Breast Cancer Screening Tests Research Articles

Abstract B70: Never screened: Understanding breast cancer nonadherence in Puerto Rico

Abstract Background: In Puerto Rico (PR), breast cancer was reported to be the leading cancer among women, accounting for approximately 31% of new cancer cases and 52% of cancer deaths. Mammography screening can reduce mortality approximately 20% by detecting breast cancer at early stages, for which less aggressive treatments and therapies are available. There is little published data regarding factors in PR that could explain mammography non-adherence and if those factors are different between previously screened and never screened women. Objectives: To analyze factors associated with breast cancer screening non-adherence between never screened and previously screened, but not currently adherent women. Methods: Cultivando La Salud is a breast and cervical cancer screening promotion program originally designed for low-income Hispanic women over 50 years old that was minimally adapted for Hispanic woman over 21 years old living in PR. The main objectives of Cultivando La Salud PR were to: (1) evaluate the effectiveness of Cultivando La Salud PR, an evidence-based educational intervention aimed to increase breast and cervical cancer screening tests; (2) increase breast and cervical cancer screening tests among women participants in the study; (3) increase the capacity of a community-based organization in the implementation and evaluation of evidence-based interventions in cancer prevention. Women were eligible to participate in Cultivando La Salud PR if they were non-adherent to breast cancer screening (women age 40 years or older that reported not having a mammography in the past year) or non-adherent to cervical cancer screening (women age 21 years or older that reported not having a Pap test in the last three years) and in good health. This program took place in Canóvanas, a municipality of PR, during the 2012-2013 year period. For purpose of this analysis, only data from not-adherent women to breast cancer screening guidelines (n=301) were used. Statistical Analysis: Descriptive statistics were performed to characterize the study population. Bivariate analysis was used to assess breast cancer screening non-adherence (never screened vs. previously screened women) as the dependent variable and variables who achieved statistical significance (p <0.05) in the bivariate analysis were then included in an age-adjusted logistic regression model. Age-adjusted Prevalence Odds Ratio (POR) with their 95% confidence intervals were also calculated. Results: Data from the baseline survey indicated that 22.0% of the participants older than 40 years old never had a mammography. Never screened women were 4 times more likely to report having Mi Salud, a governmental healthcare plan (age-adjusted POR=4.1, 95%CI:1.3-7.5) and were 3 times more likely to have a family income of less than $15,000 than women previously screened but not adherent (age-adjusted POR=3.1, 95%CI:1.3-7.5). Never screened women were also approximately 3 times more likely to report not having an usual place for receiving routine health care (age-adjusted POR=2.9, 95%CI:1.5-5.3) and were 2 times more likely to have not have a Pap test in the last three years (age-adjusted POR=2.3, 95%CI:1.2-4.3). Discussion: Never screened women reported significant socioeconomic disparities that might be affecting mammography screening practices. A better understanding of the barriers that prevent breast cancer screening in this group will help in the design of educational interventions and public health policies targeted to increase mammography rates in PR. Citation Format: Aleli M. Ayala-Marin, Vivian Colon-Lopez, Camille Velez, Natalie Fernandez-Espada, Maria E. Fernandez. Never screened: Understanding breast cancer nonadherence in Puerto Rico. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B70. doi:10.1158/1538-7755.DISP13-B70

Abstract B33: Female breast cancer in New England: Incidence, mortality, and prevention trends with attention to potential cancer racial/ethnic differences

