Breast Cancer Screening Rates Research Articles

Intention to Receive Breast Cancer Screening and Related Factors of Influence Among Vietnamese Women in Transnational Marriages.

Breast cancer is a major global health issue. Receiving regular breast cancer screenings aids in the early detection and treatment of breast cancer. Numerous factors influence whether a Vietnamese woman receives breast cancer screening. The aims of this study were to understand current rates of breast cancer screening and explore the factors that influence intention to undergo breast cancer screening among Vietnamese women in transnational marriages. This was a cross-sectional, community-based study. Data were collected via snowball sampling. We enrolled 250 women aged 18 years and over from September to December 2015. The percentage of participants who had received a breast self-examination, breast palpation, or breast ultrasound within the past year were 25.6%, 9.6%, and 21.2%, respectively. Moreover, only 6.8% of participants had received a mammography within the past 2 years. Participants with strong perceptions of breast cancer being a serious illness, who had fewer barriers to obtaining a breast cancer screening, or who had been advised by healthcare personnel to undergo screenings were more likely to report an intention to receive periodic breast self-examinations during the subsequent 1-year period. Participants who had lived in Taiwan for a longer period, had higher levels of perceived susceptibility to breast cancer, had prior experience with breast diseases, or had fewer barriers to obtaining a breast cancer screening were more likely to report an intention to receive a breast ultrasound during the subsequent 1-year period. Finally, participants who were older, perceived greater benefits from receiving breast cancer screening, and had not entered menopause were more likely to report an intention to receive a mammography during the following 2 years. Medical care personnel should promote breast cancer screening among Vietnamese women in transnational marriages. The results may be useful in promoting greater awareness among medical care personnel of breast cancer issues and efficacy in performing breast cancer screening for Vietnamese women in transnational marriages and provide references for the establishment of breast cancer prevention and control policies.

Primary care colorectal cancer screening correlates with breast cancer screening: implications for colorectal cancer screening improvement interventions.

ObjectiveNational colorectal cancer (CRC) screening rates have plateaued. To optimize interventions targeting those unscreened, a better understanding is needed of how this preventive service fits in with multiple preventive and chronic care needs managed by primary care providers (PCPs). This study examines whether PCP practices of other preventive and chronic care needs correlate with CRC screening.MethodsWe performed a retrospective cohort study of 90 PCPs and 33,137 CRC screening-eligible patients. Five PCP quality metrics (breast cancer screening, cervical cancer screening, HgbA1c and LDL testing, and blood pressure control) were measured. A baseline correlation test was performed between these metrics and PCP CRC screening rates. Multivariable logistic regression with clustering at the clinic-level estimated odds ratios and 95% confidence intervals for these PCP quality metrics, patient and PCP characteristics, and their relationship to CRC screening.ResultsPCP CRC screening rates have a strong correlation with breast cancer screening rates (r = 0.7414, p < 0.001) and a weak correlation with the other quality metrics. In the final adjusted model, the only PCP quality metric that significantly predicted CRC screening was breast cancer screening (OR 1.25; 95% CI 1.11–1.42; p < 0.001).ConclusionsPCP CRC screening rates are highly concordant with breast cancer screening. CRC screening is weakly concordant with cervical cancer screening and chronic disease management metrics. Efforts targeting PCPs to increase CRC screening rates could be bundled with breast cancer screening improvement interventions to increase their impact and success.

Vietnamese American Women's Beliefs and Perceptions About Breast Cancer and Breast Cancer Screening: A Community-Based Participatory Study.

Although breast cancer (BC) rates are declining in White non-Hispanic American women, they are increasing among Vietnamese American women (VAW) at 1.2% (95% confidence interval [0.1, 2.2]) per year. BC screening rates (64%) are below the national rates (81.1%). This article explores VAW's beliefs about BC and screening. Using community-based participatory qualitative descriptive methods, 40 VAW were recruited from Oregon, and four focus groups were conducted. A directed content analysis was used. Main themes were as follows: deferred to a health care provider or relying on self-detection and symptoms; fear of BC versus fear of procedural pain; limited knowledge; motivation by observing others' journey in BC death or survivorship; body image concern; "living carefree," "good fortune-having good health"; and coverage for a mammogram expense means health care access. Tailored interventions should address mammogram knowledge, fear, erroneous information, body image, fate and luck, and promoting access.

Demographic, psychosocial, and behavioral associations with cancer screening among a homeless population.

