-distance model using open-source population density (GeoData Institute) and road network data (OpenStreetMap) was used to estimate population-level travel time to the nearest facility for mammography, breast US, and US-guided biopsy using GIS software (ArcMAP). RESULTS In total, 1,336 facilities in Nigeria provide breast US, of which 47.8% (639 of 1,336) are public facilities, and 218 provide mammography, of which 45.4% (99 of 218) are public facilities. Of the facilities that provide breast US, only 2.5% (33 of 1,336) also provide US-guided breast biopsy. At the national level, 83.1% have access to either US or mammography and 61.7% have access to US-guided breast biopsy within 120 minutes of a continuous one-way travel. There are differences in access to mammography (64.8% v 80.6% with access at 120 minutes) and US-guided breast biopsy (49.0% v 77.1% with access at 120 minutes) between the northern and southern Nigeria and between geopolitical zones. CONCLUSION To our knowledge, this is the first comprehensive evaluation of breast cancer detection and diagnostic services in Nigeria, which demonstrates geospatial inequalities in access to mammography and US-guided biopsy. Targeted investment is needed to improve access to these essential cancer care services in the northern region and the North East geopolitical zone.
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Affiliation(s)
| | - Elizabeth J. Sutton
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Racheal A. Akinola
- Department of Radiology, Lagos State University Teaching Hospital, Lagos, Nigeria
| | | | - Adenike Akhigbe
- Department of Radiology, University of Benin Teaching Hospital, Benin, Nigeria
| | | | - Gavin Tansley
- Department of Surgery, Division of General Surgery, University of British Columbia, Vancouver, BC, Canada
| | | | - Amita Goyal
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, NS, Canada
| | | | | | - Victoria Lee Mango
- Department of Radiology, Breast Imaging Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - T. Peter Kingham
- Department of Surgery, Hepatobiliary Service, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gregory C. Knapp
- Department of Surgery, Division of General Surgery, Dalhousie University, Halifax, NS, Canada
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Funaro K, Niell B. Screening Mammography Utilization in the United States. JOURNAL OF BREAST IMAGING 2023; 5:384-392. [PMID: 38416907 DOI: 10.1093/jbi/wbad042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/01/2024]
Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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12
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Wiese D, Islami F, Henry KA. Changes in geographic accessibility to mammography by state and rural-urban status, United States, 2006-2022. J Natl Cancer Inst 2023; 115:337-340. [PMID: 36515214 PMCID: PMC9996203 DOI: 10.1093/jnci/djac217] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 10/04/2022] [Accepted: 11/21/2022] [Indexed: 12/15/2022] Open
Abstract
Although mammography is widely available in the United States, differences in accessibility in rural and urban areas and changes over time are not well described. In this study, we estimated the number and proportion of women aged 45-84 years who had limited travel time-based geographic accessibility to mammography by urban-rural status and state in the contiguous United States in 2006 and 2022. The proportion of women aged 45-84 years with limited accessibility to mammography did not substantially change from 2006 (12.7%; representing 7.5 million women) to 2022 (12.2%; 8.2 million women). Accessibility to mammography varied by state, but in 10 states, more than 26% of the statewide female population aged 45-84 years had limited accessibility in 2022. This proportion was substantially higher in rural areas (50.6% overall; ≥50% in 28 states in 2022) than in urban areas (3.0% overall). Increasing accessibility to mammography could increase utilization of breast cancer screening and, potentially, improve breast cancer survival.
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Affiliation(s)
- Daniel Wiese
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA.,Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA
| | - Farhad Islami
- Department of Surveillance and Health Equity Science, American Cancer Society, Kennesaw, GA, USA
| | - Kevin A Henry
- Department of Geography and Urban Studies, Temple University, Philadelphia, PA, USA.,Cancer Prevention and Control, Fox Chase Cancer Center, Philadelphia, PA, USA
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13
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Webster JL, Goldstein ND, Rowland JR, Tuite CM, Siegel SD. A Catchment and Location-Allocation Analysis of Mammography Access in Delaware, US: Implications for disparities in geographic access to breast cancer screening. RESEARCH SQUARE 2023:rs.3.rs-2600236. [PMID: 36909545 PMCID: PMC10002803 DOI: 10.21203/rs.3.rs-2600236/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Background Despite a 40% reduction in breast cancer mortality over the last 30 years, not all groups have benefited equally from these gains. A consistent link between later stage of diagnosis and disparities in breast cancer mortality has been observed by race, socioeconomic status, and rurality. Therefore, ensuring equitable geographic access to screening mammography represents an important priority for reducing breast cancer disparities. This study conducted a catchment and location-allocation analysis of mammography access in Delaware, a state that is representative of the US in terms of race and urban-rural characteristics and experiences an elevated burden from breast cancer. Methods A catchment analysis using the ArcGIS Pro Service Area analytic tool characterized the geographic distribution of mammography sites and Breast Imaging Centers of Excellence (BICOEs). Poisson regression analyses identified census tract-level correlates of access. Next, the ArcGIS Pro Location-Allocation analytic tool identified candidate locations for the placement of additional mammography sites in Delaware according to several sets of breast cancer screening guidelines. Results The catchment analysis showed that for each standard deviation increase in the number of Black women in a census tract, there were 64% (95% CI, 0.18-0.66) fewer mammography units and 85% (95% CI, 0.04-0.48) fewer BICOEs. The more rural counties in the state accounted for 41 % of the population but only 22% of the BICOEs. The results of the location-allocation analysis depended on which set of screening guidelines were adopted, which included increasing mammography sites in communities with a greater proportion of younger Black women and in rural areas. Conclusions The results of this study illustrate how catchment and location-allocation analytic tools can be leveraged to guide the equitable selection of new mammography facility locations as part of a larger strategy to close breast cancer disparities.
