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Tahal R, Nahvijou A, Sari AA, Daroudi R. Assessing Women's Preference and Willingness to Pay for Breast Cancer Screening: A Discrete Choice Experiment Approach. Value Health Reg Issues 2025; 48:101110. [PMID: 40132432 DOI: 10.1016/j.vhri.2025.101110] [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: 07/10/2024] [Revised: 12/29/2024] [Accepted: 02/06/2025] [Indexed: 03/27/2025]
Abstract
OBJECTIVES This study aimed to explore women's preferences regarding breast cancer screening using a discrete choice experiment and willingness-to-pay analysis. METHODS A discrete-choice experiment was conducted among 255 women aged 40 to 65 years who were referred to health centers in Tehran city. The experiment included attributes such as screening methods (clinical examination and mammography), number of deaths prevented, possibility of misdiagnosis and unnecessary biopsy, screening intervals, and cost of the screening test. A conditional logit model was used to estimate preferences, and willingness-to-pay values were derived from the model coefficients. RESULTS Women revealed a strong preference for mammography over clinical examination(odds ratio [OR] 1.73; 95% CI 1.47-2.04; P < .001). Compared with 1 death prevented per 1000 women, the ORs for 3 and 6 deaths prevented per 1000 women were 18.1 (95% CI 12.72-25.75; P < .001) and 74.48 (95% CI 49.41-112.27; P < .001), respectively. The ORs for misdiagnosis and unnecessary biopsy rates of 10 of 100 people were 0.006 (95% CI 0.003-0.012; P < .001). Preferences for screening intervals varied, with a higher preference for screening every 4 years (OR 2.77; 95% CI 1.73-4.43; P < .001) compared with annual screening. The cost was also a significant factor, with a decrease in the odds of choosing a screening option as the cost increased (OR 0.139; 95% CI 0.1396-0.1399; P = .001). CONCLUSIONS This study provides valuable insights into women's preferences for breast cancer screening in Iran.
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Affiliation(s)
- Reyhane Tahal
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Azin Nahvijou
- Cancer Research Center of Cancer Institute, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Akbari Sari
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Rajabali Daroudi
- Department of Health Management, Policy and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
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Giess CS, Lynch E, Lacson R, DiPiro PJ, Salah F, Chung SH, Wang GX, Khorasani R. Patient, Examination, and System Factors Associated with Completed Follow-up for Probably Benign (BI-RADS 3) Breast Findings in a Large, Complex Health Care System. Acad Radiol 2025; 32:681-690. [PMID: 39406580 DOI: 10.1016/j.acra.2024.09.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2024] [Revised: 09/09/2024] [Accepted: 09/16/2024] [Indexed: 02/12/2025]
Abstract
RATIONALE AND OBJECTIVES To investigate patient, examination, and system factors associated with follow-up completion for probably benign breast (BI-RADS 3) findings. MATERIALS AND METHODS Retrospective review identified all BI-RADS 3 mammography, ultrasound, and MRI reports (index studies) for unique patient encounters at a large multi-institution Health Care System Jan 1-Dec 31, 2021. Electronic health record supplied patient demographics and examination type; Radiology Information System supplied ordering and scheduling information. University of Wisconsin's Neighborhood Atlas was used to map patient home addresses to determine area deprivation index (ADI). Univariable and multivariable analyses identified variables associated with noncompleted BI-RADS 3 follow-up. RESULTS Among 8834 BI-RADS 3 examinations, 6778 (76.7%) had follow-up imaging completed within 15 months. Factors associated with incomplete follow-up on multivariable analysis included: ultrasound (Odds Ratio [OR] 0.22; 95% Confidence Interval [95%CI] 0.19-0.25); MRI (0.10, 95%CI 0.08-0.12); Asian race (0R 0.77; 95%CI 0.61-0.98); age< 40 years (OR 0.22; 95%CI 0.18-0.26); non-married status (single, OR 0.68; 95% CI 0.59-0.79; divorced OR 0.77; 95% CI 0.61-0.97; widowed OR 0.61; 95% CI 0.44-0.85); public insurance (OR 0.84; 95% CI 0.71-0.98), self-pay (OR 0.59; 95% CI 0.39-0.96); orders placed > 8 months after index examination (OR 0.20; 95%CI 0.14-0.29); ordering by non-primary care (PCP) (OR 0.51; 95%CI 0.36-0.72); and non-same day scheduling. Socioeconomic disadvantage (ADI) was not associated with incomplete BI-RADS 3 follow-up. CONCLUSION Non-completion of recommended BI-RADS 3 follow-up is associated with Asian race, age< 40 years, MRI or ultrasound (versus mammography), marital status, insurance coverage, delayed order placement or scheduling, and order placement by non-PCPs.