Although cancer incidence and mortality is declining, cancer remains among the leading causes of death in the United States. Research shows that cancer morbidity and mortality can be reduced by early detection. Yet, both cancer risks and screening behavior remain understudied in the homeless population. Researchers conducted a cross-sectional survey of homeless individuals (n=201). The analysis describes the demographic, psychosocial, and behavioral associations with cancer screenings and knowledge of the lung cancer screening recommendation. Participants' mean age was 51.7years (SD 13.6); the group was largely African American (77.3%) and male (67.9%). Among women, the breast and cervical cancer screening rates were 46.5% and 85.1%. Among men the prostate cancer screening rate was 34.2%. Among all participants, the colon cancer screening rate was 44%. Cancer risk behaviors were high. Lung cancer screening knowledge was low (23.0%). Some cancer screening behaviors were associated with age, income, health status, obesity, tobacco use, and physical activity. Despite higher cancer risk behaviors, knowledge and general participation rates for cancer screenings were below national benchmarks. To improve cancer survival among disparate populations, sustained community outreach is necessary to increase awareness of screening recommendations, identify high-risk individuals, and navigate them to resources.

Prevalence and sociodemographic correlates of routine breast cancer screening practices among migrant‐Australian women

Objective:To evaluate breast cancer screening (BCS) practice and explore the relationship between sociodemographic factors and breast awareness (BA), clinical breast examination (CBE) and mammography in migrant‐Australian women. Method:Secondary analysis was performed on the pooled sample (n=1,744) from five cross‐sectional studies of BCS rates among immigrant‐Australian women, and the associated sociodemographic factors. Results:Only 19% of women participated in routine BA, 27.4% of women in the target group of >40 year presented for an annual CBE, and 60.6% of women in the target group of 50–74 years received a biennial mammogram. Associated sociodemographic factors differed by modality except for length of Australian residency. In multivariable analysis, age, length of Australian residency, marital status, and employment status accounted for more than 50% of the variance in regular BA and CBE. Conclusion:These findings indicate suboptimal BCS rates persist among migrant‐Australian women, and suggest the importance of certain sociodemographic factors in BCS practice. Implications for public health:Further education is required for BA and CBE practice in immigrant‐Australian women, especially for those who have resided in Australia less than 12 years without a partner.

Socioeconomic Inequalities in Cervical and Breast Cancer Screening among Women in Korea, 2005-2015.

PurposeConsistent evidence indicates that cervical and breast cancer screening rates are low among socioeconomically deprived women. This study aimed to assess trends in cervical and breast cancer screening rates and to analyze socioeconomic inequalities among Korean women from 2005 to 2015.Materials and MethodsData from the Korean National Cancer Screening Survey, an annual nationwide cross-sectional survey, were utilized. A total of 19910 women were finally included for analysis. Inequalities in education and household income status were estimated by slope index of inequality (SII) and relative index of inequality (RII), along with calculation of annual percent changes (APCs), to show trends in cancer screening rates.ResultsCervical and breast cancer screening rates increased from 54.8% in 2005 to 65.6% in 2015 and from 37.6% in 2005 to 61.2% in 2015, respectively. APCs in breast cancer screening rates were significant among women with higher levels of household income and education status. Inequalities by household income in cervical cancer screening uptake were observed with a pooled SII estimate of 10.6% (95% CI: 8.1 to 13.2) and RII of 1.4 (95% CI: 1.3 to 1.6). Income inequalities in breast cancer screening were shown to gradually increase over time with a pooled SII of 5.9% (95% CI: 2.9 to 9.0) and RII of 1.2 (95% CI: 0.9 to 1.3). Educational inequalities appeared to diminish over the study period for both cervical and breast cancer screening.ConclusionOur study identified significant inequalities among socioeconomically deprived women in cervical and breast cancer screening in Korea. Especially, income-related inequalities were greater than education-related inequalities, and these were constant from 2005 to 2015 for both cervical and breast cancer screening.