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14
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Prajapati N, Soler-Michel P, Vieira VM, Padilla CM. Role of mammography accessibility, deprivation and spatial effect in breast cancer screening participation in France: an observational ecological study. Int J Health Geogr 2022; 21:21. [PMID: 36566241 PMCID: PMC9789573 DOI: 10.1186/s12942-022-00320-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 12/07/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND The detection of cancer in its early latent stages can improve patients' chances of recovery and thereby reduce the overall burden of the disease. Our objectives were to investigate factors (geographic accessibility and deprivation level) affecting mammography screening participation variation and to determine how much geographic variation in participation rates can be explained by spillover effects between adjacent areas, while controlling for covariates. METHODS Mammography screening participation rates between 2015 and 2016 were calculated by census blocks (CB), for women aged 50-74 years, residing in Lyon metropolitan area. Global spatial autocorrelation tests were applied to identify the geographic variation of participation. Spatial regression models were used to incorporate spatial structure to estimate associations between mammography participation rate and the combined effect (geographic accessibility and deprivation level) adjusting for modes of travel and social cohesion. RESULTS The mammography participation rate was found to have a statistically significant and positive spatial correlation. The participation rate of one CB was significantly and positively associated with the participation rates of neighbouring CB. The participation was 53.2% in residential and rural areas and 46.6% in urban areas, p < 0.001. Using Spatial Lag models, whereas the population living in most deprived CBs have statistically significantly lower mammography participation rates than lower deprived ones, significant interaction demonstrates that the relation differs according to the degree of urbanization. CONCLUSIONS This study makes an important methodological contribution in measuring geographical access and understanding better the combined effect of deprivation and the degree of urbanization on mammography participation and other contextual factors that affect the decision of using mammography screening services -which is a critical component of healthcare planning and equity.
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Affiliation(s)
- Nirmala Prajapati
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
| | - Patricia Soler-Michel
- Centre Régional de Coordination des Dépistages des Cancers Auvergne Rhône Alpes, Lyon, France
| | - Verónica M. Vieira
- grid.266093.80000 0001 0668 7243Department of Environmental and Occupational Health, Program in Public Health, University of California, Irvine, CA USA
| | - Cindy M. Padilla
- grid.410368.80000 0001 2191 9284Univ Rennes, EHESP, CNRS, Inserm, Arènes-UMR 6051, RSMS-U 1309, 35000 Rennes, France
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15
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Champion VL, Monahan PO, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Zaborski NL, Paskett ED. The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women. Cancers (Basel) 2022; 14:4354. [PMID: 36139515 PMCID: PMC9496655 DOI: 10.3390/cancers14184354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Erika B. Biederman
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Mira L. Katz
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH 43210, USA
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalie L. Zaborski
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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16
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A Flexible Method for Identifying Spatial Clusters of Breast Cancer Using Individual-Level Data. Ann Epidemiol 2022; 73:9-16. [PMID: 35772615 DOI: 10.1016/j.annepidem.2022.06.006] [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: 02/04/2022] [Revised: 05/16/2022] [Accepted: 06/10/2022] [Indexed: 11/22/2022]
Abstract
Prior research has shown that cancer risk varies by geography, but scan statistics methods for identifying cancer clusters in case-control studies have been limited in their ability to identify multiple clusters and adjust for participant-level risk factors. We develop a method to identify geographic patterns of breast cancer odds using the Wisconsin Women's Health Study, a series of 5 population-based case-control studies of female Wisconsin residents aged 20-79 enrolled in 1988-2004 (cases=16,076, controls=16,795). We create sets of potential clusters by overlaying a 1 km grid over each county-neighborhood and enumerating a series of overlapping circles. Using a two-step approach, we fit a penalized binomial regression model to the number of cases and trials in each grid cell, penalizing all potential clusters by the least absolute shrinkage and selection operator (Lasso). We use BIC to select the number of clusters, which are included in a participant-level logistic regression model. We identify 15 geographic clusters, resulting in 23 areas of unique geographic odds ratios. After adjustment for known risk factors, confidence intervals narrowed but breast cancer odds ratios did not meaningfully change; one additional hotspot was identified. By considering multiple overlapping spatial clusters simultaneously, we discern gradients of spatial odds across Wisconsin.
