Mammography Screening Guidelines Research Articles

Radiology advocacy: Promoting collaboration between trainees and professional societies

From mammographic screening guidelines to resident work hour regulations, public policy affects every aspect of the practice of radiology and ultimately determines how radiological care is delivered to patients. Shaping public policy through advocacy is therefore critical to ensure patient access to equitable, high-quality radiological care. In advocacy, individual practicing radiologists and radiology trainees can increase the scope of their influence by collaborating with professional radiology societies. When radiology trainees participate in organized radiology advocacy, they learn about regulatory and legislative issues that will affect their careers, and they learn how to effect policy change. Radiology societies in turn benefit from trainee involvement, as engaging trainees early in their careers leads to more robust future participation and leadership. To encourage trainee involvement, radiology societies can engage individual residency programs and medical student radiology interest groups, invest in trainee-focused events, and maximize the number of positions of responsibility open to trainees. To circumvent the barriers to participation that many trainees face, radiology societies can make meeting proceedings free and available through virtual mediums. Through active collaboration, trainees and professional societies can help assure a bright future for radiologists and patients in need of radiological care.

Identifying Frequently Endorsed Benefits and Barriers to Breast Cancer Screening for African-Born Women in the NYC Metropolitan Area: a Pilot Study.

Most cancer screening data report on Black participants without distinguishing nativity, limiting our understanding of the needs of distinct groups within the African diaspora. The purpose of this pilot study was to assess demographic characteristics and perceptions of the benefits of and barriers to mammography among African immigrant women in New York City (NYC). Forty-two women who were 40years or older, born in Africa, and English and/or French-speaking were recruited from African immigrant communities in NYC to complete a survey. Eighty percent of our sample aged 50 to 73 was adherent to the 2016 USPSTF mammography screening guideline. The most frequently endorsed benefits were that mammography will help find breast cancer early, could help find a breast lump before it is big enough to feel, and that if found early, breast cancer could be successfully treated. The most endorsed barriers were that having a mammogram is painful and that lack of insurance or being treated rudely at the mammogram center would keep participants from having a mammogram. Chi-square analyses assessed relationships between demographic characteristics and perceptions about mammography and revealed that endorsement of barriers to screening (e.g., health issues, transportation problems, pain, and time associated with mammography) varied by educational attainment. Findings suggest that future interventions should be multi-level and (1) support patients in accessing screening via resource sharing, (2) address other commonly cited barriers such as fear of pain during the procedure, and (3) support anti-racist healthcare environments especially in terms of treatment by providers.

Abstract 37: Understanding the social determinants of guideline-based mammography adherence across race/ethnicity: Results from the 2016 California Health Interview Survey

Abstract Purpose: There is not a consensus concerning recommendations about breast cancer screening which has generated confusion about when and how often to undergo mammography screening in the population, yet there is limited population-based data about the extent to which patients adhere to various mammographic screening guidelines in practice. Our purpose was to evaluate population-based adherence to mammographic screening using criteria from major guideline-producing organizations across race/ethnicity to understand what social determinants of mammography adherence are associated with each guideline producing institution. Methods: Women aged 45-79 in the 2016 California Health Interview Survey were included. Self-reported mammographic screening within 1 or 2 years, according to major guideline-producing organizations (American Cancer Society [ACS], US Preventative Services Task Force [USPSTF], American College of Radiology [ACR], American College of Obstetricians and Gynecologists [ACOG]) was calculated with logistic regression, adjusting for demographics, health care, insurance status, and BMI. Results: 7,551 women were included in this study. By age category, cross-sectional adherence to ACR/ACOG (annual screening) (65 to 67%) and USPSTF guidelines (biennial screening) ranged from 82-83% and with increasing age being generally associated higher adherence. The highest proportions of women undergoing mammographic screening were seen in women ages 60-69 (67% within last year, 85% within last 2 years). Statistically significant predictors of adherence to mammography screening included Latina race (OR 1.62, 0.18 SE), full time employment (OR 0.73, 0.09 SE), and not having a usual healthcare provider (OR 0.50, 0.12 SE), adjusted for demographics, health care, insurance status, and BMI. Conclusion: Frequency of screening increases with age with highest screening proportions in women ages 65-69 (66% within last year, 81% within last 2 years). For ACR/ACOG screening guidelines, adherence to mammography screening remains poorer in women with no usual source of care, given that their odds of exhibiting adherence was half that of women who did have a regular source of care and nearly 65 percent lower odds of those women with USPSTF mammography adherence. Key Words: Breast cancer, screening, race/ethnicity, guideline-based care Citation Format: Roman Johnson, Mieke Beth Thomeer. Understanding the social determinants of guideline-based mammography adherence across race/ethnicity: Results from the 2016 California Health Interview Survey [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 37.