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Affiliation(s)
- Catherine S Giess
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.).
| | - Elyse Lynch
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.)
| | - Ronilda Lacson
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.)
| | - Pamela J DiPiro
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.)
| | - Fatima Salah
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.)
| | - Stephanie H Chung
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.)
| | - Gary X Wang
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (G.X.W.)
| | - Ramin Khorasani
- Center for Evidence Based Imaging, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., E.L., R.L., P.J.D., F.S., R.K.); Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115 (C.S.G., R.L., P.J.D., F.S., S.H.C., R.K.)
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Sweetnam JM, Goldman L, Grimm L, Silvestri GA, Tanner NT. Two Birds With One Stone: Cross-Registry Analysis of Women Undergoing Lung Cancer and Breast Cancer Screening. Chest 2024; 166:1250-1253. [PMID: 38997086 DOI: 10.1016/j.chest.2024.06.3798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/05/2024] [Accepted: 06/25/2024] [Indexed: 07/14/2024] Open
Affiliation(s)
- John Michael Sweetnam
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | | | - Lars Grimm
- Department of Radiology, Duke University., Durham, NC
| | - Gerard A Silvestri
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, SC
| | - Nichole T Tanner
- Division of Pulmonary, Critical Care, Allergy & Sleep Medicine, Medical University of South Carolina, Charleston, SC; Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson VA Healthcare System, Charleston, SC.
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Lawson MB, Lee CI. Using Machine Learning to Predict Adherence to Recommended Imaging Follow-Up. J Am Coll Radiol 2024; 21:1632-1633. [PMID: 38461916 PMCID: PMC11380697 DOI: 10.1016/j.jacr.2024.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Accepted: 03/01/2024] [Indexed: 03/12/2024]
Affiliation(s)
- Marissa B Lawson
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington.
| | - Christoph I Lee
- Department of Radiology, University of Washington School of Medicine, Seattle, Washington; Department of Health Systems & Population Health, University of Washington School of Public Health, Seattle, Washington; Director of the Northwest Screening and Cancer Outcomes Research Enterprise at the University of Washington and Deputy Editor of JACR. https://twitter.com/christophleemd
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Wang GX, Mercaldo SF, Cahill JE, Flanagan JM, Lehman CD, Park ER. Missed Screening Mammography Appointments: Patient Sociodemographic Characteristics and Mammography Completion After 1 Year. J Am Coll Radiol 2024; 21:1645-1656. [PMID: 38599358 DOI: 10.1016/j.jacr.2024.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/12/2024]
Abstract
OBJECTIVE Patients who miss screening mammogram appointments without notifying the health care system (no-show) risk care delays. We investigate sociodemographic characteristics of patients who experience screening mammogram no-shows at a community health center and whether and when the missed examinations are completed. METHODS We included patients with screening mammogram appointments at a community health center between January 1, 2021, and December 31, 2021. Language, race, ethnicity, insurance type, residential ZIP code tabulation area (ZCTA) poverty, appointment outcome (no-show, same-day cancelation, completed), and dates of completed screening mammograms after no-show appointments with ≥1-year follow-up were collected. Multivariable analyses were used to assess associations between patient characteristics and appointment outcomes. RESULTS Of 6,159 patients, 12.1% (743 of 6,159) experienced no-shows. The no-show group differed from the completed group by language, race and ethnicity, insurance type, and poverty level (all P < .05). Patients with no-shows more often had: primary language other than English (32.0% [238 of 743] versus 26.7% [1,265 of 4,741]), race and ethnicity other than White non-Hispanic (42.3% [314 of 743] versus 33.6% [1,595 of 4,742]), Medicaid or means-tested insurance (62.0% [461 of 743] versus 34.4% [1,629 of 4,742]), and residential ZCTAs with ≥20% poverty (19.5% [145 of 743] versus 14.1% [670 of 4,742]). Independent predictors of no-shows were Black non-Hispanic race and ethnicity (adjusted odds ratio [aOR], 1.52; 95% confidence interval [CI], 1.12-2.07; P = .007), Medicaid or other means-tested insurance (aOR, 2.75; 95% CI, 2.29-3.30; P < .001), and ZCTAs with ≥20% poverty (aOR, 1.76; 95% CI, 1.14-2.72; P = .011). At 1-year follow-up, 40.6% (302 of 743) of patients with no-shows had not completed screening mammogram. DISCUSSION Screening mammogram no-shows is a health equity issue in which socio-economically disadvantaged and racially and ethnically minoritized patients are more likely to experience missed appointments and continued delays in screening mammogram completion.