Abstract Introduction: Breast cancer is estimated to be the first leading cancer type in incidence and the second leading cancer type in mortality in women in 2011 in the United States (US). In addition to the clinical breast exam, an annual mammogram is recommended as a breast cancer screening test. Cancer racial/ethnic disparities are defined as differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific racial/ethnic population groups in the US. The objectives of this study are: 1) to describe female breast cancer incidence, mortality, and mammogram use annual trends in New England; and 2) to evaluate potential female breast cancer racial/ethnic disparities in New England. Methods: Age-adjusted invasive breast cancer incidence rates in women were collected for 2004-2008 from the North American Association of Cancer Registries. Age-adjusted breast cancer mortality rates in women were collected for 2002-2006 from the Centers for Disease Control and Prevention (CDC). Mammogram use within the past 2 years, by women age 40+ or 50+, data were collected for 2000-2010 from the CDC. Results: Invasive female breast cancer shows an increasing incidence trend in Massachusetts (MA) and Rhode Island (RI), decreasing incidence trend in Maine, and stable incidence trend in Connecticut (CT), New Hampshire (NH), and Vermont. Nationwide, New England states rank among the top 10 US states in invasive female breast cancer incidence rate. In terms of race/ethnicity, non-Hispanic Blacks from RI show an increasing incidence trend of invasive female breast cancer, compared with non-Hispanic Blacks from CT, MA, and US. In addition, there is a decreasing female breast cancer mortality trend in non-Hispanic Whites from NH. The mammogram use analysis shows that VT has the lowest percentage of women having it within the past 2 years in New England and the percentage of women who have had it within the same time period is decreasing in RI. In general, 50+ women have had a mammogram within the past 2 years at a higher percentage than 40+ women. Conclusions: MA, CT, RI, and NH lead the US states in invasive female breast cancer incidence. These results suggest state or regional-specific conditions that need to be addressed. Further studies of female breast cancer racial/ethnic disparities in New England are needed. Finally, mammogram use increases with age. However, its use should be further encouraged among women in New England. Funding: National Institutes of Health, National Cancer Institute Research Supplement to Promote Diversity in Health-related Research (PI Brian C. Lewis, PhD, University of Massachusetts Medical School, Worcester, MA). Citation Format: Wilfredo Eugenio De Jesus-Monge, Vivianna Margarita De Jesus-Monge. Female breast cancer in New England: Incidence, mortality, and prevention trends with attention to potential cancer racial/ethnic differences. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B33. doi:10.1158/1538-7755.DISP13-B33

Abstract B72: Timely breast cancer diagnostic resolution: Effects of individual and neighborhood characteristics

Abstract Background: Disparities occur throughout the breast cancer continuum. African American women are more likely to be diagnosed with cancer at later stages, which results in poorer outcomes. In fact, despite lower incidence, the mortality rates are higher among black women. While timely follow-up of abnormal breast cancer diagnostic test results could lead to early diagnosis and better treatment outcomes, a myriad of factors may influence timely diagnostic resolution, even with patient navigation in place. Individual and neighborhood socioeconomic characteristics affect access to care, quality, and timeliness of care, which consequently affect health outcomes. In this study, we focus on the effects of neighborhood racial composition and poverty on timeliness of diagnostic test in African American women living in relatively poor neighborhoods in Chicago, IL. Purpose: The purpose of this study is to examine the effects of individual and neighborhood characteristics on timely resolution of breast cancer diagnostic tests among African American women who received breast cancer screening and diagnostic tests from three community hospitals in disadvantaged neighborhoods in Chicago. Methods: The analysis utilized a total of 405 African American women who participated in the Patient Navigation in Medically Underserved Areas Project in Chicago. Participating women were recruited from three hospitals. We created an indicator variable for timely diagnostic resolution (completion of follow-up tests within 60 days). We geo-coded participants' home addresses, and calculated distance from home to clinic in miles. We added census tract level data from the American Community Survey 2005-2009, including racial composition and % poverty. In addition, we used Medically Underserved Area (MUA) designation (affluent; MUA designated poor; MUA undesignated poor). Individual characteristics were: age, education, distance to clinic, marital status, and health care distrust. We used Hierarchical Linear Model (HLM) to perform two-level models explaining diagnostic resolution timeliness. Results: The average age of participants was 60 years old. Over 92% completed high school education and 81% lived in MUA designated and undesignated but poor areas (vs. 19% living in affluent areas that are not eligible for MUA). On average, women traveled 5.5 miles to clinics. The mean % whites and % poverty were respectively 11% and 32%, respectively, which differed from overall % whites (32%) and % poverty in Chicago (21%). Women living in areas with a higher % of white residents were more likely to complete diagnostic tests within 60 days, controlling for all other variables. On the other hand, women living in areas with a higher % of African American residents were less likely to have timely diagnostic resolution, controlling for % poverty and all other individual level characteristics. Neighborhood poverty level was not significantly associated with diagnostic test completion. Conclusions: Even though all participants were African American women, living in neighborhoods with a higher proportion of whites was associated with timely diagnostic test resolution. Ethnic minority women seem to benefit from living in more racially integrated neighborhood environment, regardless of the level of poverty or MUA designation. While MUA designation and poverty are known to affect access to care, which is expected to influence timeliness of diagnostic test, racial composition of neighborhoods was shown to have a significant independent effect on timeliness of diagnostic test. The mechanisms of racial residential segregation on timeliness of diagnostic tests need to be further evaluated. Citation Format: Seijeoung Kim, Yamile Molina, Nerida Berriors, Elizabeth Calhoun. Timely breast cancer diagnostic resolution: Effects of individual and neighborhood characteristics. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B72. doi:10.1158/1538-7755.DISP13-B72