Cost-effectiveness of using artificial intelligence versus polygenic risk score to guide breast cancer screening.

BackgroundCurrent guidelines for mammography screening for breast cancer vary across agencies, especially for women aged 40–49. Using artificial Intelligence (AI) to read mammography images has been shown to predict breast cancer risk with higher accuracy than alternative approaches including polygenic risk scores (PRS), raising the question whether AI-based screening is more cost-effective than screening based on PRS or existing guidelines. This study provides the first evidence to shed light on this important question.MethodsThis study is a model-based economic evaluation. We used a hybrid decision tree/microsimulation model to compare the cost-effectiveness of eight strategies of mammography screening for women aged 40–49 (screening beyond age 50 follows existing guidelines). Six of these strategies were defined by combinations of risk prediction approaches (AI, PRS or family history) and screening frequency for low-risk women (no screening or biennial screening). The other two strategies involved annual screening for all women and no screening, respectively. Data used to populate the model were sourced from the published literature.ResultsRisk prediction using AI followed by no screening for low-risk women is the most cost-effective strategy. It dominates (i.e., costs more and generates fewer quality adjusted life years (QALYs)) strategies for risk prediction using PRS followed by no screening or biennial screening for low-risk women, risk prediction using AI or family history followed by biennial screening for low-risk women, and annual screening for all women. It also extendedly dominates (i.e., achieves higher QALYs at a lower incremental cost per QALY) the strategy for risk prediction using family history followed by no screening for low-risk women. Meanwhile, it is cost-effective versus no screening, with an incremental cost-effectiveness ratio of $23,755 per QALY gained.ConclusionsRisk prediction using AI followed by no breast cancer screening for low-risk women is the most cost-effective strategy. This finding can be explained by AI’s ability to identify high-risk women more accurately than PRS and family history (which reduces the possibility of delayed breast cancer diagnosis) and fewer false-positive diagnoses from not screening low-risk women.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12885-022-09613-1.

Sociodemographic correlates of colorectal cancer screening completion among women adherent to mammography screening guidelines by place of birth

IntroductionColorectal cancer screening rates in the U.S. still fall short of national goals, while screening rates for other cancer sites, such as breast, remain high. Understanding characteristics associated with colorectal cancer screening among different groups of women adherent to breast cancer screening guidelines can shed light on the facilitators of colorectal cancer screening among those already engaged in cancer prevention behaviors. The purpose of this study was to explore which demographic characteristics, healthcare access factors, and cancer-related beliefs were associated with colorectal cancer screening completion among U.S. and foreign-born women adherent to mammography screening recommendations.MethodsAnalyses of the 2015 National Health Interview Survey were conducted in 2019. A sample of 1206 women aged 50–74 who had a mammogram in the past 2 years and were of average risk for colorectal cancer was examined. Logistic regression was used to determine demographic, health service, and health belief characteristics associated with colorectal cancer screening completion.ResultsFifty-five percent of the sample were adherent to colorectal cancer screening recommendations. Women over the age of 65 (AOR = 1.76, 95% CI 1.06–2.91), with any type of health insurance, and who were bilingual (AOR = 3.84, 95% CI 1.83–8.09) were more likely to complete screening, while foreign-born women (AOR = 0.53, 95% CI 0.34–0.83) were less likely. Cancer-related beliefs did not influence adherence. Stratified analyses by nativity revealed additional associations.ConclusionsDemographic and health service factors interact to influence colorectal cancer screening among women completing breast cancer screening. Colorectal cancer screening interventions targeting specific underserved groups and financing reforms may enhance women’s colorectal cancer screening rates.

The effect of emotional disorders on adherence to mammography screening guidelines.

