Mammography Utilization Research Articles

Housing-related disparities in receipt of breast cancer screening among Medicaid beneficiaries.

76 Background: People experiencing or at risk of homelessness (PEH) are often diagnosed with advanced breast cancer, suggesting barriers to preventive care and screening. However, there is limited data that examine screening among PEH, undermining efforts to characterize and address potential disparities in screening. To address this gap, we investigated housing-related disparities in receipt of breast cancer screening in Medicaid, which disproportionately serves low-income PEH. Methods: We used a novel linkage of Pennsylvania Medicaid data with encounter-level data on housing-related services (Housing Management Information System; HMIS) from 2011 to 2017. We compared rates of biennial mammography between a cohort of Medicaid women receiving housing-related services in HMIS (i.e., a proxy for experience/risk of homelessness) and randomly sampled comparison beneficiaries without any housing services use. We estimated both unadjusted and adjusted disparities in receipt of biennial mammography (controlled for county and year fixed effects, demographic and Medicaid eligibility characteristics, and baseline healthcare utilization and comorbidities). We also examined heterogeneity in disparities by beneficiaries in the following HMIS subgroups: 1) receiving supportive housing, 2) experiencing chronic homelessness (i.e., 12+ months of homelessness), and 3) unstably housed (housed but receiving homelessness prevention services). Results: We identified 1,792 Medicaid beneficiaries with an HMIS encounter and 71,664 comparison beneficiaries. Those in the HMIS cohort were more likely to be younger, non-Hispanic Black, eligible for Medicaid due to disability, and have a higher number of inpatient visits and comorbidities. The unadjusted proportion receiving mammogram was 44.8% and 50.1% in the HMIS vs. comparison cohort, with an overall disparity of 5.3 percentage-points (pp, P <.001). This disparity estimate remained was robust to adjusting for covariates (-4.3 pp; P < .001). We found the largest adjusted disparity when comparing beneficiaries experiencing chronic homelessness (-8.5 pp; P = .038) relative to the comparison cohort. In contrast, the disparity was smaller among women receiving supportive housing (-3.7 pp; P = .098) and unstably housed women (-3.3 pp; P = .071). Conclusions: There was a significant disparity in the utilization of mammography among women PEH, especially those who experience chronic homelessness, in Pennsylvania Medicaid. Our finding illuminates the health consequences of housing insecurity and underscore a need for programs providing adequate housing, such as supportive housing, to address disparities in screening. In the meantime, greater efforts should be dedicated to improving the uptake of screening among at-risk populations at the point of contact with the healthcare system (e.g. when PEH engage with care).

Mammography and Breast Ultrasonography Services in Ghana, Availability, and Geographic Access.

Breast cancer is the leading type of cancer diagnosed and the second leading cause of cancer-related death in Ghana. Mammography and ultrasound have proven benefits in the early detection of breast cancer. This study evaluates mammography, breast ultrasound, and radiology work force availability throughout Ghana. A survey was administered to all hospitals in Ghana from November 2020 to October 2021. Mammography, breast ultrasound services, and the number of radiologists were assessed. For mammography, the number performed per month, cost incurred by the patient, where images were read, and how long it took to receive reports were also assessed. Health Facilities Regulatory Authority records on diagnostic centers were obtained to identify additional in-country breast imaging services. Three hundred and twenty-eight of 346 hospitals participated in the survey (95%). Only 21 hospitals reported on-site mammography. One hospital reported performing >100 mammographies per month. The average cost to the patient ranged from 100 to 500 Cedis ($17-87 US dollars [USD]), although three hospitals performed mammography at no cost. An additional 10 mammography machines were identified at diagnostic centers throughout the country, with 41.3% of the female population living within 1 hour of mammography services. There were 135 hospital-based breast ultrasound services identified with 69.5% of the female population living within 1 hour of these services. There were an additional 190 ultrasound machines at diagnostic centers. There were 96 in-country radiologists identified. Although there is limited availability and utilization of mammography in Ghana, there is more readily available ultrasonography. A focus on increasing breast cancer early diagnostic capabilities with breast ultrasound should be prioritized in addition to further expansion of the radiology workforce.

