Abstract C82: Correlates of enrollee retention in a community-based breast cancer screening program

Abstract

Abstract BACKGROUND: Early detection of breast cancer with screening mammography reduces breast cancer mortality. Despite this knowledge, certain groups such as African American women who are uninsured, underinsured, live in urban areas and are of lower socioeconomic status are less likely to complete screening mammography in comparison to other ethnic/racial groups. Maryland's overall rate of breast cancer screening amongst women 40 years and older in 2012, was 55%. That rate dropped respectively to 26% and 27% in women with no usual source of health care and no insurance. This study aims to 1.) Descriptively analyze a no-cost breast cancer screening program targeted at uninsured and underinsured African American women residing in Baltimore and 2.) To identify individual level factors associated with program retention and breast cancer diagnosis. METHODS: We conducted a descriptive analysis of individual level data from women who received program services from 2001-2015. Program retention was equated to the number of breast cycles completed—one versus two or more breast cycles. A breast cycle was defined as initiation and completion of screening or completion of recommended follow-up services through diagnostic resolution after an abnormal screen. Data were analyzed using SAS 9.3 and SPSS 22 software. RESULTS: A total of 5,669 women had valid dates and cycle information available for the analysis. The mean age at enrollment was 50.3 years old. The program enrollees were 13% White; 85% African American; and 7.5% Hispanic. Uninsured women comprised 75% of program enrollees. A family history of breast cancer was reported by 14% of program enrollees and 2.1% of enrollees reported a personal history of breast cancer. Fifty-eight percent of women had completed at least one screening mammogram prior to program enrollment. A personal history of smoking was reported by 31% of enrollees. The median length of program retention was 1.7 years. 10,357 mammograms were provided to these women, with 75% of women completing 2 or more mammograms. Enrollees completed a range of 1-15 breast cycles during the analyzed period, with a median of 2 cycles per enrollee. Age, race by ethnicity, insurance, personal history of breast cancer and mammogram prior to program enrollment were statistically significantly associated with the number of breast cycles completed in the bivariate analysis. Cancer was diagnosed in 113 women. Multivariable logistic regression was performed to determine probability of cancer diagnosis. Controlling for age and other variables in the model, cancer was approximately 1.7 times more likely to be diagnosed in patients who completed only 1 cycle compared to those who completed ≥2 cycles (OR=1.7; 95% CI 1.2, 2.6; p<0.01). Patients with history of smoking were approximately 1.6 times more likely to be diagnosed with cancer compared to patients without such history (OR=1.6; 95% CI 1.1, 2.3; p<0.05). Seventy percent of women diagnosed with cancer had an early stage breast cancer. CONCLUSION: This community-based cancer screening program engaged women from its target population in breast cancer screening. Several factors associated with program retention were identified, this information can be used to direct future program outreach and planning efforts. Our findings suggests that program retention was associated with likelihood of breast cancer diagnosis, however, the initial program screen had the greatest association with breast cancer diagnosis. Citation Format: Shana O. Ntiri, Elena Klyushnenkova. Correlates of enrollee retention in a community-based breast cancer screening program. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C82.