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17
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Tumakov D, Kayumov Z, Zhumaniezov A, Chikrin D, Galimyanov D. Elimination of Defects in Mammograms Caused by a Malfunction of the Device Matrix. J Imaging 2022; 8:jimaging8050128. [PMID: 35621892 PMCID: PMC9143204 DOI: 10.3390/jimaging8050128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/15/2022] [Accepted: 04/19/2022] [Indexed: 11/22/2022] Open
Abstract
Today, the processing and analysis of mammograms is quite an important field of medical image processing. Small defects in images can lead to false conclusions. This is especially true when the distortion occurs due to minor malfunctions in the equipment. In the present work, an algorithm for eliminating a defect is proposed, which includes a change in intensity on a mammogram and deteriorations in the contrast of individual areas. The algorithm consists of three stages. The first is the defect identification stage. The second involves improvement and equalization of the contrasts of different parts of the image outside the defect. The third involves restoration of the defect area via a combination of interpolation and an artificial neural network. The mammogram obtained as a result of applying the algorithm shows significantly better image quality and does not contain distortions caused by changes in brightness of the pixels. The resulting images are evaluated using Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE) and Naturalness Image Quality Evaluator (NIQE) metrics. In total, 98 radiomics features are extracted from the original and obtained images, and conclusions are drawn about the minimum changes in features between the original image and the image obtained by the proposed algorithm.
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Affiliation(s)
- Dmitrii Tumakov
- Institute of Computational Mathematics and Information Technologies, Kazan Federal University, 420008 Kazan, Russia; (Z.K.); (A.Z.); (D.C.)
- Correspondence:
| | - Zufar Kayumov
- Institute of Computational Mathematics and Information Technologies, Kazan Federal University, 420008 Kazan, Russia; (Z.K.); (A.Z.); (D.C.)
| | - Alisher Zhumaniezov
- Institute of Computational Mathematics and Information Technologies, Kazan Federal University, 420008 Kazan, Russia; (Z.K.); (A.Z.); (D.C.)
| | - Dmitry Chikrin
- Institute of Computational Mathematics and Information Technologies, Kazan Federal University, 420008 Kazan, Russia; (Z.K.); (A.Z.); (D.C.)
| | - Diaz Galimyanov
- Medical Unit, Department of Radiology, Kazan Federal University, 420008 Kazan, Russia;
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18
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DeBenedectis CM, Spalluto LB, Americo L, Bishop C, Mian A, Sarkany D, Kagetsu NJ, Slanetz PJ. Health Care Disparities in Radiology-A Review of the Current Literature. J Am Coll Radiol 2022; 19:101-111. [PMID: 35033297 DOI: 10.1016/j.jacr.2021.08.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/31/2021] [Indexed: 12/18/2022]
Abstract
INTRODUCTION Health care disparities exist in all medical specialties, including radiology. Raising awareness of established health care disparities is a critical component of radiology's efforts to mitigate disparities. Our primary objective is to perform a comprehensive review of the last 10 years of literature pertaining to disparities in radiology care. Our secondary objective is to raise awareness of disparities in radiology. METHODS We reviewed English-language medicine and health services literature from the past 10 years (2010-2020) for research that described disparities in any aspect of radiologic imaging using radiology search terms and key words for disparities in OVID. Relevant studies were identified with adherence to the guidelines set forth by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. RESULTS The search yielded a total 1,890 articles. We reviewed the citations and abstracts with the initial search yielding 1,890 articles (without duplicates). Of these, 1,776 were excluded based on the criteria set forth in the methods. The remaining unique 114 articles were included for qualitative synthesis. DISCUSSION We hope this article increases awareness and inspires action to address disparities and encourages research that further investigates previously identified disparities and explores not-yet-identified disparities.
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Affiliation(s)
- Carolynn M DeBenedectis
- Vice-Chair, Education; Director, Radiology Residency Program; Department of Radiology, President-elect, New England Roentgen Ray Society; and Department of Radiology, University of Massachusetts Medical School, Worcester, Massachusetts.
| | - Lucy B Spalluto
- Vice-Chair, Health Equity; Director, Women in Radiology; Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee; Vanderbilt Ingram Cancer Center, Nashville, Tennessee; Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research; and Education and Clinical Center (GRECC), Nashville, Tennessee
| | - Lisa Americo
- Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Casey Bishop
- Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - Asim Mian
- Director, Radiology Residency Program; Department of Radiology, Boston Medical Center, Boston, Massachusetts
| | - David Sarkany
- Director, Radiology Residency Program; Department of Radiology, Staten Island University Hospital Northwell Health, Staten Island, New York
| | - Nolan J Kagetsu
- Department of Radiology, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Priscilla J Slanetz
- Vice-Chair, Academic Affairs; Associate Program Director, Radiology Residency Program, Boston Medical Center; President-elect Massachusetts Radiologic Society; Secretary, Association of University Radiologists; Chair, Breast Imaging Panel 2, ACR Appropriateness Guidelines Committee; and Department of Radiology, Boston Medical Center, Boston, Massachusetts
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19