Associations Between Perceived Discrimination, Screening Mammography, and Breast Cancer Stage at Diagnosis: A Prospective Cohort Analysis

BackgroundDespite higher breast cancer screening rates, black women still are more likely to have late-stage disease diagnosed. This disparity is influenced in part by structural and interpersonal racism. This prospective study sought to determine how interpersonal factors, including perceived discrimination, influence screening and stage of disease at diagnosis.MethodsA prospective cohort study analyzed adult women with stages I to IV breast cancer from the Miami Breast Cancer Disparities Study. Perceived discrimination and mistrust of providers were assessed using previously validated questionnaires. Multivariable logistic regression was used to evaluate the odds of screening mammography utilization and late-stage breast cancer at diagnosis.ResultsThe study enrolled 342 patients (54.4 % Hispanic, 15.8 % white, and 17.3 % black). Multivariate regression, after control for both individual- and neighborhood-level factors, showed that a higher level of perceived discrimination was associated with greater odds of late-stage disease (adjusted odds ratio [aOR], 1.06; range, 1.01–1.12); p = 0.022) and lower odds of screening mammography (aOR, 0.96; range, 0.92–0.99; p = 0.046). A higher level of perceived discrimination also was negatively correlated with multiple measures of provider trust.DiscussionThis study identified that high perceived level of discrimination is associated with decreased odds of ever having a screening mammogram and increased odds of late-stage disease. Efforts are needed to reach women who experience perceived discrimination and to improve the patient–provider trust relationship because these may be modifiable risk factors for barriers to screening and late-stage disease presentation, which ultimately have an impact on breast cancer survival.

A Comparative Analysis of Mammography Uptake between Migrant and Non-Migrant Women in Austria-Results of the Austrian Health Interview Survey.

Mammography can reduce breast cancer incidence and mortality. Studies on the utilization of mammography among migrant and non-migrant women are inconsistent. Many of these studies do not take the heterogeneity of migrants in terms of ethnicity and country of origin into account. The aim of the present study was to examine disparities in the use of mammography between non-migrant women and the five largest migrant groups in Austria. The study used data from a nationwide population-based survey of 5118 women aged 45 years and older and analyzed the participation in mammography as a dependent variable. Multivariable logistic regression was used to compare mammography uptake between the aforementioned groups of women, while adjusting for socioeconomic and health variables. The study shows that all migrant groups involved tended to use mammography less frequently than non-migrant women; statistically significant differences, however, were only observed for Hungarian migrant women (adjusted OR = 0.36; 95%-CI: 0.13, 0.95; p = 0.038) and women from a Yugoslavian successor state (adjusted OR = 0.55; 95%-CI: 0.31, 0.99; p = 0.044). These findings are consistent with other studies in Europe and beyond, highlighting the heterogeneity of migrant populations and emphasizing the need for a diversity-sensitive approach to health care.

National and state models for relationships between social vulnerability and mammography rates.

1573 Background: Health disparities arise from the confluence of medical and non-medical factors that affect measures of prevention, treatment, and outcomes. One crucial preventative measure is mammography rate. Neighborhood-level analysis using tools such as the CDC’s Social Vulnerability Index (SVI) may identify correlates of disparity in mammography access and utilization. Such investigation may reveal drivers of disparity in communities with lower screening. Methods: Self-reported mammography rates among women aged 50-74 were obtained from the CDC’s 2018 PLACES dataset at the Census Tract level and merged with the CDC’s 2018 SVI release. Data were available for 72,075 Census Tracts across all states and Washington, D.C. National univariate and multivariate regressions were performed between mammography rates and percentiles for SVI percentiles. State-specific multivariate regressions were performed for each state's Census Tracts. Results: In the national analysis, significant correlations with non-negligible effect size (correlation coefficient > 0.20 or < -0.20) were found between mammography rate and the following: Theme 2 - Household Composition & Disability (R = -0.22, p < 0.0001), Mobile Homes (R = -0.36, p < 0.0001), Civilians with a Disability (R = -0.24, p < 0.0001), and Minority Status (R = 0.25, p < 0.0001). The national multivariate model achieved Multiple R of 0.54 and Significance F < 0.001. The variables with the most negative associations (lower mammography rates with increased vulnerability) were Income (coefficient = -4.05, p < 0.001) and Speaks English Less than Well (coefficient = -2.33, p < 0.001). Across the state multivariate models, mean Multiple R was 0.70 (95% CI 0.67-0.73), with Significance F < 0.05 in all states (Table). The variables with the most negative mean coefficients across models were Income (-3.20) and No High School Diploma (-2.98); the most positive was Minority status (6.11). Conclusions: Neighborhood-level social determinants correlate meaningfully with mammography rates. Although lower income, limited English proficiency, and lower educational attainment are most strongly associated with lower mammography, the effect sizes vary across geographies, and additional factors have meaningful influence in certain states. The stronger performance of most state-specific models than the national model reinforces this finding. It demonstrates the need for further analysis at the level of state and within narrower geographies. Ultimately, targeted interventions should address those disparities that are most relevant to specific neighborhoods. [Table: see text]

Abstract PO5-20-05: The FOR ME (Fostering Opportunities in Research through Messaging and Education) study: Using multiple qualitative methods to develop a culturally sensitive narrative intervention to promote equity in clinical trials