Depression, anxiety, and other emotional disorders are highly prevalent; however, the impact of these on adherence to mammography screening guidelines remains unclear. We sought to determine the effect of feeling limited by emotional disorders on adherence to mammographic screening guidelines. Data from the 2018 National Health Interview Survey were used to evaluate whether women aged 50-74 who felt limited in some way by an emotional issue (EI; defined as depression, anxiety, or another emotional problem) were less likely to report having had a mammogram within the past two years than those who reported no such limitation. Of the 5815 women surveyed, 3.25% stated that they were limited in some way by EI. These women were significantly less likely to report having had a mammogram within the past two years compared to those without EI (68.28% vs. 79.36%, p = 0.002). Controlling for sociodemographic factors, EI no longer predicted worse mammography screening adherence (OR = 0.78; 95% CI: 0.54-1.12, p = 0.182). Rather, family income relative to poverty level, health insurance coverage, and having a usual place of healthcare were independent predictors of adherence to screening mammography guidelines. Women who feel limited by an EI tend to have lower mammography screening rates than those without such limitations; however, this isdriven primarily by socioeconomic factors such as income, insurance status, and access to healthcare.

Emerging From Behind the Workstation.

Emerging From Behind the Workstation.

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

ASO Visual Abstract: A Single Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients

The association between rurality, sociodemographic characteristics, and mammogram screening outcomes among a sample of low-income uninsured women

Studies have found a positive association between adherence to mammography screening guidelines and early detection of breast cancer lesions, yet the proportion of women who get screened for breast cancer remains below national targets. Previous studies have found that mammography screening rates vary by sociodemographic factors including race/ethnicity, income, education, and rurality. It is less known whether sociodemographic factors are also related to mammography screening outcomes in underserved populations. Thus, with a particular interest in rurality, we examined the association between the sociodemographic characteristics and mammography screening outcomes within our sample of 1,419 low-income, uninsured Texas women who received grant-funded mammograms between 2013 and 2019 (n = 1,419). Screening outcomes were recorded as either negative (Breast Imaging Reporting and Data System (BI-RADS) classification 1–3) or positive (BI-RADS classification 4–6). When we conducted independency tests between sociodemographic characteristics (age, race/ethnicity, rurality, county-level risk, family history, and screening compliance) and screening outcomes, we found that none of the factors were significantly associated with mammogram screening outcomes. Similarly, when we regressed screening outcomes on age, race/ethnicity, and rurality via logistic regression, we found that none were significant predictors of a positive screening outcome. Though we did not find evidence of a relationship between rurality and mammography screening outcomes, research suggests that among women who do screen positive for breast cancer, rural women are more likely to present with later stage breast cancer than urban women. Thus, it remains important to continue to increase breast cancer education and access to routine cancer screening for rural women.

A Single-Center Study of Adherence to Breast Cancer Screening Mammography Guidelines by Transgender and Non-Binary Patients.

Adherence to screening guidelines among transgender and non-binary (TGNB) populations is not well studied. This study examines breast cancer screening patterns among TGNB patients at an urban academic medical center. Demographic information, risk factors, and screening mammography were collected. Mammography rates were calculated in populations of interest according to national guidelines, and mammogram person-years were also calculated. Univariate and multivariate logistic regression was performed. Overall, 253 patients were analyzed: 193 transgender women and non-binary people designated male at birth (TGNB DMAB) and 60 transgender men and non-binary people designated female at birth (TGNB DFAB). The median (interquartile range) age was 53.2years (42.3-62.6). Most patients had no family history of breast cancer (n=163, 64.4%) and were on hormone therapy (n=191, 75.5%). Most patients where White (n=164, 64.8%), employed (n=113, 44.7%), and had public insurance (n=128, 50.6%). TGNB DFAB breast screening rates were low, ranging from 2.0 to 50.0%, as were TGNB DMAB screening rates, ranging from 7.1 to 47.6%. The screening rates among the TGNB DFAB and TGNB DMAB groups did not significantly differ from one another. Among TGNB DFAB patients, univariate analyses showed no significant predictors for mammography. Among TGNB DMAB patients, not being on hormone therapy resulted in fewer odds of undergoing mammography. There were no significant findings on multivariate analyses. Mammography rates in the TGNB population are lower than institutional and national rates for cisgender patients, which are 77.3% and 66.7-78.4%, respectively. Stage of transition, organs present, hormone therapy, and risk factors should be considered to guide screening.

Identifying Equitable Screening Mammography Strategies for Black Women in the United States Using Simulation Modeling.