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Affiliation(s)
- Gary X Wang
- Officer for Community Health and Equity, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts; Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Sarah F Mercaldo
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jennifer E Cahill
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts
| | - Jane M Flanagan
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts; Department Chairperson, Connell School of Nursing, Boston College, Chestnut Hill, Massachusetts
| | - Constance D Lehman
- Co-Director, Breast Imaging Research Center, Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Elyse R Park
- Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, Massachusetts; Director, Health Promotion and Resiliency Intervention Research Center, Massachusetts General Hospital, Boston, Massachusetts
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Jhumkhawala V, Lobaina D, Okwaraji G, Zerrouki Y, Burgoa S, Marciniak A, Densley S, Rao M, Diaz D, Knecht M, Sacca L. Social determinants of health and health inequities in breast cancer screening: a scoping review. Front Public Health 2024; 12:1354717. [PMID: 38375339 PMCID: PMC10875738 DOI: 10.3389/fpubh.2024.1354717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/18/2024] [Indexed: 02/21/2024] Open
Abstract
Introduction This scoping review aims to highlight key social determinants of health associated with breast cancer screening behavior in United States women aged ≥40 years old, identify public and private databases with SDOH data at city, state, and national levels, and share lessons learned from United States based observational studies in addressing SDOH in underserved women influencing breast cancer screening behaviors. Methods The Arksey and O'Malley York methodology was used as guidance for this review: (1) identifying research questions; (2) searching for relevant studies; (3) selecting studies relevant to the research questions; (4) charting the data; and (5) collating, summarizing, and reporting results. Results The 72 included studies were published between 2013 and 2023. Among the various SDOH identified, those related to socioeconomic status (n = 96) exhibited the highest frequency. The Health Care Access and Quality category was reported in the highest number of studies (n = 44; 61%), showing its statistical significance in relation to access to mammography. Insurance status was the most reported sub-categorical factor of Health Care Access and Quality. Discussion Results may inform future evidence-based interventions aiming to address the underlying factors contributing to low screening rates for breast cancer in the United States.