Abstract Background: Black women are more likely to present with advanced stage disease and to die following a breast cancer (BC) diagnosis compared to women from other racial/ethnic groups. In 2020, only 7.2% of enrollees in clinical trials that led to the approval of 3 novel drugs for breast cancer were Black. While there are many contributing factors to this inequity (i.e., tumor biology, social and structural health determinants, racial injustice, and differential access to and utilization of high-quality mammography, diagnostics, and therapies), persistent underrepresentation of Black patients in cancer clinical trials (CTs) slows scientific advancements. Objective: The aim of this study is to develop, optimize, and test a narrative decision aid intervention (web-based video) for Black women diagnosed with BC to promote shared decision making and CT participation. The first aim is to conduct multiple qualitative methods with multi-level stakeholders to identify barriers, facilitators, and intervention priorities that would assist Black breast cancer patients to make informed decisions about participating in clinical trials. The second aim is to create a culturally sensitive, narrative intervention designed to support decision making and motivate Black breast cancer patients to participate in clinical trials. Aim 3 will then pilot a study to determine acceptability of the intervention among patients and assess whether it increases clinical trial participation in a safety net oncology practice. Methods: Guided by community-based participatory research approaches, we used multiple qualitative methods (key informant interviews (KIIs) and story circles) to identify barriers and facilitators that support decision-making and CT participation. The KIIs, completed in-person, via phone, or video conferencing, were recorded and professionally transcribed. The research team used thematic analysis and inductive coding approaches. Next, interviews and focus groups will invite feedback on the educational/motivational content of the intervention and will be used to develop a culturally sensitive script and story boards. A video production company will produce the narrative intervention. Finally, focus groups and interviews with participant cohorts will provide feedback on the completed intervention. Black women diagnosed with BC will view the intervention in an oncology clinic. Using a pretest/posttest design, we will analyze the acceptability of the intervention and its effect on intention to participate in clinical trials. We will then conduct a quasi-experimental study in a safety net oncology practice to determine whether the rate of clinical trial participation among Black breast cancer patients increases following implementation of the intervention as a standard component of new patient education. Progress: Recruitment started in July 2022 and currently 30 of 30 interviews with patients are completed, 20 of 20 interviews with clinical stakeholders (oncologists and clinical trial staff) are completed, and 14 of 20 interviews with advocates and community partners are completed. Data collection and the analysis of the interviews and story circles is ongoing. Citation Format: Neha Hippalgaonkar, Ryan Nguyen, Leslie Carnahan, Vida Henderson, Tigist Mersha, Eliza Cohn, Kauthar Salum, Ana Williams, Lolita Coleman, Beulah Brent, AnneMarie Murphy, Paris Thomas, Paramjeet Khosla, Kent Hoskins. The FOR ME (Fostering Opportunities in Research through Messaging and Education) study: Using multiple qualitative methods to develop a culturally sensitive narrative intervention to promote equity in clinical trials [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-05.

Abstract 3474: Racial disparities in receipt of surveillance mammography after breast cancer diagnosis

Abstract Background: The 5-year survival rate for breast cancer (BC) stands at an estimated 91%, with approximately 3.8 million BC survivors in the U.S. This large population of breast cancer survivors remains at risk of loco-regional recurrence, with variations noted across racial groups. White survivors face a locoregional breast cancer recurrence rate of 1.8%, whereas Black, Asian, and Hispanic survivors experience higher rates of 3.9%, 3.6%, and 3.1%, respectively. Notably, Black BC survivors with recurrent breast cancer exhibit a median survival time of 1.8 years compared with 3.6 years observed for White BC survivors. Current recommendations from the U.S. Preventative Services Task Force and the American College of Radiology advocate for surveillance through annual mammography and routine clinical visits following breast-conserving surgery and lumpectomies. However, there are gaps in the data available regarding disparities in the utilization of surveillance mammography by race/ethnicity. Thus, the goal of this study is to estimate race/ethnic disparities in surveillance mammography utilization and its impact on survival among breast cancer survivors at a large comprehensive cancer center. Methods: A retrospective cohort study of female breast cancer survivors ≥19 years diagnosed and/or treated at the Duke Cancer Institute (DCI) between 2014 and 2022 was conducted. Data was abstracted on patient socio-demographics, cancer type (invasive ductal and ductal in situ carcinomas) and utilization of surveillance mammography within 2-5 years post initial breast cancer diagnosis. Chi-squared testing will be used to analyze rates of mammography surveillance receipt among different races presenting with BC at DCI. Kaplan-Meier estimates will be used for analysis on survival. Results: A total of 10,904 women with a mean age of 43.7 years were included in the study. The study cohort is comprised of 69% non-Hispanic (NH) White, 24% NH Black, 2.2% Hispanic, 0.5% NH Native American, 1% NH other, and 3.2% NH Asian women. There were 1,791 cases of ductal in situ carcinomas and 9,113 invasive ductal carcinoma cases. NH Black women had the lowest 5-year relative survival rate (81.5%) of all represented racial groups: NH White 89.1%, Hispanic 95.3%, NH Native 87.8%, Asian 97.9%, and NH Other 88.0%. Ongoing analysis will be completed to estimate disparities in the use of post-treatment surveillance mammography amongst breast cancer survivors. Conclusions: This study will inform efforts to increase post-treatment surveillance and improve adherence to survivorship guidelines with the ultimate goal of reducing mortality disparities among breast cancer survivors. Citation Format: Jasmine G. Wilkerson, Frances Wang, Yadurshini Raveendran, Tomi Akinyemiju. Racial disparities in receipt of surveillance mammography after breast cancer diagnosis [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2024; Part 1 (Regular Abstracts); 2024 Apr 5-10; San Diego, CA. Philadelphia (PA): AACR; Cancer Res 2024;84(6_Suppl):Abstract nr 3474.