Screening mammography guidelines do not explicitly consider racial differences in breast cancer epidemiology, treatment, and survival. To compare tradeoffs of screening strategies in Black women versus White women under current guidelines. An established model from the Cancer Intervention and Surveillance Modeling Network simulated screening outcomes using race-specific inputs for subtype distribution; breast density; mammography performance; age-, stage-, and subtype-specific treatment effects; and non-breast cancer mortality. United States. A 1980 U.S. birth cohort of Black and White women. Screening strategies until age 74 years with varying initiation ages and intervals. Outcomes included benefits (life-years gained [LYG], breast cancer deaths averted, and mortality reduction), harms (mammographies, false positives, and overdiagnoses), and benefit-harm ratios (tradeoffs) by race. Efficiency (benefits per unit resource), mortality disparity reduction, and equity in tradeoffs were evaluated. Equitable strategies for Black women were defined as those with tradeoffs closest to benchmark values for screening White women biennially from ages 50 to 74 years. Biennial screening from ages 45 to 74 years was most efficient for Black women, whereas biennial screening from ages 40 to 74 years was most equitable. Initiating screening 10 years earlier in Black versus White women reduced Black-White mortality disparities by 57% with similar LYG per mammogram for both populations. Selection of the most equitable strategy was sensitive to assumptions about disparities in real-world treatment effectiveness: The less effective treatment was for Black women, the more intensively Black women could be screened before tradeoffs fell short of those experienced by White women. Single model. Initiating biennial screening in Black women at age 40 years reduces breast cancer mortality disparities and yields benefit-harm ratios that are similar to tradeoffs of White women screened biennially from ages 50 to 74 years. National Cancer Institute at the National Institutes of Health.

Improving physician compliance with mammography screening by implementing a breast cancer screening guideline at a hospital in Bahrain

BackgroundFrom a health and safety perspective, it is critical to use adequate, evidence-based breast screening guidelines. The aim of this quality improvement project was to improve physicians’ compliance with breast...

Differential effects of the 2015 American Cancer Society guidelines on screening mammography exams based on socioeconomic status.

10539 Background: Guidelines for screening mammography have changed several times since initiation of regular screening mammography in the 1970’s. Most recently, in 2015, the American Cancer Society (ACS) revised their screening guidelines, recommending that a patient discuss screening mammography with her primary care doctor (PCP) between the ages of 40-44 and should begin yearly screening at age 45; after age 54, ACS recommended screening every other year. Prior to this, from 2003-2015, ACS had recommended screening mammography every year beginning at the age of 40. We hypothesized that these guidelines were adopted to varying degrees in different patient populations and may have disproportionately reduced screening mammography utilization in socioeconomically disadvantaged populations. Methods: Here, we analyzed monthly screening mammography rates over time in two large New York City hospitals, one in a socioeconomically advantaged area and the other in a socioeconomically disadvantaged area. Using our radiology records query system, we searched for monthly screening mammography numbers for women by decade from 2012 to 2018. We performed statistical analysis to evaluate changes in number of exams over time. Student’s t-tests were used to evaluate for significant differences. Results: In both groups of 40-49 year old patients, monthly mammograms increased from 2012-2016. In the socioeconomically advantaged group, this increase continued until 2018 resulting in an overall 400% increase in screening mammograms over time. The change in ACS screening guidelines had no effect on the rate of screening mammography in this group. Conversely, after the revision of the ACS guidelines in 2015, there was a marked decline in screening mammography in the 40-49 year old group in the socioeconomically disadvantaged population. By 2018, there was a statistically significant difference in women screened in all age groups (40-49, p<.0001; 50-59, p<.0001; 60-69, p<.01; 70-79, p<.0001; 80+, p<.0001) between these two patient populations. Conclusions: These data suggest that implementation of the 2015 ACS screening guidelines had a disproportionate effect on patients from socioeconomically disadvantaged areas and that these effects have led to significant disparities in screening mammography trends over time. We postulate that lower levels of health literacy may have contributed to misunderstanding of the screening guidelines. More research is needed to elucidate the underlying etiology of these disparities and ensure that women from all socioeconomic backgrounds receive appropriate screening mammography. Over time, this may result in disproportionate breast cancer morbidity and mortality in populations not receiving appropriate screening.

Call to action: breast cancer screening recommendations for Black women.