Diagnostic value of circulating microRNAs as biomarkers for breast cancer: a meta-analysis study

Recent studies have provided new insights into the diagnostic value of circulating microRNAs (miRNAs) for breast cancer (BCa). However, the inconsistent results between studies have prevented the widespread usage of miRNAs in clinics. To systematically assess the potential diagnostic value of circulating miRNAs in BCa, we performed a comprehensive meta-analysis. Eligible studies were retrieved by searching electronic databases. The quality of the studies was assessed on the basis of quality assessment for studies of diagnostic accuracy (QUADAS) criteria. The bivariate meta-analysis model was employed to summarize the diagnostic indices and plot the summary receiver operator characteristic (SROC) curve. A total of 15 studies were included in this meta-analysis, involving 1368 BCa patients and 849 healthy controls. Our bivariate random effects meta-analysis yielded an area under curve (AUC) value of 0.9217, with a sensitivity of 0.82 (95 % confidence interval (CI) 0.80-0.83) and specificity of 0.82 (95% CI 0.80-0.85) for the use of miRNAs in differentiating BCa patients from healthy controls. Notably, our subgroup analysis suggested that a combination of multiple miRNAs (AUC, sensitivity, and specificity of 0.9518, 0.87, and 0.88, respectively) seemed to harbor higher accuracy than single miRNA-based assays (AUC, sensitivity, and specificity of 0.8923, 0.79, and 0.77, respectively). Altogether, our data indicate that circulating miRNA profiling has a potential to be used as a screening test for BCa, among which, the detection of a combined multiple miRNAs may be a more comprehensive indicator than individual miRNA.

Evaluation of the Knowledge, Attitude, and Behavior of Female Health Workers about Breast Cancer, Cervical Cancer, and Routine Screening Tests

Evaluation of the Knowledge, Attitude, and Behavior of Female Health Workers about Breast Cancer, Cervical Cancer, and Routine Screening Tests

Jordanian women's personal practices regarding prevention and early detection of breast cancer.

Breast cancer, as a leading cause of mortality, is responsible for 12.5% of all deaths in Jordan. The aim of this study was to describe Jordanian women's personal practices and perceptions of breast cancer screening tests. A quantitative cross-sectional survey using a proportionate stratified sample of 331 women was conducted. The target population includes all Jordanian women living in high- and low-density neighborhoods. The population involved women from the 12 governorates areas. Perception of susceptibility, confidence in performing breast self-examination (BSE) barriers of the group that had previously performed BSE were significantly higher than those who did not practice (t = 8.38, p = .02; t = 9.90, p = .00; t = -0.98, p = .01, respectively). The results of this study provide information to policy makers and healthcare leaders who seek to improve breast cancer prevention and response to cancer control efforts.

The human epidermal growth factor receptor 2 screening tests for breast cancer suggested by the new updated recommendation of the american society of clinical oncology/college of american pathologists will involve a rise of the in-situ hybridization tests for the European laboratories of pathology.