Examining the impact of COVID-19 disruptions on population-based breast cancer screening in Ireland.

Many population-based breast screening programmes temporarily suspended routine screening following the COVID-19 pandemic onset. This study aimed to describe screening mammography utilisation and the pattern of screen-detected breast cancer diagnoses following COVID-19-related screening disruptions in Ireland. Using anonymous aggregate data from women invited for routine screening, three time periods were examined: (1) January-December 2019, (2) January-December 2020, and (3) January-December 2021. Descriptive statistics were conducted and comparisons between groups were performed using chi-square tests. In 2020, screening mammography capacity fell by 67.1% compared to 2019; recovering to 75% of mammograms performed in 2019, during 2021. Compared to 2019, for screen-detected invasive breast cancers, a reduction in Grade 1 (14.2% vs. 17.2%) and Grade 2 tumours (53.4% vs. 58.0%) and an increase in Grade 3 tumours (32.4% vs. 24.8%) was observed in 2020 (p = 0.03); whereas an increase in Grade 2 tumours (63.3% vs. 58.0%) and a reduction in Grade 3 tumours (19.6% vs. 24.8%) was found in 2021 (p = 0.02). No changes in oestrogen receptor-positive or nodal-positive diagnoses were observed; however the proportion of oestrogen/progesterone receptor-positive breast cancers significantly increased in 2020 (76.2%; p < 0.01) and 2021 (78.7%; p < 0.001) compared to 2019 (67.8%). These findings demonstrate signs of a grade change for screen-detected invasive breast cancers early in the pandemic, with recovery evident in 2021, and without an increase in nodal positivity. Future studies are needed to determine the COVID-19 impact on long-term breast cancer outcomes including mortality.

Unmet Social Needs and Breast Cancer Screening Utilization and Stage at Presentation

Unmet social needs in local populations may hinder the development of targeted cancer control interventions aimed at improving screening utilization and early-stage breast cancer diagnosis to ultimately improve breast cancer survival disparities. To evaluate if (1) city-funded screening mammography is associated with utilization of screening mammography, (2) unmet social needs are associated with utilization of screening mammography, and (3) unmet social needs are associated with later-stage disease at diagnosis. This cohort study included patients with stages I-IV invasive ductal or lobular carcinoma treated at an academic medical center (including both an underserved safety-net hospital [SNH] and a National Cancer Institute-designated academic cancer center [ACC]) from 2020 to 2023. Eligible patients were aged 18 years or older and able to consent. Data were analyzed between July 2023 and September 2023. The Health Leads Social Needs Screening Toolkit, a screening tool that gathers information on the most common social need domains affecting patient health. Univariable and multivariable logistic regression was utilized to evaluate the following primary outcomes: (1) routine screening mammography and (2) American Joint Committee on Cancer 8th edition clinical stage at presentation. Of the 322 women who completed the Health Leads Social Needs Screening Toolkit, 201 (62%) self-identified as Hispanic, 63 (19%) as non-Hispanic Black, and 63 (19%) as non-Hispanic White. Two hundred fifty-five (76%) patients with access to city-funded screening mammography completed a screening mammogram. Patients who presented to the SNH were more likely to present with late-stage disease compared with early-stage disease (15 of 48 [31%] vs 50 of 274 [18%]; P = .04). On multivariable logistic regression, not completing a screening mammography was associated with having an increasing number of unmet social needs (OR, 0.74; 95% CI, 0.55-0.99; P = .047) and an increasing age at diagnosis (OR, 0.92; 95% CI, 0.89-0.96; P < .001). Moreover, increasing unmet social needs was significantly associated with late-stage diagnosis above and beyond screening mammography (OR, 1.38; 95% CI, 1.01-1.89; P = .04). In this cohort study, access to screening mammography did not translate to utilization of screening mammography, increasing unmet social needs were significantly associated with lower rates of screening mammography, and those with increasing unmet social needs were more likely to present with late-stage disease. This association transcended recruitment site (SNH vs ACC), indicating that patients in either hospital setting may benefit from unmet social needs screening to overcome access to care barriers associated with late-stage disease at diagnosis.