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Schousboe JT, Sprague BL, Abraham L, O'Meara ES, Onega T, Advani S, Henderson LM, Wernli KJ, Zhang D, Miglioretti DL, Braithwaite D, Kerlikowske K. Cost-Effectiveness of Screening Mammography Beyond Age 75 Years : A Cost-Effectiveness Analysis. Ann Intern Med 2022; 175:11-19. [PMID: 34807717 PMCID: PMC9621600 DOI: 10.7326/m20-8076] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND The cost-effectiveness of screening mammography beyond age 75 years remains unclear. OBJECTIVE To estimate benefits, harms, and cost-effectiveness of extending mammography to age 80, 85, or 90 years according to comorbidity burden. DESIGN Markov microsimulation model. DATA SOURCES SEER (Surveillance, Epidemiology, and End Results) program and Breast Cancer Surveillance Consortium. TARGET POPULATION U.S. women aged 65 to 90 years in groups defined by Charlson comorbidity score (CCS). TIME HORIZON Lifetime. PERSPECTIVE National health payer. INTERVENTION Screening mammography to age 75, 80, 85, or 90 years. OUTCOME MEASURES Breast cancer death, survival, and costs. RESULTS OF BASE-CASE ANALYSIS Extending biennial mammography from age 75 to 80 years averted 1.7, 1.4, and 1.0 breast cancer deaths and increased days of life gained by 5.8, 4.2, and 2.7 days per 1000 women for comorbidity scores of 0, 1, and 2, respectively. Annual mammography beyond age 75 years was not cost-effective, but extending biennial mammography to age 80 years was ($54 000, $65 000, and $85 000 per quality-adjusted life-year [QALY] gained for women with CCSs of 0, 1, and ≥2, respectively). Overdiagnosis cases were double the number of deaths averted from breast cancer. RESULTS OF SENSITIVITY ANALYSIS Costs per QALY gained were sensitive to changes in invasive cancer incidence and shift of breast cancer stage with screening mammography. LIMITATION No randomized controlled trials of screening mammography beyond age 75 years are available to provide model parameter inputs. CONCLUSION Although annual mammography is not cost-effective, biennial screening mammography to age 80 years is; however, the absolute number of deaths averted is small, especially for women with comorbidities. Women considering screening beyond age 75 years should weigh the potential harms of overdiagnosis versus the potential benefit of averting death from breast cancer. PRIMARY FUNDING SOURCE National Cancer Institute and National Institutes of Health.
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Affiliation(s)
- John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners, Bloomington, and Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota (J.T.S.)
| | - Brian L Sprague
- Departments of Surgery and Radiology, The University of Vermont, Burlington, Vermont (B.L.S.)
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Tracy Onega
- Department of Population Health Sciences and Huntsman Cancer Institute, The University of Utah, Salt Lake City, Utah (T.O.)
| | - Shailesh Advani
- Department of Oncology, School of Medicine, Georgetown University, Washington, DC, and Terasaki Institute for Biomedical Innovation, Los Angeles, California (S.A.)
| | - Louise M Henderson
- Department of Radiology, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina (L.M.H.)
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington (L.A., E.S.O., K.J.W.)
| | - Dongyu Zhang
- Cancer Control and Population Sciences Program and Department of Epidemiology, University of Florida, Gainesville, Florida (D.Z.)
| | - Diana L Miglioretti
- Department of Public Health Sciences, University of California, Davis, California, and Kaiser Permanente Washington Health Research Institute, Seattle, Washington (D.L.M.)
| | - Dejana Braithwaite
- Cancer Control and Population Sciences Program, Department of Epidemiology, and Institute on Aging, University of Florida, Gainesville, Florida (D.B.)
| | - Karla Kerlikowske
- Departments of Medicine and Epidemiology and Biostatistics and Department of Veterans Affairs (VA) Division of General Internal Medicine, University of California, San Francisco, San Francisco, California (K.K.)
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20
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Abstract
Neighborhood has significant implications for breast cancer screening, stage, treatment, and mortality. Patients residing in neighborhoods with high deprivation or rurality face barriers and challenges to accessing and receiving care. Consequently, they experience higher mortality rates than their financially affluent or urban counterparts. There are multiple gaps in the literature on the relationship between place of residence and the use of systemic therapies or emerging surgical strategies for disease management. As the management of breast cancer continues to evolve, additional studies are needed to understand the implications of place on the implementation and dissemination of new and emerging treatment modalities.
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Affiliation(s)
- Samilia Obeng-Gyasi
- Division of Surgical Oncology, Department of Surgery, The Ohio State University, N924 Doan Hall, 410 West 10th, Columbus, OH 43210, USA.
| | - Barnabas Obeng-Gyasi
- Department of Radiology, Duke University Medical Center, 10 Duke Medicine Circle, Durham, NC 27710, USA
| | - Willi Tarver
- Division of Cancer Prevention & Control, Department of Internal Medicine, College of Medicine, The Ohio State University, 460 Medical Center Drive, Room 526, Columbus, OH 43210, USA
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21
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Kim SE, Bachorik AE, Bertrand KA, Gunn CM. Differences in Breast Cancer Screening Practices by Diabetes Status and Race/Ethnicity in the United States. J Womens Health (Larchmt) 2021; 31:848-855. [PMID: 34935471 DOI: 10.1089/jwh.2021.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Socioeconomic and health-related factors, including comorbid illness, may affect mammography screening rates and subsequently contribute to breast cancer outcomes. We explored the association between diabetes and mammography screening, and whether this association varied between racial, ethnic, and geographic groups. Methods: Cross-sectional data from the 2012, 2014, 2016, and 2018 Behavioral Risk Factor Surveillance System were used to fit logistic regression models assessing the association between diabetes and up-to-date mammography screening in 497,600 women, aged 50-74 years. Participants were considered exposed if they responded "yes" to "(Ever told) you have diabetes?" and up to date on screening if they responded "yes" to having a mammogram within the past 2 years. Models were adjusted for age, health status, socioeconomic, and access variables. Results: The majority of participants were White (79.6%), non-Hispanic (88.9%), and up to date on screening (78.8%). Overall, 16.8% reported having diabetes. In fully adjusted models, White women with diabetes were 12% more likely to be up to date on screening (odds ratio [OR]: 1.12, 95% confidence interval [CI]: 1.06-1.19) than those without diabetes. Black/African American women and those of Hispanic ethnicity with diabetes were more likely to report being up to date with mammography (ORBlack: 1.28, 95% CI: 1.12-1.45; ORHispanic: 1.19, 95% CI: 1.13-1.24) than those without. Patterns were similar across geographic regions. Conclusions: Women of ages 50-74 years with diabetes were more likely to be up to date on screening than women without diabetes. Chronic disease management may represent an opportunity to address cancer screening.
