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Knerr S, Guo B, Wernli KJ, Mittendorf KF, Feigelson HS, Gilmore MJ, Jarvik GP, Kauffman TL, Keast E, Liles EG, Lynch FL, Muessig KR, Okuyama S, Veenstra DL, Zepp JM, Wilfond BS, Devine B, Goddard KAB. Longitudinal adherence to breast cancer surveillance following cancer genetic testing in an integrated health care system. Breast Cancer Res Treat 2023; 201:461-470. [PMID: 37470892 PMCID: PMC10503958 DOI: 10.1007/s10549-023-07007-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: 04/20/2023] [Accepted: 05/31/2023] [Indexed: 07/21/2023]
Abstract
PURPOSE Screening with mammography and breast magnetic resonance imaging (MRI) is an important risk management strategy for individuals with inherited pathogenic variants (PVs) in genes associated with increased breast cancer risk. We describe longitudinal screening adherence in individuals who underwent cancer genetic testing as part of usual care in a vertically integrated health system. METHODS We determined the proportion time covered (PTC) by annual mammography and breast MRI for individuals with PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, and ATM. We determined time covered by biennial mammography beginning at age 50 years for individuals who received negative results, uncertain results, or with PVs in genes without specific breast cancer screening recommendations. RESULTS One hundred and forty individuals had PVs in TP53, BRCA1, BRCA2, PALB2, NF1, CHEK2, or ATM. Among these individuals, average PTC was 48% (range 0-99%) for annual screening mammography and 34% (range 0-100%) for annual breast MRI. Average PTC was highest for individuals with PVs in CHEK2 (N = 14) and lowest for individuals with PVs in TP53 (N = 3). Average PTC for biennial mammography (N = 1,027) was 49% (0-100%). CONCLUSION Longitudinal screening adherence in individuals with PVs in breast cancer associated genes, as measured by the proportion of time covered, is low; adherence to annual breast MRI falls below that of annual mammography. Additional research should examine screening behavior in individuals with PVs in breast cancer associated genes with a goal of developing interventions to improve adherence to recommended risk management.
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Affiliation(s)
- Sarah Knerr
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98195, USA.
| | - Boya Guo
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA, USA
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Kathleen F Mittendorf
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Marian J Gilmore
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Gail P Jarvik
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA, USA
| | - Tia L Kauffman
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Erin Keast
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | | | - Frances L Lynch
- Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Kristin R Muessig
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Sonia Okuyama
- Denver Health and Hospital Authority, Denver, CO, USA
| | - David L Veenstra
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Jamilyn M Zepp
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
| | - Benjamin S Wilfond
- Department of Pediatrics, School of Medicine, University of Washington, Seattle, WA, USA
| | - Beth Devine
- Department of Health Systems and Population Health, School of Public Health, University of Washington, Box 351621, Seattle, WA, 98195, USA
- Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, WA, USA
| | - Katrina A B Goddard
- Department of Translational and Applied Genomics (TAG), Kaiser Permanente Center for Health Research, Portland, OR, USA
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA
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Nair RG, Lee SJC, Berry E, Argenbright KE, Tiro JA, Skinner CS. Long-term Mammography Adherence among Uninsured Women Enrolled in the Breast Screening and Patient Navigation (BSPAN) Program. Cancer Epidemiol Biomarkers Prev 2022; 31:77-84. [PMID: 34750203 PMCID: PMC8755604 DOI: 10.1158/1055-9965.epi-21-0191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 06/10/2021] [Accepted: 11/05/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The Breast Screening and Patient Navigation (BSPAN) Program provides access to no-cost breast cancer screening services to uninsured women in North Texas. Using data from the longitudinal BSPAN program (2012-2019), we assessed prevalence and correlates of (i) baseline adherence and (ii) longitudinal adherence to screening mammograms. METHODS Outcomes were baseline adherence (adherent if women received second mammogram 9-30 months after the index mammogram) and longitudinal adherence (assessed among baseline adherent women and defined as being adherent 39 months from the index mammogram). We used multivariable logistic regression and multivariable Cox proportional hazards model to assess associations of sociodemographic and clinical characteristics with baseline and longitudinal adherence, respectively. RESULTS Of 19,292 women, only 5,382 (27.9%) were baseline adherent. Baseline adherence was more likely among women who were partnered, preferred speaking Spanish, had poor reading ability, had prior Papanicolaou (PAP) testing, and prior screening mammograms, compared with women who were non-partnered, preferred speaking English, had good reading ability, had no prior PAP testing, and no prior screening mammograms, respectively. Of those who were baseline adherent, 4,364 (81.1%) women demonstrated longitudinal adherence. Correlates of longitudinal adherence were similar to those from baseline adherence. CONCLUSIONS A large proportion of baseline adherent women (>80%) achieved longitudinal adherence, which highlights the importance of concentrating resources during the second mammogram in the progression toward continued adherence. IMPACT Results from our unique dataset provide realistic mammography adherence rates and may be generalizable to other areas introducing no-cost screening to low-income women, independent of any regular patient-centered medical home.
