Factors Associated with Breast Cancer Screening in a Country with National Health Insurance: Did We Succeed in Reducing Healthcare Disparities?

Objectives To analyse the effect of an organized, nationwide breast cancer screening programme on non-organized mammography activities in Hungary. Setting The nationwide dataset of the Hungarian National Health Insurance Fund Administration covering the years 2000-2005. Methods Data derived from the nationwide database of the Hungarian National Health Insurance Fund Administration. The study includes all women undergoing mammography before (2000-2001) and after (2002-2003/2004-2005) the introduction of organized screening. Results The number of women having non-organized (opportunistic/diagnostic) mammograms was around 250,000 in 2000-2001, but increased to 350,000 in 2005. In the age group 45-64 years in 2000-2001, only 27.4% of all women undergoing mammography were examined within locally-organized programmes. After the introduction of the nationwide programme, this percentage increased to 61.0% in 2002-2003, and 56.3% in 2004-2005. After the introduction of the nationwide organized programme (2002-2003), the proportion of organized screening mammographics remained among the highest in county Hajdú-Bihar (78.4%) and Zala (88.3%) and increased significantly in county Vas (87.7%). Conclusion The introduction of an organized nationwide screening programme in Hungary resulted in increases in the number of screening mammographics, and also of non-organized mammographics. Although the ratio of organized screening versus non-organized mammography changed in favour of screening mammographics, there are large within-country differences between counties.

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Prevalence and determinants of breast cancer screening in four sub-Saharan African countries: a population-based study

BMJ Open ◽

10.1136/bmjopen-2020-039464 ◽

2020 ◽

Vol 10 (10) ◽

pp. e039464

Author(s):

Djibril M Ba ◽

Paddy Ssentongo ◽

Edeanya Agbese ◽

Yanxu Yang ◽

Ramata Cisse ◽

...

Keyword(s):

Breast Cancer ◽

Health Insurance ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Insurance Coverage ◽

Reproductive Age ◽

Sub Saharan Africa ◽

African Countries ◽

Factors Associated ◽

Sub Saharan

ObjectivesBreast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women after cervical cancer in much of sub-Saharan Africa. This study aims to examine the prevalence and sociodemographic–socioeconomic factors associated with breast cancer screening among women of reproductive age in sub-Saharan Africa.DesignA weighted population-based cross-sectional study using Demographic and Health Surveys (DHS) data. We used all available data on breast cancer screening from the DHS for four sub-Saharan African countries (Burkina Faso, Ivory Coast, Kenya and Namibia). Breast cancer screening was the outcome of interest for this study. Multivariable Poisson regression was used to identify independent factors associated with breast cancer screening.SettingFour countries participating in the DHS from 2010 to 2014 with data on breast cancer screening.ParticipantsWomen of reproductive age 15–49 years (N=39 646).ResultsThe overall prevalence of breast cancer screening was only 12.9% during the study period, ranging from 5.2% in Ivory Coast to 23.1% in Namibia. Factors associated with breast cancer screening were secondary/higher education with adjusted prevalence ratio (adjusted PR)=2.33 (95% CI: 2.05 to 2.66) compared with no education; older participants, 35–49 years (adjusted PR=1.73, 95% CI : 1.56 to 1.91) compared with younger participants 15–24 years; health insurance coverage (adjusted PR=1.57, 95% CI: 1.47 to 1.68) compared with those with no health insurance and highest socioeconomic status (adjusted PR=1.33, 95% CI : 1.19 to 1.49) compared with lowest socioeconomic status.ConclusionDespite high breast cancer mortality rates in sub-Saharan Africa, the prevalence of breast cancer screening is substantially low and varies gradually across countries and in relation to factors such as education, age, health insurance coverage and household wealth index level. These results highlight the need for increased efforts to improve the uptake of breast cancer screening in sub-Saharan Africa.

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Factors Associated with Breast Cancer Screening Adherence among Church-Going African American Women

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18168494 ◽

2021 ◽

Vol 18 (16) ◽

pp. 8494

Author(s):

Pooja Agrawal ◽

Tzuan A. Chen ◽

Lorna H. McNeill ◽

Chiara Acquati ◽

Shahnjayla K. Connors ◽

...

Keyword(s):

Breast Cancer ◽

African American ◽

Health Insurance ◽

Cancer Screening ◽

African American Women ◽

Breast Cancer Screening ◽

Provider Communication ◽

Factors Associated ◽

Screening Adherence ◽

Patient Provider Communication

Relative to White women, African American/Black women are at an increased risk of breast cancer mortality. Early detection of breast cancer through mammography screening can mitigate mortality risks; however, screening rates are not ideal. Consequently, there is a need to better understand factors associated with adherence to breast cancer screening guidelines to inform interventions to increase mammography use, particularly for groups at elevated mortality risk. This study used the Andersen Behavioral Model of Health Services Use to examine factors associated with adherence to National Comprehensive Cancer Network breast cancer screening guidelines amongst 919 African American, church-going women from Houston, Texas. Logistic regression analyses measured associations between breast cancer screening adherence over the preceding 12 months (adherent or non-adherent) and predisposing (i.e., age, education, and partner status), enabling (i.e., health insurance status, annual household income, employment status, patient-provider communication, and social support), and need (i.e., personal diagnosis of cancer, family history of cancer, and risk perception) factors, separately and conjointly. Older age (predisposing: OR = 1.015 (1.007–1.023)), having health insurance and ideal patient–provider communication (enabling: OR = 2.388 (1.597–3.570) and OR = 1.485 (1.080–2.041)), and having a personal diagnosis of cancer (need: OR = 2.244 (1.058–4.758)) were each associated with greater odds of screening adherence. Only having health insurance and ideal patient-provider communication remained significantly associated with screening adherence in a conjoint model; cancer survivorship did not moderate associations between predisposing/enabling factors and screening adherence. Overall, results suggest that interventions which are designed to improve mammography screening rates amongst African American women might focus on broadening health insurance coverage and working to improve patient–provider communication. Implications for multi-level intervention approaches, including the role of churches in their dissemination, are proposed.

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