African-American/Black women have more aggressive breast cancer subtypes, are diagnosed at younger ages, and have an increasing incidence rate. These disparities have resulted in Black women continuing to experience the highest mortality rate from breast cancer of any US racial or ethnic group. However, national screening mammography guidelines do not reflect the high-risk status of Black women. Here we review breast cancer screening guidelines and address the lack of inclusion of the specific needs of Black women. In order to equitably care for the health needs of Black women, high-risk designation would improve access to earlier screening and supplemental imaging including breast MRI.

The Impact of Mammography Screening Guideline Changes in a Universally Insured Population.

Background: The U.S. Preventive Services Task Force (USPSTF) modified breast cancer screening guidelines in November 2009. The impact has been studied among privately and Medicare insured populations, but not among universally insured women. Materials and Methods: This study compared the proportion of TRICARE beneficiaries aged 40-64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis to determine the impact of the 2009 USPSTF guideline changes. Stratified analyses evaluated differences by age (ages 40-49, 50-64), race, care setting, beneficiary type, and military status. Results: The proportion of women receiving mammograms increased from October 2005 through September 2009. A small, but significant decrease of 65-66 fewer women screened per 10,000 occurred in the first quarter of 2010 (October 1 to December 31) following the screening guideline update publication. The proportion screened then remained unchanged through 2015. Comparative analysis revealed no differences in impact between age groups, blacks and whites, or military dependents and active-duty/retirees. Conclusions: This study determined that the USPSTF guideline updates had a small, but immediate and lasting impact that was not different across age groups, beneficiary type, or race. No racial disparities in the proportion screened or in the impact of the guideline change were noted in our universally insured population.

Abstract PS8-35: Use of a web-based decision aid to promote chemoprevention uptake among racially/ethnically diverse women at high-risk for developing breast cancer: A qualitative study

Abstract Background: Chemopreventive agents such as selective estrogen receptor modulators (SERMs; tamoxifen and raloxifene) and aromatase inhibitors (AIs; exemestane and anastrozole) have proven efficacy in reducing breast cancer risk by 41%-79% in high risk women. Women at high risk of developing breast cancer face the complex decision of whether to take SERMs or AIs for breast cancer chemoprevention. Underserved racial/ethnic minority women are less likely to take chemoprevention, contributing to higher rates of advanced tumors, and poorer clinical outcomes compared to non-Hispanic whites, which could exacerbate health disparities. RealRisks is a patient-centered web-based decision aid (DA) that was designed to promote understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision-making about taking chemoprevention. We aimed to understand perceptions of women at high-risk for developing breast cancer regarding their use of RealRisks. Methods: We completed enrollment to a randomized controlled trial (RCT) among 300 racially/ethnically diverse high-risk women assigned to standard educational materials alone or in combination with RealRisks, with the primary endpoint of chemoprevention uptake at 6 months. We conducted a qualitative study using semi-structured interviews with a subset of 27 high-risk women enrolled in the intervention arm of the RCT to understand how they interact with the DA. All interviews were audio-recorded, transcribed verbatim, and compared against the digital recordings to ensure accuracy of the content. Content analysis was used as a method to analyze the data and to generate themes. Results: The mean age of the participants was 60.9 years (SD, 10.3). Our sample was racially and ethnically diverse with 59.3% non-Hispanic white, 18.5% non-Hispanic black, 14.8% Hispanic/Latina, and 3.7% Asian. Most participants had a family history of breast cancer (70.4%) and most (78%) reported using RealRisks after being granted access to the DA. Three overarching themes emerged from the qualitative analyses: (1) acceptability of the intervention, (2) usability of the intervention, (3) and information needs. RealRisks was found to be acceptable among the women who used the DA (n=21/27). Most women (n=18/21) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and informed their decision-making about whether or not taking chemoprevention was the right choice for them (n=17/21). Most women reported that RealRisks was easy to navigate, user-friendly, and easily accessible online. Alternatively, a subset of women (n=9/21) shared challenges with using the DA, as they wanted more tailoring based on user characteristics; felt that the DA was specifically targeting multi-ethnic populations that did not reflect them; used difficult terminology; and had a strong emphasis on chemoprevention drugs. Participants offered recommendations for improving the DA and shared their information needs, which mainly focused on wanting to learn about guidelines for mammography screening and lifestyle modification. Conclusions: With this qualitative study, we demonstrated the acceptability of the RealRisks web-based DA among diverse high-risk women with a few caveats and recommendations for improvement. These results emphasize the need for more tailoring of the DA based on user characteristics and a holistic approach to reducing breast cancer risk, to include information on breast cancer screening, as well as lifestyle risk factors. Next steps include incorporating feedback from this study to further enhance the DA and to optimize the modular architecture within RealRisks to include additional modules to meet the needs of diverse high-risk women. Citation Format: Ashlee Guzman, Thomas Silverman, Jennie Mata, Rita Kukafka, Katherine D Crew, Tarsha Jones. Use of a web-based decision aid to promote chemoprevention uptake among racially/ethnically diverse women at high-risk for developing breast cancer: A qualitative study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-35.