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Affiliation(s)
- Vama Jhumkhawala
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Diana Lobaina
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Goodness Okwaraji
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Yasmine Zerrouki
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Sara Burgoa
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Adeife Marciniak
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Sebastian Densley
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Meera Rao
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Daniella Diaz
- Charles E. Schmidt College of Science, Boca Raton, FL, United States
| | - Michelle Knecht
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
| | - Lea Sacca
- Charles E. Schmidt College of Medicine, Florida Atlantic University, Boca Raton, FL, United States
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7
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Record SM, Thomas SM, Chanenchuk T, Baker JA, Grimm LJ, Plichta JK. Breast Cancer Risk Assessment and Screening Practices Reported Via an Online Survey. Ann Surg Oncol 2023; 30:6219-6229. [PMID: 37460738 PMCID: PMC10528282 DOI: 10.1245/s10434-023-13903-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 06/27/2023] [Indexed: 09/12/2023]
Abstract
BACKGROUND Breast cancer screening guidelines differ between organizations, and significant variations in practice patterns exist. Previous evidence suggests that provider-level factors are the greatest contributors to risk assessment and screening practice variability. This study aimed to characterize provider factors associated with breast cancer risk assessment and screening practice patterns, and to assess perceived barriers to providing risk assessment. METHODS An online survey was distributed to providers at a single academic institution and to providers publicly via social media (January to August 2022). Respondents in the United States who care for adult women at risk for the development of breast cancer were included. RESULTS Most of the respondents in the 143 completed surveys were white/Caucasian (79%) females (90%) age 50 years or younger (79%), and whereas 97% discuss breast cancer screening with their patients, only 90% order screening mammograms. Risk factor assessment was common (93%), typically performed at the first visit (51%). Additional training in genetics or risk assessment was uncommon (17%), although the majority were interested but did not have the time or resources (55%). Although most (64%) did not perceive barriers to providing risk assessment or appropriate screening, the most common barriers were time (77%) and education (55%). Barriers were more common among family practice or obstetrics and gynecology (OB/GYN) providers and those who worked in an academic setting (all p < 0.05). CONCLUSIONS Breast cancer risk assessment and screening practices are highly variable. Although time is the major barrier to providing risk assessment, providers also need education. Primary care organizations could partner with breast cancer-focused societies for additional resources.
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Affiliation(s)
- Sydney M Record
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Samantha M Thomas
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Biostatistics and Bioinformatics, Duke University, Durham, NC, USA
| | - Tori Chanenchuk
- Department of Surgery, Duke University Medical Center, Durham, NC, USA
| | - Jay A Baker
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Lars J Grimm
- Duke Cancer Institute, Duke University, Durham, NC, USA
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Jennifer K Plichta
- Department of Surgery, Duke University Medical Center, Durham, NC, USA.
- Duke Cancer Institute, Duke University, Durham, NC, USA.
- Department of Population Health Sciences, Duke University Medical Center, Durham, NC, USA.
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Miller MM, Ganti R, Repich K, Patrie JT, Anderson RT, Harvey JA. Factors Associated With Breast Cancer Screening Behaviors Among Women With Dense Breasts. JOURNAL OF BREAST IMAGING 2023; 5:125-134. [PMID: 38416932 DOI: 10.1093/jbi/wbac090] [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: 09/13/2022] [Indexed: 03/01/2024]
Abstract
OBJECTIVE We sought to identify patient factors associated with patient-reported screening behaviors in women with dense breasts. METHODS An IRB-approved survey study of women with dense breasts presenting for annual screening mammography at an outpatient imaging center was previously conducted from March 2017 to February 2018. The survey included questions regarding mammographic screening frequency and recent participation in supplemental screening. These survey data were combined post hoc with clinical and demographic data and socioeconomic data imputed from census data. Logistic regression was used to identify patient factors associated with reported screening behaviors. RESULTS Surveys were completed by 508 women (median age, 59.0 years; range, 31.0-86.0 years) with dense breasts. Multivariable analysis demonstrated an independent association of undergoing mammographic screening annually with a history of discussing breast density with a doctor (adjusted odds ratio [AOR], 2.60; P = 0.019). Undergoing supplemental screening in the previous three years was independently associated with younger age (AOR, 1.59; P = 0.004), strong family history of breast cancer (AOR, 3.84; P = 0.027), higher perceived personal risk for breast cancer (AOR, 3.47; P = 0.004), and increased concern about radiation associated with screening examinations (AOR, 3.31; P = 0.006). CONCLUSION Women with dense breasts who had discussed breast density with a doctor were more likely to report undergoing annual screening mammography, while younger women and women with a strong family history of breast cancer, higher perceived personal risk for breast cancer, or greater concern about radiation were more likely to report recently undergoing supplemental screening.
