The Impact of Race, and Insurance Status on Breast Cancer Screening: Results from the Behavioral Risk Factor Surveillance System Data

Abstract Purpose Breast cancer is the second major cause of cancer-related death of women in the United States 1, yet current gaps exist in breast cancer screening for minority women 2. The purpose of this study is to address these gaps by assessing the relationships among race, health insurance coverage, and breast cancer screening in a nationally representative sample of women. Design: A cross-sectional descriptive analysis of the 2018 BRFSS survey data was used to meet the study purpose. BRFSS participants who declared themselves to be of female sex and who were adults with the age ≥ of 40 years were selected for inclusion. Methods Data were analyzed using SPSS version 26. Exploratory and descriptive analyses were performed, followed by comparative analyses based on the variable type. Relationships between race, insurance status, and mammogram screening were examined. Chi-square, logistic, and multinomial logistic regression were used. Findings: The original 2018 BRFSS dataset included 437,436 participants and 145,837 women were selected based on inclusion criteria. Participant age ranged from 40 to 74 years. The majority were White only non-Hispanic (78.1%), reported having a mammogram in the past two years (76.1%), had earned < a 4-year college degree (61.1%), had an annual income of < $75,000 (58.4%) and married (58.2%). Less than half had a healthcare plan through an employer (44.9%) and were employed (40.5%). Participants who had a plan purchased through an employer or union were more likely to have a mammogram in the past two years when compared with other health coverage. Furthermore, White only, non-Hispanics were 1.25 times more likely and Black only, non-Hispanics were 1.98 times more likely to have a mammogram in the past two years compared to participants from other racial and ethnic groups. Conclusion The findings of this study provide an additional indication that race, and health insurance status do impact breast cancer screening. Clinical Relevance: Knowledge gained from this study can be used by practicing nurses to educate racial and ethnic minority women on the significance of breast cancer screening and prevention.

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Food security status and breast cancer screening among women in the United States: Evidence from Health and Retirement Study and Health Care and Nutrition Study

10.21203/rs.3.rs-176608/v1 ◽

2021 ◽

Author(s):

Asos Mahmood ◽

Satish Kedia ◽

Patrick Dillon ◽

Hyunmin kim ◽

Hassan Arshad ◽

...

Keyword(s):

Breast Cancer ◽

Health Care ◽

Cancer Screening ◽

Food Insecurity ◽

Breast Cancer Screening ◽

The United States ◽

The Past ◽

Cancer Screenings ◽

Nutrition Study ◽

Retirement Study

Abstract Purpose: To assesses the impact of food insecurity on biennial breast cancer screenings (i.e., mammography or breast x-ray) among older women in the United States (US).Methods: Data from the 2014 and 2016 waves of the Health and Retirement Study and the 2013 Health Care and Nutrition Study were used. The analyses were limited to a nationally representative sample of 2,861 women between 50 to 74 years of age, residing in the US. We employed a propensity score weighting method to balance observed confounders between food-secure and food-insecure women and fitted a binary logistic regression to investigate population-level estimates for the association between food security and breast cancer screening.Results: Food insecurity was significantly associated with failure to obtain a mammogram or breast x-ray within the past two years. Food-insecure women had 54% lower odds of reporting breast cancer screening in the past two years (OR=0.46; 95% CI: 0.30-0.70, P-value <.001) as compared to food-secure women. Additional factors associated with a higher likelihood of receiving breast cancer screenings included greater educational attainment, higher household income, regular access to health care/advice, not smoking, and not being physically disabled or experiencing depressive symptoms.Conclusion: Results demonstrate a socioeconomic gradient existing in regard to the utilization of regular breast cancer screenings among women. Those who tend to have lower education, lower-income and lack of reliable healthcare access are more likely to be food insecure. Thus, more likely to face the financial, logistical, or environmental barriers in obtaining screening services that accompany food insecurity.

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Physician initiated cancer screening discussions and patient intention to engage in screening behavior

Journal of Clinical Oncology ◽

10.1200/jco.2007.25.18_suppl.1528 ◽

2007 ◽

Vol 25 (18_suppl) ◽

pp. 1528-1528

Author(s):

S. W. Gray ◽

N. Wong ◽

B. Kelly ◽

A. Romantan ◽

S. Ramirez ◽

...