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Affiliation(s)
- Rasmi G Nair
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas.
| | - Simon J Craddock Lee
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Emily Berry
- Moncrief Cancer Institute, University of Texas Southwestern, Fort Worth, Texas
| | - Keith E Argenbright
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
- Moncrief Cancer Institute, University of Texas Southwestern, Fort Worth, Texas
| | - Jasmin A Tiro
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Celette Sugg Skinner
- Department of Population and Data Sciences, University of Texas Southwestern Medical Center, Dallas, Texas
- Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, Texas
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Valdez A, Napoles AM, Stewart SL, Garza A. A Randomized Controlled Trial of a Cervical Cancer Education Intervention for Latinas Delivered Through Interactive, Multimedia Kiosks. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:222-230. [PMID: 27573420 PMCID: PMC5332337 DOI: 10.1007/s13187-016-1102-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
US Latina women experience disproportionately high cervical cancer incidence and mortality rates. These health disparities are largely preventable with routine pap tests and human papillomavirus (HPV) screening. This study tested the efficacy of a cervical cancer education intervention to improve risk factor knowledge, attitudes, self-efficacy, and self-reported behavior related to cervical cancer screening among low-income Latinas who had not been screened in the past 2 years, compared to a usual care control group. Low-income Latinas who had not had a pap test in the prior 2 years were recruited from three Federally Qualified Health Centers and randomly assigned to intervention and control groups, with in-person assessment at baseline and 6-month follow-up. Women in the intervention group received a one-time low-literacy cervical cancer education program through an interactive, multimedia kiosk in either English or Spanish based on their language preference. Compared to the control group, the intervention group demonstrated greater knowledge (p < 0.0001) and more favorable attitudes at follow-up; fewer intervention group women never thought of getting a pap test (46 vs. 54 %, p = 0.050) or agreed that it is fate whether a woman gets cervical cancer or not (24 vs. 31 %, p = 0.043). The groups did not differ significantly on the proportion who had obtained or made an appointment for a pap test at follow-up (51 vs. 48 %, p = 0.35). Both groups reported high levels of self-efficacy regarding pap screening at post-intervention. A one-time interactive, multimedia educational intervention improved cervical cancer knowledge and attitudes among low-income Latinas but had no effect on cervical cancer-screening behavior. Exposure of the control group to the pre-test conducted on the multimedia kiosk may have influenced their screening behavior.
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Affiliation(s)
- Armando Valdez
- HealthPoint Communications Institute, 10 Jordan, Avenue Los Altos, CA, 94022, USA.
| | - Anna M Napoles
- University of California, San Francisco, San Francisco, CA, 94143, USA
| | | | - Alvaro Garza
- San Joaquin County Public Health Services, Stockton, CA, 95205, USA
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Durham DD, Robinson WR, Lee SS, Wheeler SB, Reeder-Hayes KE, Bowling JM, Olshan AF, Henderson LM. Insurance-Based Differences in Time to Diagnostic Follow-up after Positive Screening Mammography. Cancer Epidemiol Biomarkers Prev 2017; 25:1474-1482. [PMID: 27803069 DOI: 10.1158/1055-9965.epi-16-0148] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 08/10/2016] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Insurance may lengthen or inhibit time to follow-up after positive screening mammography. We assessed the association between insurance status and time to initial diagnostic follow-up after a positive screening mammogram. METHODS Using 1995-2010 data from a North Carolina population-based registry of breast imaging and cancer outcomes, we identified women with a positive screening mammogram. We compared receipt of follow-up within 60 days of screening using logistic regression and evaluated time to follow-up initiation using Cox proportional hazards regression. RESULTS Among 43,026 women included in the study, 73% were <65 years and 27% were 65+ years. Median time until initial diagnostic follow-up was similar by age group and insurance status. In the adjusted model for women <65, uninsured women experienced a longer time to initiation of diagnostic follow-up [HR, 0.47; 95% confidence interval (CI), 0.25-0.89] versus women with private insurance. There were increased odds of these uninsured women not meeting the Centers for Disease Control and Prevention guideline for follow-up within 60 days (OR, 1.59; 95% CI, 1.31-1.94). Among women ages 65+, women with private insurance experienced a faster time to follow-up (adjusted HR, 2.09; 95% CI, 1.27-3.44) than women with Medicare and private insurance. Approximately 10% of women had no follow-up by 365 days. CONCLUSIONS We found differences in time to initial diagnostic follow-up after a positive screening mammogram by insurance status and age group. Uninsured women younger than 65 years at a positive screening event had delayed follow-up. IMPACT Replication of these findings and examination of their clinical significance warrant additional investigation. Cancer Epidemiol Biomarkers Prev; 25(11); 1474-82. ©2016 AACR.