Aims. The differences between the 2007 and the 2013 ASCO/CAP HER2 guidelines have been compared. We also discussed the potential consequences in our pathological practice. Material and Methodology. 189 HER2 fluorescence in situ hybridisation (FISH) tests were performed from 1016 preliminary HER2 immunohistochemical tests (IHC). All cases were reviewed and reclassed following the 2007 and 2013 ASCO/CAP recommendations. Results. The 2013 version decreased false-negative IHC (3/118 versus 1/54, P = ns) and created more 2+ IHC (40/186 versus 89/186, P = 0.001) or more 3+ IHC (9/186 versus 39/186, P = 0.001). One false-positive IHC was described for the 2013 version (0/9 versus 1/39, P = ns). Equivocal FISH was reduced (8/186 versus 2/186, P = ns). An estimation based on our data for 1000 patients showed a rise of our FISH tests for the control of 2+ IHC (180 tests for the 2007 version versus 274 tests for the 2013 version or FISH work overflow is +52%) and for the control of 2+/3+ IHC (300 for the 2007 version versus 475 for the 2013 version or FISH work overflow is +58%). Conclusions. The new 2013 ASCO/CAP guidelines have detected more HER2 positive cases but have increased the number of FISH tests.

Neighborhood and Geographic Factors Associated with Diagnostic Resolution After an Abnormal Breast or Cervical Cancer Screening Test Among Women Enrolled in a Patient Navigator Program

Abstract This study's aim was to assess the associations between neighborhood and geographic factors and diagnostic resolution within 12 months following an abnormal screening test for breast or cervical cancer among participants of the Ohio Patient Navigator Research Program. Methods: Patient (demographic, psychosocial, and socioeconomic status [SES]) and neighborhood (SES, racial segregation, healthcare access) factors of 776 women attending one of 16 clinics and living in one of 285 census tracts in greater Columbus, Ohio were examined. Women were randomized at the clinic level to determine receipt of the navigation intervention. Multilevel logistic regression was used to estimate associations between these factors and diagnostic resolution while controlling for clinic and neighborhood clustering. Spatial analysis assessed the presence of geographic disparities (i.e., regions of significantly high odds of not resolving). Results: After adjustment for individual-level SES and the receipt of the clinic-level navigation intervention, there was a significant inverse association between neighborhood-level percent of residents without a bachelor's degree and odds of diagnostic resolution (odds ratio = 0.79, 95% confidence interval = 0.63–0.98). Adjustment for neighborhood percent of residents without a bachelor's degree accounted for geographic disparities in diagnostic resolution. Racial segregation, home-to-clinic distance and PN were not associated with odds of resolution. Conclusions: Women were more likely to have diagnostically resolved 12 months following an abnormal breast or cervical cancer screening test if they lived in neighborhoods of higher SES. Geographic disparities in diagnostic resolution could be reduced if there was no variation in neighborhood SES.

Time and Motion Study of a Community Patient Navigator.

Research on patient navigation has focused on validating the utility of navigators by defining their roles and analyzing their effects on patient outcomes, patient satisfaction, and cost effectiveness. Patient navigators are increasingly used outside the research context, and their roles without research responsibilities may look very different. This pilot study captured the activities of a community patient navigator for uninsured women with a positive screening test for breast cancer, using a time and motion approach over a period of three days. We followed the actions of this navigator minute by minute to assess the relative ratios of actions performed and to identify areas for time efficiency improvement to increase direct time with patients. This novel approach depicts the duties of a community patient navigator no longer fettered by navigation logs, research team meetings, surveys, and the consent process. We found that the community patient navigator was able to spend more time with patients in the clinical context relative to performing paperwork or logging communication with patients as a result of her lack of research responsibilities. By illuminating how community patient navigation functions as separate from the research setting, our results will inform future hiring and training of community patient navigators, system design and operations for improving the efficiency and efficacy of navigators, and our understanding of what community patient navigators do in the absence of research responsibilities.