Keyword(s):

Breast Cancer ◽

Prostate Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Information Acquisition ◽

Prostate Cancer Screening ◽

The Past ◽

Screening Intentions ◽

Breast And Prostate Cancer ◽

The Impact

1528 Background: Cancer screening for colon, breast, and prostate cancer remains underutilized. Physician (MD)-patient discussions of screening are common but the impact of these discussions is unknown. Methods: 2489 40–70 year old subjects completed a national survey of cancer prevention information acquisition and decision making (median age 53, 49% male, 77% white, 59% married, 61% some college). Subjects reported whether their MD initiated discussions (MDID) about colonoscopy, mammography, & PSA within the past year. Age eligible subjects were “non-routine screeners” (NRS: never screened or colonoscopy >10 yrs, mammography >2 yrs or PSA>2 yrs prior) or “routine screeners” (RS).The endpoint was intention to screen when next eligible. Results: 46%, 75% and 60% of subjects reported intentions to obtain colonoscopy, mammography and/or PSA. Logistic regression was used to determine the association between MDID and intentions to screen controlling for sociodemographics and recency of screening. For colonoscopy and mammography, MDID was significantly associated with intention to screen for NRS but not RS groups; the opposite was true for PSA. For the NRS group: comparing those saying no versus yes to MDID, intentions were 15% vs. 43% for colonoscopy, 29% to 61% for mammography (RS: 85% vs. 91% and 82% vs. 85%). For PSA, NRS: 46% vs.52% but RS group 65% vs. 85%. All interactions (screening by MDID) were significant, p<.001. Conclusions: Given high intentions to undergo colon and breast cancer screening among patients who have been screened routinely, physician discussion preferentially increases intentions for colon and breast cancer screening among patients who are not routinely undergoing the screening test. Conversely, physician discussion preferentially influences prostate cancer screening intentions among patients who have been screened in the past two years- perhaps because men who have not undergone screening are more resolved in their decision not to screen. These results define subgroups of patients where physician attention may have the greatest impact on screening adherence. No significant financial relationships to disclose.

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Disability as a predictor of breast cancer screening uptake: A population-based study of 57,328 women

Journal of Medical Screening ◽

10.1177/0969141319888553 ◽

2019 ◽

Vol 27 (4) ◽

pp. 194-200

Author(s):

Emma Ross ◽

Aideen Maguire ◽

Michael Donnelly ◽

Adrian Mairs ◽

Clare Hall ◽

...

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Northern Ireland ◽

Breast Cancer Screening ◽

Breast Screening ◽

The United States ◽

Ageing Population ◽

Screening Uptake ◽

National Breast ◽

The Impact

Objective Despite a growing body of evidence suggesting inequalities in breast cancer screening uptake in the United States for women with disabilities, few attempts have been made to examine whether this association applies to the United Kingdom. We conducted the first population-wide study investigating the impact of disability on uptake of breast cancer screening in Northern Ireland. Methods Breast screening records extracted from the National Breast Screening System were linked to the Northern Ireland Longitudinal Study. This identified a cohort of 57,328 women who were followed through one complete three-year screening cycle of the National Health Service Breast Screening Programme in Northern Ireland. The presence of disability was identified from responses to the 2011 Census. Results Within this cohort, 35.8% of women reported having at least one chronic disability, and these individuals were 7% less likely to attend compared with those with no disability (odds ratio 0.93; 95% confidence interval 0.89–0.98). Variation in the degree of disparity observed was evident according to the type and number of comorbid disabilities examined. Conclusion This is the first population-wide study in Northern Ireland to identify disparities in breast screening uptake for women with chronic disabilities, in particular, those with multimorbidity. This is of particular concern, given the projected rise in the prevalence of disability associated with the ageing population.

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Screening Mammography: Guidelines versus Clinical Practice

Journal of Breast Imaging ◽

10.1093/jbi/wbaa003 ◽

2020 ◽

Vol 2 (3) ◽

pp. 217-224 ◽

Cited By ~ 1

Author(s):

Rebecca Oudsema ◽

Esther Hwang ◽

Sharon Steinberger ◽

Rowena Yip ◽

Laurie R Margolies

Keyword(s):

Breast Cancer ◽

Clinical Practice ◽

Cancer Screening ◽

Medical Students ◽

Breast Cancer Screening ◽

The United States ◽

Screening Mammography ◽

Medical Specialties ◽

Patients Âgés ◽

The Impact

Abstract Objective To understand physicians’ comprehension of breast cancer screening guidelines and the existing literature on breast cancer screening, and whether this contributes to how patient screening is implemented in clinical practice. Methods A survey of 18 questions was distributed across the United States via e-mail and social media resources to physicians and medical students of all disciplines and levels of training. Responses from 728 physicians and medical students were reviewed. Respondents were from over 200 different institutions and over 60 different medical specialties. Results Our survey demonstrates that more than half of the participants felt uncomfortable in their knowledge of breast cancer screening recommendations (399/728, 54.8%) and existing literature on breast cancer screening (555/728, 76.2%). When stratified based on level of training, those at the attending level reported a greater level of comfort in their knowledge of breast cancer screening recommendations (168/238, 70.6%) and literature (95/238, 39.9%) compared with respondents at the trainee level. Attending physicians are also more likely to recommend screening for patients between the ages of 40–49 years old (209/238, 87.7%) compared to those at the trainee level. Responses on whether to screen based on age were most consistent for patients ages 50–74, with greater than 90% of the respondents endorsing screening mammogram for this age group in all levels of training. There were greater inconsistencies in the support to screen age groups 40–49 and 75+ . Conclusions The results showed a disparity in screening practices by clinicians in all levels of training, particularly for patients ages 40–49 and 75+ , and for the interval of screening. Later initiation with less frequent intervals between screens may reduce the impact of screening on mortality reduction.