Abstract A060: “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer

Abstract Background: Black women are more likely to present with advanced stage disease and to die following a breast cancer (BC) diagnosis compared to women from other racial/ethnic groups. While there are many contributing factors to this inequity (i.e., tumor biology, social and structural health determinants, racial injustice, and differential access to and utilization of high-quality mammography, diagnostics and therapies), persistent underrepresentation of Black patients in cancer clinical trials (CTs) slows scientific advancements. Objective: The goal of the FOR ME (Fostering Opportunities in Research through Messaging and Education) Study is to develop, optimize, and test a narrative decision aid intervention (web-based video) for Black women diagnosed with BC to promote shared decision making and CT participation. Here, we report on the development phase, wherein our objective was to identify salient themes and to understand lived experiences to enhance authenticity and to inform video content. Methods: Guided by community-based participatory research approaches, we used multiple qualitative methods (key informant interviews (KIIs) and story circles) to identify barriers and facilitators that support decision-making and CT participation. The KIIs, completed in-person, via phone, or video conferencing, were recorded and professionally transcribed. The research team used thematic analysis and inductive coding approaches. First, a subset of transcripts was annotated, then annotations were compiled into a preliminary codebook. Inter-coder reliability testing is ongoing to improve quality and to refine the codebook. The analysis team is using Dedoose, to analyze quotations and code co-occurrences, application frequencies, and relationships. Data collection and analysis of the story circles is ongoing. Results: In total, 30 Black women with BC participated in KIIs. Interviewees ranged in age from 27 to 75 years (M=59 + 12 years); concerning insurance, 63% had a public and 33% had a private source. About 27% were currently receiving BC treatment and 27% had prior CT participation. Participants expressed both positive and negative perceptions of CTs, sometimes concurrently. Barriers to CT participation included competing responsibilities, logistical burdens, ineffective provider communication, a lack of knowledge of CTs, individual and systemic racism, CT burdensome characteristics (invasive, potential for side effects), and comorbidities. Facilitators to CT participation included strong patient-provider communication and relationships, CT non-burdensome characteristics (non-invasive, minimal side effects), having a sense that participation benefits future generations, increased understanding of the CT, and feeling empowered in decision-making .Conclusion: To promote health equity in CTs, interventions should promote strong culturally sensitive patient-provider communication with emphasis on shared decision-making and patient empowerment along with emphasis on benefits toward future generations to promote a willingness to participate in CTs. Citation Format: Leslie R Carnahan, Vida Henderson, Tigist Mersha, Neha Hippalgaonkar, Ryan Nguyen, Eliza B Cohn, Kauthar Salum, Ana Williams, Lolita Coleman, Beulah Brent, AnneMarie Murphy, Paris Thomas, Paramjeet Khosla, Kent Hoskins. “If it’s something that I can do for my future generations…”: Using multiple qualitative methods to inform an intervention to promote shared decision making and participation in clinical trials among Black women diagnosed with breast cancer [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A060.

Rural racial disparities and barriers in mammography utilization among Medicare beneficiaries in Texas: A longitudinal study

This study examined rural racial/ethnic disparities in long-term mammography screening practices among Medicare beneficiaries. A retrospective longitudinal study was conducted using 100% Texas Medicare data for women aged 65-74 who enrolled in Medicare between 2010-2013. Of the 114,939 eligible women, 21.2% of Hispanics, 33.3% of non-Hispanic Blacks (NHB), and 38.4% non-Hispanic Whites (NHW) in rural areas were regular users of mammography, compared to 33.5%, 44.9%, and 45.3% of their counterparts in urban areas, respectively. Stratification analyses showed rural Hispanics and NHB were 33% (95% CI, 25% - 40%) and 22% (95% CI, 6% - 36%) less likely to be regular users of mammography compared to their urban counterparts. Major barriers to routine mammography screening included the lack of a primary care provider, frequent hospitalization, and comorbidity. The findings of this study highlight the importance of addressing rural racial disparities in mammography utilization among older women to ensure equitable screening practices for all populations.

The Impact of COVID-19 on the Utilization of Public Sector Radiological Services in the Western Cape Province of South Africa.