Assessing inequalities in preventive care use in Europe

This paper presents new international evidence on the extent of inequalities in breast cancer screening and blood test (cholesterol and blood sugar test) in 13 European Countries using data from the 2009 wave of the Survey of Health, Ageing and Retirement in Europe (SHARE). One important contribution of the paper is the inclusion of preexisting health conditions in the needs standardization procedure with the aim of taking into account utilization due to diagnosis or follow-up reasons. We find evidence of pro-rich inequalities in blood test use in some countries while high inequalities emerge in virtually every country with respect to mammography use. Decomposition analysis reveals that inequalities in mammography use are mostly driven by income while preventive needs distribution is only slightly pro-rich. On the other side, richer individuals appear to be much more likely to do blood tests despite their substantially lower diagnostic needs for that care. Generally, inequalities in mammography use are higher in countries without national breast cancer screening programs or in countries with only regional or less participated programs. Inequalities in blood tests are higher in countries with a high share of out-of-pocket payments and/or non universalistic entitlement to insurance coverage.

165 Breast and cervical cancer screening utilisation among insured female employees at a large US company

ObjectivesFemale employees enrolled in a company-sponsored health insurance plan are eligible to receive preventive care benefits. We examined the utilisation of recommended screening tests for breast and cervical cancer among...

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Professional organizations have issued guidelines recommending breast cancer screening for women 50 years of age. This study examines the percent of U.S. primary care physicians who report breast cancer screening practices that are not consistent with guidelines, and the characteristics of physicians who reported offering extra test modalities. We analyzed a subset of a 2008 cross-sectional Women's Health Care survey sent to primary care physicians randomly selected from the national American Medical Association (AMA) Physician Masterfile. A subset of physicians received a survey that presented a vignette of a health maintenance visit for an asymptomatic 51-year-old woman who was not at high risk for breast cancer. Responses were weighted to represent physicians nationally. 1,654 U.S. family physicians, general internists, and obstetrician-gynecologists under age 65, who practiced in office or hospital based settings (62.8 % response rate). After exclusions, 553 study physicians remained for analysis. Physician self-report of breast cancer screening practices that are not consistent with the recommendations of the U.S. Preventive Services Task Force (USPSTF), the American College of Obstetrics and Gynecology (ACOG), and the American Cancer Society (ACS), defined as almost always offering mammography. 36.0 % (95 % CI: 31.8 %-40.5 %) of physicians reported offering breast cancer screening tests inconsistent with national guidelines, with most offering extra tests (magnetic resonance imaging [MRI] and/or ultrasound) (33.2 %, 95 % CI 29.1 %-37.6 %). In adjusted analysis, risk-averse physicians and those who believed in the clinical effectiveness of MRI were more likely to offer extra breast cancer screening tests. Physicians often report offering breast cancer screening test modalities beyond those recommended for a 51-year-old woman. Strategies, such as academic detailing regarding appropriate use of technology and provision of clinical decision support for breast cancer screening, could decrease overuse of resources.

Awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests in Spain

We aim to describe levels of awareness and uptake of colorectal, breast, cervical and prostate cancer screening tests and to analyze the association to socio-demographic and health-related variables. Population-based cross-sectional study conducted using a home-based personal interview survey on a nationwide representative sample (n = 7938) of population aged ≥18 years (Oncobarometro Survey). Awareness was assessed by asking participants: Now I am going to mention several medical tests for cancer detection, please tell me if you already know about them or if this is the first time you have heard of them? The tests mentioned were faecal occult blood test (FOBT), mammography, Pap smear and prostate-specific antigen (PSA). Cancer screening uptake was assessed by asking participants whether they had received tests within the previous 2 years. Awareness rates of 38.55% for FOBT, 95.03% for mammography, 70.84% for Pap smears and 54.72% for PSA were found. Uptake mammography was 74.46%, Pap smears 65.57%, PSA 35.19% and FOBT 9.40%. Factors such as immigration status, lower educational level or income and not suffering from chronic conditions are negative predictors for uptake. Awareness and uptake results showed acceptable figures for mammography, moderate for Pap smears and unacceptably low for FOBT. Inequalities exist in uptake of cancer screening. It is necessary to develop public health educational programmes, especially for the vulnerable populations, aiming to inform and motivate them to use screening services on a regular basis. Our data suggest that although PSA is not recommended, this opportunistic screening is frequently used in Spain.