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Primary Care and Regular Breast Cancer Screening Among Under-Served Minority Women

10.21236/ada392775 ◽

2000 ◽

Author(s):

Ann O'Malley

Keyword(s):

Breast Cancer ◽

Primary Care ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Minority Women

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Evaluation of Patterns in Access to Breast Cancer Care and Breast Cancer Presentation in a Safety Net Patient Population

The American Surgeon ◽

10.1177/0003134820966288 ◽

2021 ◽

pp. 000313482096628

Author(s):

Erica Choe ◽

Hayoung Park ◽

Ma’at Hembrick ◽

Christine Dauphine ◽

Junko Ozao-Choy

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Cancer Care ◽

Patient Population ◽

Safety Net ◽

Minority Women ◽

Breast Cancer Care ◽

Safety Net Hospital ◽

Screening Mammograms

Background While prior studies have shown the apparent health disparities in breast cancer diagnosis and treatment, there is a gap in knowledge with respect to access to breast cancer care among minority women. Methods We performed a retrospective analysis of patients with newly diagnosed breast cancer from 2014 to 2016 to evaluate how patients presented and accessed cancer care services in our urban safety net hospital. Patient demographics, cancer stage, history of breast cancer screening, and process of referral to cancer care were collected and analyzed. Results Of the 202 patients identified, 61 (30%) patients were younger than the age of 50 and 75 (63%) were of racial minority background. Only 39% of patients with a new breast cancer were diagnosed on screening mammogram. Women younger than the age of 50 ( P < .001) and minority women ( P < .001) were significantly less likely to have had any prior screening mammograms. Furthermore, in patients who met the screening guideline age, more than half did not have prior screening mammograms. Discussion Future research should explore how to improve breast cancer screening rates within our county patient population and the potential need for revision of screening guidelines for minority patients.

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Women's considerations and experiences for breast cancer screening and surveillance during the COVID-19 pandemic in the United States: A focus group study

Preventive Medicine ◽

10.1016/j.ypmed.2021.106542 ◽

2021 ◽

Vol 151 ◽

pp. 106542

Author(s):

Karen E. Schifferdecker ◽

Danielle Vaclavik ◽

Karen J. Wernli ◽

Diana S.M. Buist ◽

Karla Kerlikowske ◽

...

Keyword(s):

Breast Cancer ◽

United States ◽

Cancer Screening ◽

Focus Group ◽

Breast Cancer Screening ◽

The United States ◽

Focus Group Study ◽

Screening And Surveillance

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Relationship of attitudes toward uncertainty and preventive health behaviors with breast cancer screening participation

BMC Women s Health ◽

10.1186/s12905-021-01317-1 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Miho Satoh ◽

Naoko Sato

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Alcohol Consumption ◽

Risk Aversion ◽

Health Behaviors ◽

Breast Cancer Screening ◽

Time Preference ◽

The Past ◽

Screening Participation ◽

Cancer Screening Participation

Abstract Backgroundcxs Early detection of breast cancer is effective for prolonging survival, but the participation rate in breast cancer screening among target Japanese women remains low. This study examined the relationships between tendencies in decision-making under conditions of uncertainty, health behaviors, demographics, and breast cancer screening participation in Japanese women. Methods Secondary analysis was performed using data from the 2017 Keio Household Panel Survey (KHPS). The study population consisted of 2945 households. Data were obtained from the KHPS for women aged 40 years or older. Breast cancer screening participation in the past year, risk aversion, time preference, health behaviors (e.g., smoking, alcohol consumption, and medical treatment received in the past year), and demographic variables were analyzed. Results Data from 708 women were analyzed. Among the respondents, 28.8% had attended breast cancer screening in the past year. Factors found to significantly contribute to breast cancer screening participation included higher risk aversion (odds ratio [OR], 2.34; 95% confidence interval [CI] = 1.03–5.32; p = 0.043), medical treatment received in the past year (OR, 1.56; 95% CI = 1.06–2.30; p = 0.026), higher self-rated health (OR, 1.47; 95% CI = 1.18–1.83; p = 0.001), living above the poverty line (OR, 2.31; 95% CI = 1.13–4.72; p = 0.022), and having children (OR, 1.57; 95% CI = 1.02–2.42; p = 0.042). Factors significantly associated with non-participation in breast cancer screening were smoking (OR, 0.20; 95% CI = 0.10–0.42; p < 0.000), alcohol consumption (OR, 0.56; 95% CI = 0.37–0.86; p = 0.007), being self-employed (OR, 0.22; 95% CI = 0.10–0.46; p < 0.000), and being unemployed (OR, 0.48; 95% CI = 0.26–0.90; p = 0.022). No significant relationship was observed between time preference and screening participation. Conclusions The results indicate that women who recognize the actual risk of developing breast cancer or have high awareness of breast cancer prevention tend to participate in breast cancer screening. Barriers to screening participation are not working for an organization that encourages screening and low income.

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