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Affiliation(s)
- Matthew M Miller
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Ramapriya Ganti
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - Kathy Repich
- University of Virginia Health System, Department of Radiology and Medical Imaging, Charlottesville, VA, USA
| | - James T Patrie
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA, USA
| | - Roger T Anderson
- University of Virginia School of Medicine, Department of Public Health Sciences, Charlottesville, VA, USA
| | - Jennifer A Harvey
- University of Rochester Medical Center, Department of Imaging Sciences, Rochester, NY, USA
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Pett L, Hollenberg B, Mahoney J, Paz J, Siu N, Sun A, Zhang R, von Euler-Chelpin M. Participation and adherence to mammography screening in the Capital Region of Denmark: The importance of age over time. PLoS One 2023; 18:e0280790. [PMID: 36689434 PMCID: PMC9870097 DOI: 10.1371/journal.pone.0280790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/05/2022] [Indexed: 01/24/2023] Open
Abstract
Mammography screening's effectiveness depends on high participation levels. Understanding adherence patterns over time is important for more accurately predicting future effectiveness. This study analyzed longitudinal adherence to the biennial invitations in the Capital Region of Denmark from 2008-2017. We analyzed participation rates for five-year age groups along with their percent changes in each invitation round using linear regressions. Participation in the mammography screening program increased from 73.1% to 83.1% from 2008-2017. The participation rate among all age groups increased from the first to the fifth round, with the oldest age group having the largest increase (average percent change = 3.66; p-value = 0.03).
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Affiliation(s)
- Lindsay Pett
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Becky Hollenberg
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jessica Mahoney
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jake Paz
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nathan Siu
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Amanda Sun
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Rachel Zhang
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Shete S, Deng Y, Shannon J, Faseru B, Middleton D, Iachan R, Bernardo B, Balkrishnan R, Kim SJ, Huang B, Millar MM, Fuemmler B, Jensen JD, Mendoza JA, Hu J, Lazovich D, Robertson L, Demark-Wahnefried W, Paskett ED. Differences in Breast and Colorectal Cancer Screening Adherence Among Women Residing in Urban and Rural Communities in the United States. JAMA Netw Open 2021; 4:e2128000. [PMID: 34605915 PMCID: PMC8491105 DOI: 10.1001/jamanetworkopen.2021.28000] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2021] [Accepted: 07/30/2021] [Indexed: 12/13/2022] Open
Abstract
Importance Screening for breast and colorectal cancer has resulted in reductions in mortality; however, questions remain regarding how these interventions are being diffused to all segments of the population. If an intervention is less amenable to diffusion, it could be associated with disparities in mortality rates, especially in rural vs urban areas. Objectives To compare the prevalence of breast and colorectal cancer screening adherence and to identify factors associated with screening adherence among women residing in rural vs urban areas in the United States. Design, Setting, and Participants This population-based cross-sectional study of women aged 50 to 75 years in 11 states was conducted from 2017 to 2020. Main Outcomes and Measures Adherence to cancer screening based on the US Preventative Services Task Force guidelines. For breast cancer screening, women who had mammograms in the past 2 years were considered adherent. For colorectal cancer screening, women who had (1) a stool test in the past year, (2) a colonoscopy in the past 10 years, or (3) a sigmoidoscopy in the past 5 years were considered adherent. Rural status was coded using Rural Urban Continuum Codes, and other variables were assessed to identify factors associated with screening. Results The overall sample of 2897 women included 1090 (38.4%) rural residents; 2393 (83.5%) non-Hispanic White women; 263 (9.2%) non-Hispanic Black women; 68 (2.4%) Hispanic women; 1629 women (56.2%) aged 50 to 64 years; and 712 women (24.8%) with a high school education or less. Women residing in urban areas were significantly more likely to be adherent to colorectal cancer screening compared with women residing in rural areas (1429 [82%] vs 848 [78%]; P = .01), whereas the groups were equally likely to be adherent to breast cancer screening (1347 [81%] vs 830 [81%]; P = .78). Multivariable mixed-effects logistic regression analyses confirmed that rural residence was associated with lower odds of being adherent to colorectal cancer screening (odds ratio [OR], 0.81; 95% CI, 0.66-0.99, P = .047). Non-Hispanic Black race was associated with adherence to breast cancer screening guidelines (OR, 2.85; 95% CI, 1.78-4.56; P < .001) but not colorectal cancer screening guidelines. Conclusions and Relevance In this cross-sectional study, women residing in rural areas were less likely to be adherent to colorectal cancer screening guidelines but were similarly adherent to breast cancer screening. This suggests that colorectal cancer screening, a more recent intervention, may not be as available in rural areas as breast cancer screening, ie, colorectal screening has lower amenability.