The Impact of Mammography Screening Guideline Changes Among Women Serving in the U.S. Military.

The U.S. Preventive Services Task Force (USPSTF) modified their screening guidelines for breast cancer in November 2009. Previous studies evaluated the impact of these guideline changes among privately and Medicare insured populations. Women in the military form a unique population exposed to many social, environmental, and occupational hazards that may increase breast cancer incidence. By evaluating mammography screening rates among women in the military before and after the USPSTF guideline changes, this study evaluated the impact of the USPSTF breast cancer guideline change on screening mammography use within the military population and determined whether current guidelines were followed for this high-risk population with universal health care access. This study evaluated the impact of the 2009 guideline changes among the population of universally insured military servicewomen, comparing the proportion of active duty women aged 40 to 64 receiving mammograms from fiscal years 2006 to 2015 using an interrupted time series analysis. Stratified analyses evaluated differences by age (aged 40-49, 50-64), race, military branch, and rank. This research is considered exempt by the Uniformed Services University Institutional Review Board. The proportion of insured military servicewomen receiving mammograms increased from October 2005 through September 2009. A significant decrease occurred in the first quarter of 2010 following the publication of the screening guideline update. From this new baseline, the proportion of women screened increased again through September 2015. Comparative analyses showed more pronounced effects both immediately and over time among the women aged 50 to 64 compared to those aged 40 to 49years and among older enlisted women compared with their officer counterparts. The patterns were near identical in all subgroups; however, no changes in rate were evident among Air Force and black servicewomen aged 50 to 64 and Army and Navy/Marine Corps servicewomen aged 40 to 49years. No racial disparities in screening or impact were noted. The USPSTF guidelines had differential impacts among some subpopulations. While older women, aged 50 to 64years, had a greater temporary reduction immediately after the guideline change, younger women aged 40 to 49years had a longer-term reduction in screening following the guideline changes. No racial disparities in the proportion screened or in the impact of the guideline change were noted in this population with universal health coverage. The lack of Department of Defense standard breast cancer screening guidelines was evident from the different patterns of mammography utilization observed among military branches. To completely understand the impact of the updated screening guidelines, future studies must incorporate research focusing on changes in breast cancer morbidity and mortality as well as updated cost-benefit analyses.

Abstract PO-240: The effect of emotional disorders on adherence to mammography screening guidelines

