Adherence to screening mammogram guidelines in the transgender/non-binary population.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 120-120
Author(s):  
Natalie Luehmann ◽  
Mona Ascha ◽  
Emily Chwa ◽  
Caitlin Stockslager ◽  
Paige Hackenberger ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Demographic Data ◽  
Univariate Analysis ◽  
Retrospective Chart Review ◽  
Screening Mammogram ◽  
Provider Education ◽  
Hospital System ◽  
Screening Guidelines

120 Background: Data is limited regarding rates of breast cancer and mammography screening within the transgender/non-binary (TGNB) population. Screening recommendations vary and there is no global consensus. TGNB patients face unique challenges that may preclude screening and risk assessment, such as barriers to accessing healthcare, lack of provider education, and limited data regarding hormonal impacts on risk. This study aims to address adherence to current screening mammogram recommendations within the TGNB population at a single hospital system. Methods: A retrospective chart review was performed using ICD codes, sexual orientation and gender identity data, and key words to identify TGNB patients that had contact with the Northwestern Hospital system between March 2019 and February 2021. Patients designated female at birth (DFAB) and age ≥ 40 with breasts at time of screening eligibility were included as well as patients designated male at birth (DMAB) and age ≥ 50 with ≥ 5 years of hormone therapy (HT). Rates of screening mammogram were evaluated along with analysis of demographic factors that may predict for or against adherence to recommendations. ASBrS and USPSTF guidelines, screening mammograms starting at age 40 and 50, respectively, were applied to patients DFAB. UCSF Center for Transgender Health and Fenway Health guidelines (screening mammogram at age 50 and ≥ 5 years of HT) were applied to patients DMAB. Results: The table illustrates screening adherence rates according to guidelines with two definitions of adherence. We evaluated patients who had screening mammogram “on-time” which was defined at age 40 or 50 with a two year grace period. We also defined adherence as having had a screening mammogram within the two year study period regardless of age. Univariate analysis and multivariate analysis evaluating for insurance status, employment status, level of education, and hormone use did not identify any factors associated with likelihood of adhering to screening guidelines in either the DFAB or DMAB population. Conclusions: Adherence to screening mammogram recommendations among the TGNB population at Northwestern Hospital system is low across all sub-groups. In contrast, the ACO rate of adherence to screening mammogram (within the last two years) at our institution for all-comers (age ≥ 50-74) in 2019 was 77.33%. Demographic data failed to elucidate any association with likeliness to undergo appropriate breast cancer screening. This disparity demands the development of initiatives aimed at increasing breast cancer screening rates for the Northwestern TGNB population.[Table: see text]

scholarly journals Linking Reminders and Physician Breast Cancer Screening Recommendations: Results From a National Survey

2017 ◽  
pp. 1-10 ◽  
Author(s):  
Elizabeth J. Siembida ◽  
Archana Radhakrishnan ◽  
Sarah A. Nowak ◽  
Andrew M. Parker ◽  
Craig Evan Pollack
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Mammography Screening ◽  
Primary Care Physicians ◽  
Age Groups ◽  
National Sample ◽  
Average Risk ◽  
Screening Guidelines ◽  
Practice Characteristics

Purpose Physician reminders have successfully increased rates of mammography. However, considering recent changes to breast cancer screening guidelines that disagree on the optimal age to start and stop mammography screening, we sought to examine the extent to which reminders have been deployed for breast cancer screening targeting younger and older patients. Methods A mailed survey was sent to a national sample of 2,000 primary care physicians between May and September 2016. Physicians were asked whether they received reminders to screen women in various age groups (40 to 44, 45 to 49, and ≥ 75 years), the organizational screening guidelines they trusted most, and whether they recommended routine breast cancer screening to average-risk women in the different age groups. Using regression models, we assessed the association between reminders and physician screening recommendations, controlling for physician and practice characteristics, and evaluated whether the association varied by the guidelines they trusted. Results A total of 871 physicians responded (adjusted response rate, 52.3%). Overall, 28.9% of physicians reported receiving reminders for patient ages 40 to 44 years, 32.5% for patient ages 45 to 49 years, and 16.5% for patient ages ≥ 75 years. Receiving reminders significantly increased the likelihood of physicians recommending mammography screening. In adjusted analyses, 84% (95% CI, 77% to 90%) of physicians who received reminders recommended screening for women ages ≥ 75 versus 65% (95% CI, 62% to 69%) of those who did not receive reminders. The associations between reminders and screening recommendations remained consistent regardless of which guidelines physicians reported trusting. Conclusion Reminders were significantly associated with increases in physician screening recommendations for mammography, underscoring the need for careful implementation in scenarios where guidelines are discordant.

scholarly journals The Effect of California’s Breast Density Notification Legislation on Breast Cancer Screening