Technology Assessment No. 9

Mammography has been the primary screening test for early breast cancer for more than five decades, but conventional mammography imaging continues to have limitations in sensitivity and specificity. Digital mammography detects some cases of cancer that are not identified by film mammography, but overall detection is similar for many women. Digital breast tomosynthesis offers the potential to overcome one of the primary limitations of mammography, which is the inability to image overlapping dense normal breast tissue. Clinical data suggest that digital mammography with tomosynthesis produces a better image, improved accuracy, and lower recall rates compared with digital mammography alone. Further study will be necessary to confirm whether digital mammography with tomosynthesis is a cost-effective approach, capable of replacing digital mammography alone as the first-line screening modality of choice for breast cancer screening.

Perceptions of Patient-Provider Communication in Breast and Cervical Cancer-Related Care: A Qualitative Study of Low-Income English- and Spanish-Speaking Women

To explore patient perceptions of patient-provider communication in breast and cervical cancer-related care among low-income English- and Spanish-speaking women, we examined communication barriers and facilitators reported by patients receiving care at safety net clinics. Participants were interviewed in English or Spanish after receiving an abnormal breast or cervical cancer screening test or cancer diagnosis. Following an inductive approach, interviews were coded and analyzed by the language spoken with providers and patient-provider language concordance status. Of 78 participants, 53% (n=41) were English-speakers and 47% (n=37) were Spanish-speakers. All English-speakers were language-concordant with providers. Of Spanish-speakers, 27% (n=10) were Spanish-concordant; 38% (n=14) were Spanish-discordant, requiring an interpreter; and 35% (n=13) were Spanish mixed-concordant, experiencing both types of communication throughout the care continuum. English-speakers focused on communication barriers, and difficulty understanding jargon arose as a theme. Spanish-speakers emphasized communication facilitators related to Spanish language use. Themes among all Spanish-speaking sub-groups included appreciation for language support resources and preference for Spanish-speaking providers. Mixed-concordant participants accounted for the majority of Spanish-speakers who reported communication barriers. Our data suggest that, although perception of patient-provider communication may depend on the language spoken throughout the care continuum, jargon is lost when health information is communicated in Spanish. Further, the respective consistency of language concordance or interpretation may play a role in patient perception of patient-provider communication.

Differences in Pain Perceptions between Automated Breast Ultrasound and Digital Screening Mammography

A prospective single-site survey was performed to gauge perceived pain during automated breast ultrasound (ABUS) and digital x-ray mammography (XRM). Patients also described differences in duration of the exams, provided their bra size, and indicated whether they would recommend ABUS to a friend. Pain was measured on a Likert-type visual analog scale (1–10). Participants were 199 female volunteers who also participated in the prospective, multicenter, nationwide clinical research study SOMO•INSIGHT. There was a mean pain and/or discomfort score of 6.41 (± 2.41) for XRM and a mean score of 1.86 (± 1.24) for ABUS ( P = .001). Bra size and perceived examination duration played no role in determining patient pain and/or discomfort. One hundred percent of patients who participated said that they would recommend ABUS to a friend. These data suggest that if ABUS is proven to be a valuable adjunctive screening test for breast cancer among women with dense breast tissue, its routine use will be well tolerated by patients.

Breast Cancer Screening: A Stochastic DEA Study

The goal of screening tests for breast cancer is early detection and treatment with a consequent reduction in mortality caused by the disease. Screening tests, however, might produce misleading diagnoses and potentially significant emotional, financial and health costs. The effectiveness of a breast screening program has effects on the quality of life of the target population. Even if the screening units regularly attain coverage targets, it remains essential to ensure that women receive the same high standard of service wherever they live. In order to assess the relative efficiency of individual screening units we use stochastic D.E.A. models, which can be used as reliable tools for external audit. The technique is tested on breast cancer screening data of two Italian regions.