Abstract INTRODUCTION: Approximately 18 million adults in the US experience a major depressive episode and 48 million report having some anxiety disorder each year. While some studies have found having an emotional disorder to be correlated with lower rates of screening mammography, this is not a consistent finding. We sought to determine whether women who felt limited by such disorders had lower mammography guideline compliance rates compared to women who did not, in a population-based study. METHODS: The National Health Interview Survey is a population-based survey administered annually by the Centers for Disease Control and is designed to be representative of the entire US civilian non-institutionalized population. We defined “emotional disorders” (EMD) as occurring in individuals who felt that they were limited in some way by depression, anxiety or another emotional problem. Women between the ages of 50 and 74, with and without EMD, were compared in terms of their adherence to screening guidelines, defined as having had a mammogram within the past two years, controlling for sociodemographic factors. RESULTS: In 2018, of the 5815 women surveyed who met our inclusion criteria (representing 48,522,391 women in the population), 3.25% stated that they were limited in some way by emotional issues. Of these, 68.28% stated they had a mammogram within the past two years; compared to 79.36% of women without EMD (p=0.002). Compared to those with no EMD, women with EMD tended to have lower education levels (less than grade 12: 19.51% vs 11.22%, p<0.001), lower family income (above four times the poverty threshold: 15.31% vs 44.74%, p<0.001) and less private insurance coverage (16.48% vs 55.93%, p<0.001). However, those with EMD were more likely to report having a usual place to go when sick than those without EMD (90.65% vs. 86.23%, p=0.003). Compliance with mammography screening was similarly influenced by these factors (p<0.001 for all). Controlling for these potential confounders, we found that EMD was no longer a significant predictor of mammography screening adherence (OR=0.77; 95% CI: 0.48-1.22, p=0.131). Rather, having a family income four times the poverty line or greater (OR=1.75; 95% CI: 1.29-2.37, p=0.001), having a usual place of healthcare (OR=2.67; 95% CI: 1.92-3.71, p<0.001), and insurance coverage (OR=1.65; 95% CI: 1.17-2.35, p=0.005 for governmental insurance, and OR=1.74; 95% CI: 1.21-2.51, p=0.003 for private insurance, vs. uninsured) were significant independent predictors of adherence to screening mammography guidelines. CONCLUSION: While EMD is correlated with lower mammography screening rates, adherence to screening mammography guidelines are driven primarily by socioeconomic factors such as income, insurance status, and access to healthcare. There is a need for policy level changes that target these modifiable issues for those who are medically underserved, including those with EMD who are more likely to have a family income that is below the poverty line. Citation Format: Idil Yazgan, Anees Chagpar. The effect of emotional disorders on adherence to mammography screening guidelines [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-240.

Adherence to Mammography and Pap Screening Guidelines Among Medically Underserved Women: the Role of Family Structures and Network-Level Behaviors.

Poor adherence to screening recommendations is an important contributing factor to disparities in breast and cervical cancer outcomes among women in the USA. Screening behaviors are multifactorial, but there has been limited focus on how family network beliefs and behaviors influence individual's likelihood to complete screening. This research aims to fill this gap by evaluating the role of family network composition and screening behaviors on women's likelihood to adhere to mammogram and pap screening recommendations. We used an ego network approach to analyze data from 137 families and their networks. Primary outcomes were whether an individual had received a mammogram in the past year and whether she had received a pap screening in the past 3 years. Network-level predictors included network composition (size of network, average age of network members, satisfaction with family communication) and network screening behaviors. We conducted multivariable logistic regressions to assess the influence of network-level variables on both mammogram and pap smears, adjusting for potential individual-level confounders. Each network had an average age of 47.9 years, and an average size of 3.05 women, with the majority of members being sisters (57.7%). We found differences in network screening behaviors by race, with Arab networks being less likely to have completed self-breast exams (OR = 0.21, 95%CI = 0.05-0.76, p = 0.02), ever a gotten pap screen (OR = 0.11, 95%CI = 0.01-0.85, p = 0.04), and gotten pap screening in the last 3 years (OR = 0.31, 95%CI = 0.10-0.99, p = 0.04) compared with African American networks. Network screening behaviors also strongly influenced the likelihood of an individual completing a similar screening behavior. This analysis sheds light on family network characteristics that influence screening behaviors among medically underserved women. These findings support the development and dissemination of screening interventions among female's family networks.

Use of a Paper Checklist to Increase Clinician Adherence to Mammography Screening Guidelines

ObjectiveTo increase clinician adherence to mammography screening guidelines. DesignQuality improvement initiative. Setting/Local ProblemAt a nurse practitioner–led primary care practice, a chart audit of adherence to American Cancer Society mammography screening guidelines indicated a 12% adherence rate for clinicians writing mammography orders. ParticipantsNurse practitioners providing care to women ages 40 years and older. Intervention/MeasurementsThe intervention was a screening checklist that was completed by the woman at registration and given to the clinician during the examination. The pre- and postintervention measurement was the percentage of mammogram orders. A Fisher exact test was used to examine changes from pre- to postintervention rates of adherence. ResultsAfter the intervention, the percentage of women for whom a mammogram was recommended and ordered was 69.6%, compared to 12% from the original chart audit. This change was statistically significant (p = .01). ConclusionClinicians must find efficient approaches to improve processes within their practice settings to ensure that preventive care recommendations are made during visits. Although the screening checklist was deemed useful, improvement in adherence rates is still needed, and a paperless system should be initiated.