2016 ◽  
Vol 8 (2) ◽  
pp. 55-62 ◽  
Author(s):  
Stephanie Lynn Chau ◽  
Amy Alabaster ◽  
Karin Luikart ◽  
Leslie Manace Brenman ◽  
Laurel A. Habel
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Breast Density ◽  
Screening Mammography ◽  
Median Income ◽  
Cancer History ◽  
Screening Guidelines ◽  
Younger Women ◽  
Dense Breasts

Purpose: Half of US states mandate women be notified if they have dense breasts on their mammogram, yet guidelines and data on supplemental screening modalities are limited. Breast density (BD) refers to the extent that breast tissue appears radiographically dense on mammograms. High BD reduces the sensitivity of screening mammography and increases breast cancer risk. The aim of this study was to determine the potential impact of California’s 2013 BD notification legislation on breast cancer screening patterns. Methods: We conducted a cohort study of women aged 40 to 74 years who were members of a large Northern California integrated health plan (approximately 3.9 million members) in 2011-2015. We calculated pre- and post-legislation rates of screening mammography and magnetic resonance imaging (MRI). We also examined whether women with dense breasts (defined as BI-RADS density c or d) had higher MRI rates than women with nondense breasts (defined as BI-RADS density a or b). Results: After adjustment for race/ethnicity, age, body mass index, medical facility, neighborhood median income, and cancer history, there was a relative 6.6% decrease (relative risk [RR] 0.934, confidence interval [CI] 0.92-0.95) in the rate of screening mammography, largely driven by a decrease among women <50 years. While infrequent, there was a relative 16% increase (RR 1.16, CI 1.07-1.25) in the rate of screening MRI, with the greatest increase among the youngest women. In the postlegislation period, women with extremely dense breasts (BI-RADS d) had 2.77 times (CI 1.93-3.95) the odds of a MRI within 9 months of a screening mammogram compared with women with nondense breasts (BI-RADS b). Conclusions: In this setting, MRI rates increased in the postlegislation period. In addition, women with higher BD were more likely to have supplementary MRI. The decrease in mammography rates seen primarily among younger women may have been due to changes in national screening guidelines.

Characterizing participants in the North Carolina Breast and Cervical Cancer Control Program (NC BCCCP): A review of 90,000 women.

2020 ◽  
Vol 38 (29_suppl) ◽  
pp. 101-101
Author(s):  
Sarah D Tait ◽  
Yi Ren ◽  
Cushanta C. Horton ◽  
Sachiko M. Oshima ◽  
Samantha M. Thomas ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Negative Binomial ◽  
Hispanic Women ◽  
Univariate Analysis ◽  
Breast Pathology ◽  
National Quality ◽  
Race Ethnicity ◽  
Racial Ethnic

101 Background: Overall breast cancer mortality in the US has declined since 1990, but racial/ethnic disparities have worsened. Since 1992, NC BCCCP has provided free/low-cost breast cancer screening to underserved women as part of a national effort by the Centers for Disease Control and Prevention (CDC) to mitigate these disparities. We sought to characterize and evaluate benchmarks for this previously unstudied, state-level cohort. Methods: We identified women ≥18y who underwent their first breast cancer screening via NC BCCCP from 2009-2018. Univariate analysis was used to compare differences in timeline of care and rates of breast pathology (i.e., cancer or atypia) by race/ethnicity and age. Logistic and negative binomial regression were used to identify factors associated with cancer diagnosis and time from enrollment to diagnosis (TTD) and treatment (TTT), respectively. Results: 88,893 women with complete records were identified (median age 50y, IQR 44-56): 45.5% were Non-Hispanic (NH) white, 30.9% NH black, 19.5% Hispanic, 1.7% American Indian (AI), and 1.1% Asian. Overall participation peaked in 2012 but steadily increased among Hispanic women over time (p < 0.001). Breast pathology was diagnosed in 2,016 (2.3%) women, with rates ranging from 1% in Hispanic women to 2.7% in NH whites. After adjustment, Hispanic women were least likely (vs NH white women: OR 0.40; 95% CI 0.34-0.47) to be diagnosed with breast cancer. Median TTD was 19d and TTT was 33d, both within the CDC’s 60d standard. In univariate analyses, women < 50 had shorter TTD (median 18d vs 21d) and TTT (median 30d vs 35d) vs women ≥50 (both p < 0.01), and there were no significant differences by race/ethnicity or between women with atypia vs cancer. In multivariate models, however, older age and NH black race were associated with longer TTD and TTT. Conclusions: NC BCCCP meets national quality benchmarks for TTD and TTT. These data also highlight broader opportunities to achieve racial/ethnic parity and improve equity for breast cancer prevention. [Table: see text]

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