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Affiliation(s)
- Sanjay Shete
- Division of Cancer Prevention, Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston
| | | | - Jackilen Shannon
- Oregon Health & Sciences University, Portland State University School of Public Health, Portland
| | - Babalola Faseru
- Department of Population Health, University of Kansas Medical Center, Kansas City
| | | | | | - Brittany Bernardo
- Division of Population Sciences, The Ohio State University Comprehensive Cancer Center, Columbus
| | | | - Sunny Jung Kim
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | - Bin Huang
- Department of Cancer Biostatistics, University of Kentucky, Lexington
| | | | - Bernard Fuemmler
- Department of Health Behavior and Policy, Virginia Commonwealth University School of Medicine, Richmond
| | | | - Jason A. Mendoza
- Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
- Department of Pediatrics, University of Washington, Seattle
| | - Jinxiang Hu
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City
| | - DeAnn Lazovich
- University of Minnesota School of Public Health, Minneapolis
| | - Linda Robertson
- UPMC Hillman Cancer Center, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Electra D. Paskett
- Division of Cancer Prevention and Control, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, College of Medicine, Columbus
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Roubidoux MA, Richards B, Honey NE, Begay JA. Adherence to Screening Among American Indian Women Accessing a Mobile Mammography Unit. Acad Radiol 2021; 28:944-949. [PMID: 33896716 DOI: 10.1016/j.acra.2021.03.014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 03/14/2021] [Accepted: 03/16/2021] [Indexed: 01/29/2023]
Abstract
RATIONALE AND OBJECTIVES Although screening mammography is essential to reducing breast cancer morbidity and mortality, barriers exist especially among underrepresented minority groups. There are few studies of mammogram screening among American Indian women, many of whom reside in rural areas where screening access is challenging. A mobile mammography unit served 24 Indian Health Service clinics during 2013-17. Screening mammography adherence was evaluated. MATERIALS AND METHODS Among mobile unit women, 'adherence to screening' was determined by the date of the most recent prior mammogram. Those having a prior mammogram 9-27 months ago were classified as 'adherent to screening'. Comparison screening data were obtained from the American College of Radiology National Mammography Database, consisting of screening cases occurring in year 2015. Additionally, among mobile unit women 'continued adherence to screening' was determined, defined as at least one repeat screening at the mobile unit within the subsequent 9-27 months after a screening there. RESULTS Among 1,615 mobile unit women, 624 (38.6%) were adherent to screening. Among 2,509,826 National Mammography Database women, 1,481,021 (59.0%) were adherent to screening. (p<0.0001) The prevalence of a >27-month interval between mammograms was 3.13 (95% CI 2.91-3.36) times greater among mobile unit women than National Mammography Database women. 'Continued adherence to screening' of mobile unit women was 428/1194 (35.9%). CONCLUSION Adherence to screening and continued adherence to screening were low among mobile unit women and time interval between screenings was longer than National Mammography Database women. Factors to improve screening adherence among these underserved women should be determined.
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Affiliation(s)
- Marilyn A Roubidoux
- Department of Radiology, Michigan Medicine, TC 2910 Box 5326; 1500 E. Ann Arbor Michigan.