Relationship Between the Annual Mammography Implementation and Early Diagnosis of Breast Cancer

OBJECTIVE: To evaluate the practice of screening tests for breast cancer among women with the disease and identify whether the recommendations were followed with regard to risks in addition to the association between high risk, screening tests and tumor staging. METHODOLOGY: Were included 100 women with breast cancer in different staging, mean age 58.38 ± 11.13 years, ranging from 37 to 82 years. Data were collected by interview, model question vs. answer, guided by an instrument developed by the researchers. RESULTS: Just over half of cases (n=58, 58.0%) performed mammography annually. Moreover, 37.0% (n=37) had never performed the examination until the time of diagnosis. Among the risk factors related to reproductive life, early menarche reached almost half (n=46, 46.0%) and late menopause occurred in only 16.25% (n=13) of postmenopausal women. Comparing the two groups that reported realization (annual or biannual) or not of mammography, there was no significant difference in the initial stage (IIa) or advanced (IIb, III or IV) between the groups. Moreover, among the cases with positive family history of breast cancer (n=16) and were diagnosed with advanced disease, 62.5% (n=10) underwent mammography at an annual or biennial. DISCUSSION/CONCLUSION: The frequency of the test does not require initial stages mammography in diagnosing the disease and the risk factors associated with family history and characteristics of their reproductive life. Our results demonstrate the need for further research and development of new practices for tracking a consensus covering the new epidemiological profile of women affected by breast cancer.

Abstract A88: Perceived discrimination and cancer screening behaviors in U.S. Hispanics: Preliminary results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study.

Abstract Background: Perceived discrimination among the US population has been associated with lower utilization of cancer screening tests. Data from the Hispanic Community Health Study / Study of Latinos (HCHS/SOL) Socio-cultural Ancillary Study were analyzed to determine if perceived discrimination was associated with adherence to breast, cervical and colorectal cancer screening tests. Methods: Respondents included 5,313 participants from Bronx NY, Chicago IL, Miami FL, and San Diego CA recruited using a 2-stage area household probability design. Of these, 3,083 women aged 18-74 and 840 men aged 50-74 were included in the analysis. Cancer screening behaviors, income, health insurance status, and having a usual source of healthcare were assessed via self-report. Perceived discrimination was measured using the Perceived Ethnic Discrimination Questionnaire (PEDQ). Acculturation was measured using the Short Acculturation Scale for Hispanics. Adherence to cervical and breast cancer screening tests was defined as receipt of a Pap smear within the last 2 years (in women 18-74) and receipt of a mammogram within the last 2 years (in women 40-74), respectively. In all participants 50-74, adherence to fecal occult blood testing (FOBT) was defined as having FOBT within the 1 year; adherence to colonscopy/sigmoidoscopy was defined as having had either test in the last 5 years. Chi-square tests were used to test for differences between groups. Multivariate polytomous logistic regression models were fit to assess the association between perceived discrimination and cancer screening adherence. Models were adjusted for income, health insurance status, having a usual source of care, location, and acculturation. Results: Among women, 72.1% were adherent to cervical cancer screening and 54.2% were adherent to breast cancer screening. In participants aged 50-74, 23.5% of women and 27.2% of men were adherent to FOBT; 36.9% of women and 30.0% of men were adherent to colonscopy/sigmoidoscopy. After adjustment for covariates, men in the highest quartiles of perceived discrimination were more likely be non-adherent to FOBT compared to men in the lowest quartile of perceived discrimination (Q3 vs. Q1, OR: 2.3 [1.1-4.7]; Q4 vs. Q1, OR: 4.4 [2.0-9.7]). We observed no association between perceived discrimination, and breast or cervical cancer screening, or colonoscopy/sigmoidoscopy. Not having health insurance was a significant independent predictor of non-adherence to breast, cervical, and colorectal cancer screening (breast cancer, OR: 2.5 [1.7-3.5]; cervical cancer, OR: 1.7 [1.2-2.4]; FOBT in women, OR: 2.6 [1.3-4.9]; colonoscopy/sigmoidoscopy in women, OR: 5.5[2.7-11.3]; in men, OR: 3.4 [1.5-7.4]). Greater degree of acculturation to the dominant US culture was associated with non-adherence to cervical and colorectal cancer screening in women (cervcal cancer, OR: 1.4 [1.1-1.8]; FOBT, OR: 2.0 [1.3-3.2]; colonscopy/sigmoidoscopy, OR: 1.7 [1.1-2.8]). Conclusions: For breast, cervical and colorectal cancer screening behaviors, not having health insurance and being more acculturated to US culture were significant predictors of lower rates of cancer screening; perceived discrimination was not significantly related. The finding that higher levels of discrimination are associated to non-adherence to FOBT among men warrants further research. Citation Format: Cristina Valdovinos, Carmen Isasi, Molly Jung, Heather Greenlee, Robert Kaplan, Frank J. Penedo, Rebeca A. Espinoza, Patricia Gonzalez, Vanessa L. Malcarne, Krista Perreira, Hugo Salgado, Melissa A. Simon, Lisa M. Wruck. Perceived discrimination and cancer screening behaviors in U.S. Hispanics: Preliminary results from the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Sociocultural Ancillary Study. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr A88.