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Affiliation(s)
- Sydney E Kim
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Alexandra E Bachorik
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | | | - Christine M Gunn
- Section of General Internal Medicine, Women's Health Unit, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA.,Department of Health Law, Policy, and Management, Boston University School of Public Health, Boston, Massachusetts, USA
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22
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The Role of Screening Mammography in Addressing Disparities in Breast Cancer Diagnosis, Treatment, and Outcomes. CURRENT BREAST CANCER REPORTS 2021. [DOI: 10.1007/s12609-021-00427-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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23
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Adams SJ, Babyn P, Mendez I. Access to Mammography Among Indigenous Peoples in North America. Acad Radiol 2021; 28:950-952. [PMID: 33975789 DOI: 10.1016/j.acra.2021.04.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 04/05/2021] [Indexed: 02/08/2023]
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24
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Amram O, Robison J, Amiri S, Pflugeisen B, Roll J, Monsivais P. Socioeconomic and Racial Inequities in Breast Cancer Screening During the COVID-19 Pandemic in Washington State. JAMA Netw Open 2021; 4:e2110946. [PMID: 34028552 PMCID: PMC8144923 DOI: 10.1001/jamanetworkopen.2021.10946] [Citation(s) in RCA: 52] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
This cohort study investigates the rates of breast cancer screening before and during the COVID-19 pandemic among women in Washington State.
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Affiliation(s)
- Ofer Amram
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
- Paul G. Allen School for Global Animal Health, Washington State University, Pullman
| | - Jeanne Robison
- Multicare Institute for Research & Innovation, Tacoma, Washington
- Multicare Deaconess Cancer & Blood Specialty Centers, Spokane, Washington
| | - Solmaz Amiri
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | | | - John Roll
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
| | - Pablo Monsivais
- Department of Nutrition and Exercise Physiology, Elson S. Floyd College of Medicine, Washington State University, Spokane
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25
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Norfjord van Zyl M, Tillgren P, Asp M. The politicians' perspectives on participation in mammographic screening: an interview-based study from a region in Sweden. ACTA ACUST UNITED AC 2021; 79:52. [PMID: 33865449 PMCID: PMC8052730 DOI: 10.1186/s13690-021-00576-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/07/2021] [Indexed: 11/23/2022]
Abstract
Background Breast cancer is the most common cancer type among women globally. To facilitate early detection, all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims to describe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation. Methods Qualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues. Results Two main themes have been identified: 1) expected actions and 2) expected conditions for acting, including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health. The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation. Conclusions Expected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of the screening and an understanding of social determinants’ impacts on women’s decision to refrain from mammographic screening, as well as available resources. Supplementary Information The online version contains supplementary material available at 10.1186/s13690-021-00576-6.
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Affiliation(s)
- Maria Norfjord van Zyl
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| | - Per Tillgren
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Margareta Asp
- Division of Caring Sciences and Health Care Pedagogics, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
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Davis KM, Monga N, Sonubi C, Asumu H, DeBenedectis CM, Spalluto LB. Educational Strategies to Achieve Equitable Breast Imaging Care. JOURNAL OF BREAST IMAGING 2021; 3:231-239. [PMID: 38424828 DOI: 10.1093/jbi/wbaa082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Indexed: 03/02/2024]
Abstract
As the population of the United States becomes increasingly diverse, radiologists must learn to both understand and mitigate the impact of health disparities. Significant health disparities persist in radiologic care, including breast imaging. Racial and ethnic minorities, women from lower socioeconomic status, those living in rural areas, and the uninsured bear a disproportionate burden of breast cancer morbidity and mortality. Currently, there is no centralized radiology curriculum focusing on breast health disparities available to residents, breast imaging fellows, or practicing breast radiologists. While patient-, provider-, and system-level initiatives are necessary to overcome disparities, our purpose is to describe educational strategies targeted to breast imaging radiologists at all levels to provide equitable care to a diverse population. These strategies may include, but are not limited to, diversifying the breast imaging workforce, understanding the needs of a diverse population, cultural sensitivity and bias training, and fostering awareness of the existing issues in screening mammography access, follow-up imaging, and clinical care.
