Barriers to screening and treatment of breast cancer: Data analysis from Edgecombe County.

Abstract

232 Background: Edgecombe County in NC was described as the 3rd highest location breast cancer mortality according to the Susan G. Komen report (2007). The major issues detected were low education, lack of healthcare providers, and large numbers of uninsured individuals. Our analysis sought to further characterize the circumstances unique to this region and measures to improve mortality. Methods: Between October 2008 and January 2009, 493 surveys were conducted throughout the county. The surveyors randomly approached female residents of Edgecombe County who completed a questionnaire, which was analyzed for this study. Results: Of the total population 354 women were older than age 40. In this group 82.5% had recent mammograms and 79.8% clinical breast examinations. Also, 91.7% had a Primary Physician who recommended mammograms in 85% of the cases. Only 27.1% had family history of breast cancer and, of those, 86.2% were recommended mammograms. Most were educated (58.6%), had low income (76%) and health insurance (87.4%). Nearly equal numbers of Caucasians and African Americans completed the survey (50.6% vs. 47.6%). Just 8.1% had transportation problems and 3.6% were aware of free mammograms in the health department. Statistical analysis by the Fisher’s Exact Test evaluated the relationship between the likelihood of having a screening mammogram and different variables. Women who attended church were more likely to undergo mammograms (p=0.00054), as were women with insurance (p=0.024). Family histories of breast cancer, lack of transportation, low income or deficient education were not significant determinants to obtain a mammogram. A logistical regression model demonstrated that attendance to church and insurance were the two factors statistically significant in terms of obtaining a mammogram. Conclusions: The main issues identified by our analysis were low-income, low health care literacy and lack of awareness regarding breast cancer programs. Our results were discordant with some of the Susan Komen report data, particularly that the majority of participants had a mammogram. Transportation and religious beliefs were not barriers to screening of breast cancer.