Background Coronavirus (COVID-19) was officially declared a pandemic in March 2020 and has had a major impact on global healthcare services, including radiology. However, little is known about the full impact of COVID-19 on the utilization of diagnostic imaging in Africa's public healthcare sector. Objectives The objective of this study was to compare public sector diagnostic imaging utilization by modality for the whole Western Cape Province (WCP) of South Africa (SA), as well as its metropolitan and rural areas, in 2019 and 2020 in terms of the absolute number of investigations and investigations per 1000 people. Method We performed a retrospective analysis of Western Cape Government Department of Health and Wellness and Stats SA District Council 2021 Mid-Year Population Estimates data. All diagnostic imaging investigations performed in 2019 and 2020 were collated and stratified by imaging modality, geographic region (metropolitan/rural), and calendar year. Data are presented as the total number of investigations and investigations per 1000people. We calculated mammography utilization for women aged 40-70 years and compared data for 2019 and 2020. Results Between 2019 and 2020, the provincial population increased by 1.9%, while total imaging investigations and investigations per 1000 people decreased by 19% (1,384,941 vs. 1,123,508, -261,433) and 20% (262/103 vs. 208/103), respectively. Total numerical decline was highest in plain radiographs (1,005,545 vs. 800,641, -204,904), accounting for more than three-quarters (78%) of the total reduction. Percentage decline was most pronounced for mammography, as utilization was almost halved (15.7/103vs.8.9/103, -43%), whereas computed tomography was the least impacted (17.9/103vs.16.7/103, -12%) with the remaining modalities decreasing between approximately one-quarter and one-fifth (magnetic resonance imaging = 26%, fluoroscopy = 25%, general radiographs = 23%, ultrasound = 16%, chest radiographs = 18%). Proportional metropolitan (-18.7%) and rural decreases (-19.3%) were similar. Conclusion COVID-19 had a substantial impact on WCP imaging services, decreasing overall radiological investigations by almost one-fifth. The greatest impact was on elective investigations, particularly mammography. Although the proportional impact was similar for the metropolitan and rural areas, COVID-19 nonetheless exacerbated existing discrepancies in imaging utilization between the geographical regions.The medium- and long-term clinical impacts of decreased imaging are still to be defined.

Risk perception and barriers to utilization of mammogram for breast cancer screening among female healthcare professionals in a tertiary health institution, Benin City, Nigeria

Abstract Background: For the effective functioning of health workers as promoters of breast cancer prevention through early detection, the need for relevant knowledge about the disease and its early detection is crucial. Objective: This study assessed the risk perceptions and barriers to use mammograms for breast cancer screening among female healthcare professionals in a tertiary health institution in Benin City, Nigeria. Materials and Methods: The quantitative approach was utilized in this study as it is a systematic process that helps to describe and test relationships among variables without bias. In line with this, a descriptive cross-sectional study was conducted with a sample of 255 female healthcare professionals from April 2023 to July 2023, using the multistage and convenience sampling method. A structured questionnaire was used to collect data with a reliability of 0.781. Data were analyzed using Statistical Package for Social Science (SPSS) version 22.0 and presented in words and frequency distribution tables. Hypotheses were tested with chi-square at a 5% level of significance. Results: A total of 225 nurses (88.2%) and 30 doctors (11.8%) participated in the study. The mean age was 45.69 ± 5.814 years (nurses = 45.55 ± 5.679 years; doctors 46.73 ± 6.757 years). Overall, 223 (87.5%) showed a positive risk perception of breast cancer with a mean of 2.74 ± 0.966. Only 35 (13.7%) respondents had a mammogram in the last 24 months before the study. Mean ± SD = 1.15 ±.376. Utilization was not associated with risk perception (P = 0.409), but there was a significant difference (P = 0.001) in the utilization of mammograms between nurses (10.7%) and doctors (36.7%). Perceived barriers to utilization of mammogram include cost 190 (86.4%), preference for other screening methods 210 (95.5%), fear of abnormal findings 189 (85.9%), and busy work schedule 200 (90.9%). Conclusion: There is a high positive risk perception of breast cancer but poor utilization of mammography. Therefore, it is recommended to sensitize female healthcare professionals on the need for mammography breast screening through training and re-training.

Latent pathway-based Bayesian models to identify intervenable factors of racial disparities in breast cancer stage at diagnosis.

We built Bayesian Network (BN) models to explain roles of different patient-specific factors affecting racial differences in breast cancer stage at diagnosis, and to identify healthcare related factors that can be intervened to reduce racial health disparities. We studied women age 67-74 with initial diagnosis of breast cancer during 2006-2014 in the National Cancer Institute's SEER-Medicare dataset. Our models included four measured variables (tumor grade, hormone receptor status, screening utilization and biopsy delay) expressed through two latent pathways-a tumor biology path, and health-care access/utilization path. We used various Bayesian model assessment tools to evaluate these two latent pathways as well as each of the four measured variables in explaining racial disparities in stage-at-diagnosis. Among 3,010 Black non-Hispanic (NH) and 30,310 White NH breast cancer patients, respectively 70.2% vs 76.9% were initially diagnosed at local stage, 25.3% vs 20.3% with regional stage, and 4.56% vs 2.80% with distant stage-at-diagnosis. Overall, BN performed approximately 4.7 times better than Classification And Regression Tree (CART) (Breiman L, Friedman JH, Stone CJ, Olshen RA. Classification and regression trees. CRC press; 1984) in predicting stage-at-diagnosis. The utilization of screening mammography is the most prominent contributor to the accuracy of the BN model. Hormone receptor (HR) status and tumor grade are useful for explaining racial disparity in stage-at diagnosis, while log-delay in biopsy impeded good prediction. Mammography utilization had a significant effect on racial differences in breast cancer stage-at-diagnosis, while tumor biology factors had less impact. Biopsy delay also aided in predicting local and regional stages-at-diagnosis for Black NH women but not for white NH women.