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Affiliation(s)
- Katie M Davis
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | - Natasha Monga
- Case Western Reserve University - The MetroHealth System, Department of Radiology, Cleveland, OH
| | | | - Hazel Asumu
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
| | | | - Lucy B Spalluto
- Vanderbilt University Medical Center, Department of Radiology and Radiological Sciences, Nashville, TN
- Vanderbilt University Medical Center, Vanderbilt-Ingram Cancer Center, Nashville, TN
- Veterans Health Administration, Tennessee Valley Healthcare System Geriatric Research, Education, and Clinical Center, Nashville, TN
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Patel MM, Parikh JR. Patient Diversity in Breast Imaging: Barriers and Potential Solutions. JOURNAL OF BREAST IMAGING 2021; 3:98-105. [PMID: 38424834 DOI: 10.1093/jbi/wbaa092] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Indexed: 03/02/2024]
Abstract
Recent reports have highlighted disparities in breast cancer care related to patient diversity. Breast radiologists represent the face of breast imaging and are key players in advocating for patients to reduce these disparities. Diversity-related barriers for breast imaging patients, as they journey from screening to survivorship, include impediments to access and quality of care, gaps in communication, and lack of knowledge in both providers and patients. Potential strategies for overcoming these specific barriers include "culturally tailored" nurse navigators, mobile mammography, improved communication, patient and provider education, and breast radiologist involvement in advocacy efforts promoting diversity. As current trends in recommendations and guidelines for breast imaging include more numerous and advanced imaging modalities, it is important to acknowledge and address diversity-related disparities.
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Affiliation(s)
- Miral M Patel
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- The University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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Spada NG, Geramita EM, Zamanian M, van Londen GJ, Sun Z, Sabik LM. Changes in Disparities in Stage of Breast Cancer Diagnosis in Pennsylvania After the Affordable Care Act. J Womens Health (Larchmt) 2020; 30:324-331. [PMID: 32986501 DOI: 10.1089/jwh.2020.8478] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: This study sought to determine if increased access to health insurance following the Affordable Care Act (ACA) resulted in an increased proportion of early-stage breast cancer diagnosis among women in Pennsylvania, particularly minorities, rural residents, and those of lower socioeconomic status. Materials and Methods: Data on 35,735 breast cancer cases among women 50-64 and 68-74 years of age in Pennsylvania between 2010 and 2016 were extracted from the Pennsylvania Cancer Registry and analyzed in 2019. Women 50-64 years of age were subdivided by race/ethnicity, area of residence, and socioeconomic status as measured by area deprivation index (ADI). We compared the proportions of early-stage breast cancer diagnosis pre-ACA (2010-2013) and post-ACA (2014-2016) for all women 50-64 years of age to all women 68-74 years of age. This comparison was also made between paired sociodemographic subgroups for women 50-64 years of age. Multivariable logistic regression models were constructed to assess how race, area of residence, ADI, and primary care physician (PCP) density interacted to impact breast cancer diagnosis post-ACA. Results: The proportion of early-stage breast cancer diagnosis increased by 1.71% post-ACA among women 50-64 years of age (p < 0.01), whereas women 68-74 years of age saw no change. Multivariable logistic regression analysis demonstrated that minority women had lower odds of early-stage breast cancer diagnosis pre-ACA, but not post-ACA, when controlling for ADI. Meanwhile, increased area-level socioeconomic advantage was associated with higher odds of being diagnosed with early-stage breast cancer pre- and post-ACA irrespective of controlling for race, area of residence, or PCP density. Conclusions: Enhanced access to health insurance under the ACA was associated with an increased proportion of early-stage breast cancer diagnosis in Pennsylvanian women 50-64 years of age and may have reduced racial, but not socioeconomic, disparities in breast cancer diagnosis.
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Affiliation(s)
- Neal G Spada
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Emily M Geramita
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Maryam Zamanian
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - G J van Londen
- Department of Medicine and University of Pittsburgh, Pennsylvania, USA
| | - Zhaojun Sun
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania, USA
| | - Lindsay M Sabik
- Department of Health Policy and Management, University of Pittsburgh, Pennsylvania, USA
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Emerson MA, Reeder-Hayes KE, Tipaldos HJ, Bell ME, Sweeney MR, Carey LA, Earp HS, Olshan AF, Troester MA. Integrating biology and access to care in addressing breast cancer disparities: 25 years' research experience in the Carolina Breast Cancer Study. CURRENT BREAST CANCER REPORTS 2020; 12:149-160. [PMID: 33815665 DOI: 10.1007/s12609-020-00365-0] [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: 11/24/2022]
Abstract
Purpose of Review To review research on breast cancer mortality disparities, emphasizing research conducted in the Carolina Breast Cancer Study, with a focus on challenges and opportunities for integration of tumor biology and access characteristics across the cancer care continuum. Recent Findings Black women experience higher mortality following breast cancer diagnosis, despite lower incidence compared to white women. Biological factors, such as stage at diagnosis and breast cancer subtypes, play a role in these disparities. Simultaneously, social, behavioral, environmental, and access to care factors are important. However, integrated studies of biology and access are challenging and it is uncommon to have both data types available in the same study population. The central emphasis of Phase 3 of the Carolina Breast Cancer Study, initiated in 2008, was to collect rich data on biology (including germline and tumor genomics and pathology) and health care access in a diverse study population, with the long term goal of defining intervention opportunities to reduce disparities across the cancer care continuum. Summary Early and ongoing research from CBCS has identified important interactions between biology and access, leading to opportunities to build greater equity. However, sample size, population-specific relationships among variables, and complexities of treatment paths along the care continuum pose important research challenges. Interdisciplinary teams, including experts in novel data integration and causal inference, are needed to address gaps in our understanding of breast cancer disparities.