| | | | | | - Joel A Begay
- Senior Research Assistant and Data Analyst Colorado School of Public Health, Anschutz Medical Campus, University of Colorado, Aurora, Colorado
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Ding L, Jidkova S, Greuter MJW, Van Herck K, Goossens M, Martens P, de Bock GH, Van Hal G. Coverage determinants of breast cancer screening in Flanders: an evaluation of the past decade. Int J Equity Health 2020; 19:212. [PMID: 33246477 PMCID: PMC7694412 DOI: 10.1186/s12939-020-01323-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022] Open
Abstract
Background Breast cancer (BC) is the most common cancer in women in the developed world. In order to find developing cancers in an early stage, BC screening is commonly used. In Flanders, screening is performed in and outside an organized breast cancer screening program (BCSP). However, the determinants of BC screening coverage for both screening strategies are yet unknown. Objective To assess the determinants of BC screening coverage in Flanders. Methods Reimbursement data were used to attribute a screening status to each woman in the target population for the years 2008–2016. Yearly coverage data were categorized as screening inside or outside BCSP or no screening. Data were clustered by municipality level. A generalized linear equation model was used to assess the determinants of screening type. Results Over all years and municipalities, the median screening coverage rate inside and outside BCSP was 48.40% (IQR: 41.50–54.40%) and 14.10% (IQR: 9.80–19.80%) respectively. A higher coverage rate outside BSCP was statistically significantly (P < 0.001) associated with more crowded households (OR: 3.797, 95% CI: 3.199–4.508), younger age, higher population densities (OR: 2.528, 95% CI: 2.455–2.606), a lower proportion of unemployed job seekers (OR: 0.641, 95% CI: 0.624–0.658) and lower use of dental care (OR: 0.969, 95% CI: 0.967–0.972). Conclusion Coverage rate of BC screening is not optimal in Flanders. Women with low SES that are characterized by younger age, living in a high population density area, living in crowded households, or having low dental care are less likely to be screened for BC in Flanders. If screened, they are more likely to be screened outside the BCSP.
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Affiliation(s)
- L Ding
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium
| | - S Jidkova
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M J W Greuter
- Department of Radiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.,Department of Robotics and Mechatronics, University of Twente, Enschede, The Netherlands
| | - K Van Herck
- Department of Public Health and Primary Care, Ghent University, Ghent, Belgium.,Center for Cancer Detection, Flanders, Belgium
| | - M Goossens
- Center for Cancer Detection, Flanders, Belgium
| | - P Martens
- Center for Cancer Detection, Flanders, Belgium
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - G Van Hal
- Department of Social Epidemiology and Health Policy, University of Antwerp, Antwerp, Belgium.,Center for Cancer Detection, Flanders, Belgium
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Implementation and Utilization of a "Pink Card" Walk-In Screening Mammography Program Integrated With Physician Visits. J Am Coll Radiol 2020; 17:1602-1608. [PMID: 32739416 DOI: 10.1016/j.jacr.2020.07.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/04/2020] [Accepted: 07/06/2020] [Indexed: 01/15/2023]
Abstract
PURPOSE The aim of this study was to evaluate the implementation and utilization of the Pink Card program, which links a physician-delivered reminder that a woman is due for screening mammography (SM) during an office visit with the opportunity to undergo walk-in screening. METHODS In 2016, the authors' community-based breast imaging center provided physicians from three primary care and obstetrics and gynecology practices located in the same outpatient facility business card-sized Pink Cards to offer women due for SM during office visits. The card includes a reminder that screening is due and can be used to obtain SM on a walk-in basis. The primary outcome measure was the proportion of women who used Pink Cards among all screened women over 2 years. Independent predictors of Pink Card utilization were evaluated using multivariate logistic regression analyses. RESULTS Among 3,688 women who underwent SM, Pink Cards were used by 19.9% (733 of 3,688). Compared with women with prescheduled screening visits, Pink Card users were more likely to be Asian (odds ratio [OR], 1.37; P =.032), Black (OR, 2.05; P = .002), and Medicaid insured (OR, 1.71; P = .013) and less likely to use English as their primary language (OR, 2.75; P = .003). Additionally, Pink Card users were less likely to be up to date for biennial SM compared with women with prescheduled visits (31.9% [234 of 733] versus 66.6% [1,968 of 2,955], P < .001). CONCLUSIONS The Pink Card walk-in SM program can improve screening access, particularly for racial/ethnic minorities and Medicaid-insured patients. Expansion of this program may help reduce disparities and increase engagement in breast cancer screening.
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Taplin SH. Needing More to Understand Breast Cancer Screening Adherence: Multilevel Analysis. J Womens Health (Larchmt) 2019; 28:1011-1012. [DOI: 10.1089/jwh.2018.7637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen H. Taplin
- National Cancer Institute, Center for Global Health, Rockville, Maryland
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