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Affiliation(s)
- Danielle D Durham
- Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina
| | - Whitney R Robinson
- Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina
| | - Sheila S Lee
- Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
| | - Stephanie B Wheeler
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.,Department of Health Policy and Management, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine E Reeder-Hayes
- Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.,Division of Hematology/Oncology, UNC School of Medicine, Chapel Hill, North Carolina
| | - J Michael Bowling
- Department of Health Behavior, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Andrew F Olshan
- Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina.,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina
| | - Louise M Henderson
- Department of Epidemiology, UNC Gillings School of Public Health, The University of North Carolina at Chapel Hill, North Carolina. .,Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, North Carolina.,Department of Radiology, UNC School of Medicine, Chapel Hill, North Carolina
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McDonald JT, Wang Y, Liu Z. Participation and retention in the breast cancer screening program in New Brunswick Canada. Prev Med Rep 2017; 6:214-220. [PMID: 28377847 PMCID: PMC5377004 DOI: 10.1016/j.pmedr.2017.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 10/24/2022] Open
Abstract
New Brunswick (NB) Canada uses its breast cancer screening service program to assess the extent to which eligible NB women are complying with mammography guidelines. While many studies have investigated factors associated with participation in periodic breast cancer screening in Canada and elsewhere, most work has relied on self-reported surveys or smaller scale primary data collection. Using a longitudinal administrative dataset for NB over the period 1996-2011 of 255,789 eligible women aged 45-69, this study examined demographic, socioeconomic and geographic factors associated with initial participation in regular screening at age 50 and ongoing retention in the program. Logistic regression was used to examine correlates of initial screening, while rescreening participation was estimated using survival analysis accounting for rescreening episodes. Initial screening participation was lower for women born outside of NB, many women living farther away from screening centers, women in rural areas, and higher for married women. In contrast, retention was higher for rural women and women recently arrived in NB. For both participation and retention, regional disparities across health zone persisted after controlling for observable personal and locational factors. The analysis highlights important characteristics to be targeted to increase screening but also that how health zones operate their screening programs exerts a very significant effect on the use of screening services by eligible women. This offers lessons for the design and evaluation of any cancer screening program.
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Affiliation(s)
| | - Yunli Wang
- University of New Brunswick, Fredericton, NB, Canada
| | - Zikuan Liu
- University of New Brunswick, Fredericton, NB, Canada
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Garza MA, Luan J, Blinka M, Farabee-Lewis RI, Neuhaus CE, Zabora JR, Ford JG. A culturally targeted intervention to promote breast cancer screening among low-income women in East Baltimore, Maryland. Cancer Control 2006; 12 Suppl 2:34-41. [PMID: 16327749 DOI: 10.1177/1073274805012004s06] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In Maryland, outreach initiatives have been unsuccessful in engaging low-income African American women in mammography screening. This study aimed to identify factors influencing screening rates for low-income African American women. Based on the Health Belief Model, a modified time series design was used to implement a culturally targeted intervention to promote a no-cost mammography-screening program. Data were collected from women 40 years of age and older on their history of mammography use and their knowledge and beliefs about breast cancer. A 50% screening rate was achieved among 119 eligible participants. Significant predictors of screening behaviors were perceived barriers, lack of insurance, and limited knowledge. This culturally targeted intervention resulted in an unprecedented screening rate among low-income African American women in Baltimore, Maryland.
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Affiliation(s)
- Mary A Garza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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