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Affiliation(s)
- Marc A Emerson
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Heather J Tipaldos
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mary E Bell
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Marina R Sweeney
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - H Shelton Earp
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Andrew F Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Melissa A Troester
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Tsui J, Hirsch JA, Bayer FJ, Quinn JW, Cahill J, Siscovick D, Lovasi GS. Patterns in Geographic Access to Health Care Facilities Across Neighborhoods in the United States Based on Data From the National Establishment Time-Series Between 2000 and 2014. JAMA Netw Open 2020; 3:e205105. [PMID: 32412637 PMCID: PMC7229525 DOI: 10.1001/jamanetworkopen.2020.5105] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE The association between proximity to health care facilities and improved disease management and population health has been documented, but little is known about small-area health care environments and how the presence of health care facilities has changed over time during recent health system and policy change. OBJECTIVE To examine geographic access to health care facilities across neighborhoods in the United States over a 15-year period. DESIGN, SETTING, AND PARTICIPANTS Using longitudinal business data from the National Establishment Time-Series, this cross-sectional study examined the presence of and change in ambulatory care facilities and pharmacies and drugstores in census tracts (CTs) throughout the continental United States between 2000 and 2014. Between January and April 2019, multinomial logistic regression was used to estimate associations between health care facility presence and neighborhood sociodemographic characteristics over time. MAIN OUTCOMES AND MEASURES Change in health care facility presence was measured as never present, lost, gained, or always present between 2000 and 2014. Neighborhood sociodemographic characteristics (ie, CTs) and their change over time were measured from US Census reports (2000 and 2010) and the American Community Survey (2008-2012). RESULTS Among 72 246 included CTs, the percentage of non-US-born residents, residents 75 years or older, poverty status, and population density increased, and 8.1% of CTs showed a change in the racial/ethnic composition of an area from predominantly non-Hispanic (NH) white to other racial/ethnic composition categories between 2000 and 2010. The presence of ambulatory care facilities increased from a mean (SD) of 7.7 (15.9) per CT in 2000 to 13.0 (22.9) per CT in 2014, and the presence of pharmacies and drugstores increased from a mean (SD) of 0.6 (1.0) per CT in 2000 to 0.9 (1.4) per CT in 2014. Census tracts with predominantly NH black individuals (adjusted odds ratio [aOR], 2.37; 95% CI, 2.03-2.77), Hispanic/Latino individuals (aOR 1.30; 95% CI, 1.00-1.69), and racially/ethnically mixed individuals (aOR, 1.53; 95% CI, 1.33-1.77) in 2000 had higher odds of losing health care facilities between 2000 and 2014 compared with CTs with predominantly NH white individuals, after controlling for other neighborhood characteristics. Census tracts of geographic areas with higher levels of poverty in 2000 also had higher odds of losing health care facilities between 2000 and 2014 (aOR, 1.12; 95% CI, 1.05-1.19). CONCLUSIONS AND RELEVANCE Differential change was found in the presence of health care facilities across neighborhoods over time, indicating the need to monitor and address the spatial distribution of health care resources within the context of population health disparities.
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Affiliation(s)
- Jennifer Tsui
- Rutgers Cancer Institute of New Jersey, Rutgers, The State University of New Jersey, New Brunswick
- Department of Health Behavior, Society, and Policy, Rutgers School of Public Health, Rutgers, The State University of New Jersey, New Brunswick
- Rutgers Center for State Health Policy, Rutgers, The State University of New Jersey, New Brunswick
| | - Jana A. Hirsch
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - Felicia J. Bayer
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
| | - James W. Quinn
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Jesse Cahill
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - David Siscovick
- Research, Evaluation & Policy, New York Academy of Medicine, New York, New York
| | - Gina S. Lovasi
- Department of Epidemiology and Biostatistics, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania
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Liu Z, Li R, Liang K, Chen J, Chen X, Li X, Li R, Zhang X, Yi L, Long W. Value of digital mammography in predicting lymphovascular invasion of breast cancer. BMC Cancer 2020; 20:274. [PMID: 32245448 PMCID: PMC7119272 DOI: 10.1186/s12885-020-6712-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 03/03/2020] [Indexed: 12/15/2022] Open
Abstract
Background Lymphovascular invasion (LVI) has never been revealed by preoperative scans. It is necessary to use digital mammography in predicting LVI in patients with breast cancer preoperatively. Methods Overall 122 cases of invasive ductal carcinoma diagnosed between May 2017 and September 2018 were enrolled and assigned into the LVI positive group (n = 42) and the LVI negative group (n = 80). Independent t-test and χ2 test were performed. Results Difference in Ki-67 between the two groups was statistically significant (P = 0.012). Differences in interstitial edema (P = 0.013) and skin thickening (P = 0.000) were statistically significant between the two groups. Multiple factor analysis showed that there were three independent risk factors for LVI: interstitial edema (odds ratio [OR] = 12.610; 95% confidence interval [CI]: 1.061–149.922; P = 0.045), blurring of subcutaneous fat (OR = 0.081; 95% CI: 0.012–0.645; P = 0.017) and skin thickening (OR = 9.041; 95% CI: 2.553–32.022; P = 0.001). Conclusions Interstitial edema, blurring of subcutaneous fat, and skin thickening are independent risk factors for LVI. The specificity of LVI prediction is as high as 98.8% when the three are used together.