Abstract B55: Barriers to care reported among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program.

Abstract Purpose: To evaluate patient-reported barriers to care among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program. Methods: Patients from 18 primary care and specialty clinics within the Ohio State University Medical Center and Columbus Neighborhood Health Centers with an abnormal cervical or breast cancer screening test were eligible for this group-randomized trial. Clinics were paired and randomized within pairs to usual care or patient navigation (PN). Navigators were not clinic-based, but followed the American Cancer Society-PN model where navigators mainly used phone contact from a non-clinic location. During conversations, the navigators documented patient-reported barriers, actions taken to address barriers, and the amount of time spent. We report data on 406 patients with cervical (n=150) or breast (n=256) abnormalities from clinics assigned to the PN arm and who were reached and did not refuse navigation. Differences between patient groups were compared using t-test (demographics) and Fisher's exact test (barriers). Cox proportional hazard models examined the effects of barriers on time to resolution (i.e., cancer diagnosis or determination of a benign condition) of patients' abnormalities. Results: Patients with breast abnormalities were older than patients with cervical abnormalities (mean age: 53 vs. 36 years; p<0.01). Additionally, more patients with breast abnormalities were: married; had higher levels of education and income; owned their home; were retired, and had some form of health insurance than patients with cervical abnormalities (all p<0.01). Approximately half (48%) of the patients reported no barriers. More cervical than breast patients reported having a language barrier and needed assistance with interpretation (3% vs. 0; p<0.05). The patient-reported barriers most commonly reported, but not statistically significant, among cervical and breast patients were: communication concerns with providers (19% vs. 12%), perceptions and beliefs about tests or treatment (18% vs. 16%), system problems with scheduling care (15% vs. 9%); insurance (11% vs. 6%), employment issues (3% vs. 1%), co-morbidities (10% vs. 5%), and not a priority (9% vs. 6%). In multivariable models, both breast (OR=0.66; 95% CI: 0.51–0.86) and cervical patients (OR=0.56; 95% CI: 0.38–0.82) who reported at least one barrier had slower resolution of their abnormalities. Conclusions: Patients with breast and cervical abnormalities reported similar barriers to care. However, patients with cervical abnormalities reported the barriers more often, which may be due to differences in key demographic characteristics. Patients who reported at least one barrier were slower to resolution of their abnormality and the most common barriers reported provide clues as to where the health care system is breaking down for patients and how patient navigation can help. Citation Format: Mira L. Katz, Paul L. Reiter, G. Young, Electra D. Paskett. Barriers to care reported among patients with cervical and breast abnormalities in the Ohio Patient Navigation Research Program. [abstract]. In: Proceedings of the Fifth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2012 Oct 27-30; San Diego, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2012;21(10 Suppl):Abstract nr B55.