German mammography screening program: adherence, characteristics of (non-)participants and utilization of non-screening mammography—a longitudinal analysis

BackgroundIn Germany, all women aged 50–69 have been invited to biennial mammography screening since 2009. We aimed to assess longitudinal adherence over ten years in women aged 50 in 2009 and characterize the different adherence groups.MethodsUsing the German Pharmacoepidemiological Research Database (GePaRD, ~ 20% of the German population), we included women aged 50 in 2009 (baseline) with continuous health insurance coverage and without breast cancer or in-situ-carcinoma. We followed them until age 59 and categorized them according to mammography screening participation into the following groups: never, 1–2, 3–4, 5–6 times. We characterized these groups, inter alia, regarding the use of other preventive measures, non-screening mammography (i.e., mammography outside the organized screening program) and menopausal hormone therapy.ResultsOverall, 82,666 women were included. Of these, 27.6% never participated in the screening program, 15.1% participated 1–2 times, 31.7% participated 3–4 times and 25.6% participated regularly (5–6 times). Among regular participants, 91% utilized other preventive measures (e.g., cervical cancer screening, general health checkup) before baseline as compared to 66% among non-participants. Menopausal hormone therapy was least common among non-participants (11% vs. 18% among regular participants). Among non-participants, the proportions using ≥ 1, ≥ 2, and ≥ 3 non-screening mammographies between age 50–59 were 25%, 18%, and 15%, respectively.ConclusionsUsing a large cohort based on claims data, this study provides novel insights into longitudinal adherence to the mammography screening program and the use of mammography outside of the program in Germany. Between age 50–59, 57% of eligible women participated at least three times in the German mammography screening program and 28% (~ 3 in 10 women) never participated. Among non-participants, 15% had at least three non-screening mammographies during this period, indicating potential gray screening. Participants more often utilized other preventive measures as compared to non-participants.

Breast Cancer Knowledge and Mammography Use Among Asian American Women Aged 40 and Older: Using the Transtheoretical Model Approach.

Mammography screening rates remain low among Asian American women (AAW). The aims of our study were to: (a) assess breast cancer knowledge and mammography screening behaviors, and (b) identify the factors related to the transtheoretical model (TTM) stages of change in relation to mammography utilization among AAW aged 40 and older. Using a cross-sectional design, a convenience sample of 714 AAW completed a structured questionnaire in 2021. Participants demonstrated a moderate level of knowledge regarding breast cancer and mammography. Only 34.2% of the participants reported obtaining regular mammograms. The ordinal logistic regression indicated that age, birthplace, health perception, breast biopsy history, breast cancer knowledge, self-efficacy, and perceived barriers were correlated with TTM stages of change. Our results highlight the need for implementing effective interventions aimed at increasing knowledge and screening rates for breast cancer among AAW. Additional TTM studies with AAW are needed to determine the relationships among TTM constructs and develop theory-based programs to improve adherence to screening guidelines. Future research using a mixed-method design may provide opportunities to explore complex phenomena associated with breast cancer screening behaviors. Finally, further assessments of the Breast Cancer Knowledge Scale's psychometric properties are necessary to improve this instrument.

The Impact of Online Self-Scheduling Platform Optimization on Patient Directed Access to Screening Mammography Appointments During the COVID-19 Pandemic | A Single Institution Experience

Objective: During the COVID-19 pandemic, screening mammography utilization declined nationally by nearly 65% compared to pre-pandemic volumes. This study assessed the impact of online screening mammography self-scheduling platform optimization on patient scheduling, rescheduling and cancellation rates during the COVID-19 pandemic. Methods: A retrospective review of online SM scheduling utilization between October 1, 2019, and December 31, 2022 was performed. The electronic health record (EHR) was queried to extract the total number of SMs performed, online scheduling, rescheduling and cancellation rates during the busiest screening mammography months of October through December in 2019 and 2022. Results: October to December online SM scheduling patient activity rose from 57 to 1481 patients when comparing 2019 and 2022 performance, representing a 26-fold increase in online platform utilization after EHR-tethered scheduling integration (p=0.013). This resulted in a concurrent 16x fold reduction in patient access specialist SM scheduling engagement. Concurrently, SM scheduling automation resulted in increases in appointment rescheduling and cancellation rates, from 14% to 22% (p=0.005) and 18% to 38% (p=0.000), respectively. Discussion: Optimization of our online self-scheduling platform with EHR integration resulted in a 26-fold increase in online self-scheduling patient utilization and a 16x fold reduction in DI-PAS hands on SM scheduling engagement. The rates of OSS patient appointment rescheduling and cancellation also increased but the overall net gain in self-scheduling automation should not deter continued use and implementation of this program.