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Affiliation(s)
- Zhuangsheng Liu
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Ruqiong Li
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Keming Liang
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Junhao Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Xiangmeng Chen
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China
| | - Xiaoping Li
- Department of Gastrointestinal Surgery, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Ronggang Li
- Department of Pathology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Xin Zhang
- Department of Clinical Experimental Center, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, Jiangmen, Guangdong, China
| | - Lilei Yi
- Department of Radiology, Foshan Hospital of Traditional Chinese Medicine, Foshan, Guangdong, China
| | - Wansheng Long
- Department of Radiology, Jiangmen Central Hospital, Affiliated Jiangmen Hospital of Sun Yat-Sen University, No. 23 Haibang Street, Jiangmen, 529000, Guangdong, China.
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Chung HL, Parikh JR. Telemammography: Technical Advances Improve Patient Access in Breast Care. JOURNAL OF BREAST IMAGING 2020; 2:152-156. [PMID: 38424884 DOI: 10.1093/jbi/wbz088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2019] [Indexed: 03/02/2024]
Abstract
Screening mammography's efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist's interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation's mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today's information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control's Healthy People 2020 goals related to breast cancer.
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Affiliation(s)
- Hannah L Chung
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
| | - Jay R Parikh
- University of Texas MD Anderson Cancer Center, Department of Radiology, Houston, TX
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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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Norfjord van Zyl M, Akhavan S, Tillgren P, Asp M. Non-participation in mammographic screening - experiences of women from a region in Sweden. BMC Public Health 2020; 20:219. [PMID: 32050943 PMCID: PMC7017469 DOI: 10.1186/s12889-020-8306-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 01/31/2020] [Indexed: 12/03/2022] Open
Abstract
Background Understanding women’s life conditions regarding their non-participation in different health-promoting and disease-preventing activities is important as it may draw attention to potential areas for improvement in the healthcare sector. Mammographic screening, a disease-preventing service, facilitates early detection of any potential malignancies and consequently prompts initiation of treatment. The reasons for non-participation in mammographic screening can be understood from different perspectives, such as socioeconomic and lifestyle-related determinants of health. This study aims to gain a deeper understanding of women’s experiences and perceptions about non-participation in mammographic screening in a Swedish region with a single mammographic facility. Methods Data from individual semi-structured interviews, conducted in 2018 with eleven women between the ages of 48 and 73, were analysed by a qualitative content analysis. Results The findings reveal three main categories: 1) doubts regarding mammographic screening and its organisation, 2) sense and sensibility in the decision to refrain from mammographic screening, and 3) dependency and options. These three categories indicate aspects, such as the individual’s life situation, accessibility to the offered service, and the flexibility of the healthcare system, that need to be considered to improve the organisation of mammographic screening. Conclusion Listening to the women’s voices regarding their experiences and perceptions about mammographic screening is important as individual characteristics and social circumstances interact with healthcare and affect the degree of participation.
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Affiliation(s)
- Maria Norfjord van Zyl
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden.
| | - Sharareh Akhavan
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Per Tillgren
- Division of Public Health Sciences, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
| | - Margareta Asp
- Division of Caring Sciences and Health Care Pedagogics, School of Health, Care and Social Welfare, Mälardalen University, Box 883, 721 23, Västerås, Sweden
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Moss JL, Ehrenkranz R, Perez LG, Hair BY, Julian AK. Geographic disparities in cancer screening and fatalism among a nationally representative sample of US adults. J Epidemiol Community Health 2019; 73:1128-1135. [PMID: 31615890 DOI: 10.1136/jech-2019-212425] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/06/2019] [Accepted: 09/28/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Cancer screening in the USA is suboptimal, particularly for individuals living in vulnerable communities. This study aimed to understand how rurality and racial segregation are independently and interactively associated with cancer screening and cancer fatalism. METHODS We used data from a nationally representative sample of adults (n=17 736) from National Cancer Institute's Health Information National Trends Survey, 2011-2017, including cancer screening (colorectal, breast, cervical, prostate) among eligible participants and cancer fatalism. These data were linked to county-level metropolitan status/rurality (US Department of Agriculture) and racial segregation (US Census). We conducted multivariable analyses of associations of geographic variables with screening and fatalism. RESULTS Breast cancer screening was lower in rural (92%, SE=1.5%) than urban counties (96%, SE=0.5%) (adjusted OR (aOR)=0.52, 95% CI 0.31 to 0.87). Colorectal cancer screening was higher in highly segregated (70%, SE=1.0%) than less segregated counties (65%, SE=1.7%) (aOR=1.28, 95% CI 1.04 to 1.58). Remaining outcomes did not vary by rurality or segregation, and these variables did not interact in their associations with screening or fatalism. CONCLUSION Similar to previous studies, breast cancer screening was less common in rural areas. Contrary to expectations, colorectal cancer screening was higher in highly segregated counties. More research is needed on the influence of geography on cancer screening and beliefs, and how access to facilities or information may mediate these relationships.
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Affiliation(s)
- Jennifer L Moss
- National Cancer Institute, Bethesda, Maryland, USA .,Family and Community Medicine, Penn State College of Medicine, Hershey, Pennsylvania, USA
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