Disparities in screening mammography utilization among Hispanic women in rural Texas from 2002 to 2018.

To examine the trends of racial/ethnic and urban-rural disparities in screening mammography use with a focus on Hispanic women in rural Texas, as well as to further investigate barriers to mammography screening practices. A serial cross-sectional study was conducted on screening mammography including eligible female respondents (≥ 40years) from the Texas Behavioral Risk Factor Surveillance System survey from 2002 to 2018. Weighted descriptive analyses showed persistent racial/ethnic and urban-rural disparities in mammography screening rates among eligible women (≥ 40years) in Texas. Overall, the mammography screening rates for women in rural areas were significantly lower than women in urban areas with a mean rate of 64.09% versus 70.89% (p < 0.001). Rural Hispanic women had the lowest mean mammography screening rate (55.98%) among all eligible women which is 16.27% below the mean mammography screening rate of non-Hispanic white women in urban areas. Weighted logistic regression model revealed that women with no health insurance or primary care providers were 52% (95% Confidence Interval [CI] 0.36-0.63, p < 0.001) or 54% (95% CI 0.35-0.6, p < 0.001) less likely having an up-to-date mammography screening compared with women with health insurance or primary care providers, respectively. Our study demonstrated significant and persistent racial and urban-rural disparities in screening mammography utilization among Hispanic women compared with non-Hispanic white women from 2002 to 2018. Healthcare access is a major contributor to these disparities. It highlights the need for wide-scale interventions from public health and policymakers targeting under screened racial minorities and rural regions population to promote screening mammography services among disadvantaged population.

The role of facility and patient mix factors on recovery of screening and diagnostic mammography volumes following the initial COVID-19 pandemic wave.

The goal of this study was to understand the extent to which mammography facilities were able to recover monthly screening and diagnostic mammography volumes to their prepandemic levels and to determine what facility and patient mix factors were associated with recovery. Facilities, located in and adjacent to Cook County, Illinois, were eligible. In all, 58 screening and 30 diagnostic mammogram facilities submitted mammogram volumes by month with a cross-listing of patient ZIP codes by screening volumes. Monthly screening and diagnostic volumes for the 6-month immediate postpandemic period (July-December 2020) and for the subsequent postpandemic period (January-June 2021) were compared with the same months in 2019. ZIP code distributions were used to define patient mix characteristics related to disadvantage. Compared with the prepandemic period, Breast Imaging Centers of Excellence conducted roughly 50 fewer monthly screening mammograms (95% CI: -91, -9) but 50 more diagnostic mammograms (95% CI: 24, 82) on average in the immediate postpandemic period. Facilities serving a predominantly Black population conducted roughly 50 fewer monthly screens (95% CI: -93, -13) without any increase in monthly diagnostics. Highly accredited (and typically higher volume) facilities appeared to actively triage diagnostics, whereas lower resource facilities appeared to struggle to recover to prepandemic volumes without triage to diagnostics. The pandemic disproportionally impacted minority populations already affected by differential access to and utilization of high-quality mammography. Potential explanations are discussed. Policies should be strengthened to facilitate triaging of services during times of stress to the healthcare system.

Correlates of Breast Cancer Screening in Arab Muslim Women Living in the United States

Background: Breast cancer is the most diagnosed cancer in women, with mammography being the most efficient at detecting early-stage breast cancer. Arab Muslim women living in the United States are an understudied minority group with cultural differences that may influence their utilization of mammography. Objective: Guided by the Neuman Systems Model, this study aimed to determine correlates of using mammography, including acculturation, modesty, and breast cancer knowledge, of Arab Muslim women living in New England aged 40 years and older. Interventions/Methods: A correlational study design was used with 118 Arab Muslim women with a survey that included sociodemographic data, acculturation, Islamic modesty, and breast cancer knowledge scales. Results: The screening rate for women aged 50 years and older was statistically significant in comparison to the Center for Disease Control report (2018) (Z = −2.15, P &lt; .01). Multivariate analysis revealed that modesty (odds ratio = 0.90; confidence interval [0.81-0.99]; P = 0.04), decreased length of stay in the United States (r = 0.34; P &lt; .01), and the use of the Arabic language in the survey (r = −0.20; P &lt; .05) were negatively associated with mammography use. Conclusions: Educational and cultural factors may influence use of mammography screening by Arab Muslim women living in the United States. Implications for Practice: The study findings underscore the need for a better understanding of modesty by health care providers to enhance use of mammography by Arab Muslim women. What is Foundational: Cultural, educational, and religious variables may be drivers of decreased mammography use in minority women. Barriers to breast cancer detection can be overcome by improving sensitivity to such variables.