Study of the Determinants of the Use of Breast Cancer Screening in Women 35 to 65 Years in the Region of Thies (Senegal)

Introduction: In Senegal, breast cancer is the second most common cancer of women after cervical cancer. It is a cancer accessible to clinical and radiological screening. The objective of this study was to study the determinants of the use of breast cancer screening among women aged 35 to 65 in the Thies region in 2015. Material and Methods: It was a descriptive and analytical cross-sectional study. It was conducted with a sample of women selected using a two-stage cluster survey. The study used a questionnaire to collect data on the individual characteristics of women, knowledge, attitudes and practice on breast cancer and quality of care in an individual interview at the homes of women after consent. The data was entered on the Epi Info 3.5.3 software and analyzed with the R 3.3.3 software. A description of qualitative variables across proportions and quantitative variables by mean and standard deviation was performed. Parametric or non-parametric tests were used to examine the association between the dependent variable (breast cancer screening) and explanatory variables (predisposing factors, resources, health needs) according to their applicability conditions and at a risk α equal 5%. Finally, all variables with p less than 0.25 were used to construct an explanatory model by simple logistic regression. Results: The study involved 960 women aged 35 to 65 years. The average age was 43.8 years with a standard deviation of 8.3 years. The rate of breast cancer screening was 25.7%. Educated women (OR adjusted = 1.89 [1.25 - 2.85]), women who resided in urban settings (adjusted OR = 1.79 [1.05 - 3.04]), those who experienced at least one risk factor for breast cancer (OR adjusted = 2.71 [1.81 - 4.06]) were more likely to use screening breast cancer. In contrast, women with low socioeconomic status (adjusted OR = 0.66 [0.45 - 0.97]) were less likely to be screened. Conclusion: Level of education, knowledge of breast cancer and having received screening advice are factors to consider in improving the rate of breast cancer screening in Thies, and the most important remains public awareness.

Evaluation of the relationship between health belief of breast cancer screening and health anxiety; A cross-sectional study

Breast cancer (BC) is the most frequent type of cancer among women. Screening and early diagnosis is crucial for reducing the disease burden. However the screening rates for BC is not at desired levels. Health belief and health anxiety are two conditions that affect participation in cancer screening. The aim of this study is to explore the relationship between health beliefs regarding breast cancer screening and health anxiety among women. This cross-sectional study included 301 women between 20 and 69 years of age who were admitted to the family medicine outpatient clinic. The study data was collected using the Health Anxiety Inventory (HAI) and ChampionÂ’s Health Belief Model Scale (CHBMS). The questionnaires were filled with face-to-face interview technique. To explain the relationship between anxiety and the components of the health belief model a multivariate linear regression model was used. High anxiety levels were positively correlated with the seriousness and health motivation components and negatively correlated with the self-efficacy component of the health belief model related to breast cancer (p

Impact of an education-centered medical home on quality at a student-volunteer free clinic

ABSTRACTBackground: The continuity provided by longitudinal clerkships has documented benefits to medical student education. Yet, little quantitative data exist on the association between longitudinal clerkships and patient outcomes.Objective: This study compares screening metrics of a longitudinal clerkship called the education-centered medical home (ECMH) with the standard clinical model at a student-volunteer free clinic (SVFC). In the ECMH model, the same attending physician staffs one half-day of clinic with same group of students weekly for 4 years. Standard clinical models are staffed with students and physicians who come to the SVFC based on availability.Design: ECMH students aimed to increase human immunodeficiency virus (HIV) screening rates in their patient panel as part of a quality improvement project. Students prepared individualized care plans prior to patient visits that included whether screening had been performed. They were also reminded to confirm completion of testing. Percentages of patients screened for HIV before and after establishment of the ECMH were compared with four standard clinical models. Screening rates for breast, colon, and cervical cancer, as well as hepatitis C, served as secondary endpoints.Results: While screening rates were initially similar between models (43.2% and 34.8% for the ECMH and standard clinical panels, respectively, p = 0.32), HIV screening rates increased from 43.2% to 95.0% in the ECMH compared with a significantly smaller increase from 35.0% to 50.0% in the standard clinical panel (p < 0.0001). Additionally, the ECMH resulted in statistically significantly increased screening rates for cervical cancer (p < 0.001) and hepatitis C (p < 0.0001).Conclusions: This study demonstrates an association between a longitudinal ECMH clerkship and improved quality metrics at an SVFC. Even measures not targeted for intervention, such as colorectal cancer and hepatitis C, showed significant improvement in screening rates when compared with the standard clinical model.

The burden of breast cancer in adult women with congenital heart disease

Breast cancer (BC) is the most common cancer among women in Quebec. Screening plays an important role in reducing its burden. BC incidence in adult women with congenital heart disease (ACHD) has not been studied. To compare ACHD women BC incidence rates to general population. To assess if ACHD women have comparable BC screening rates to non-ACHD women. The Quebec CHD database which includes 84,498 CHD patients was used to calculate the incidence rate of BC among ACHD women in 1992–2009. Age-specific and cumulative incidence of BC were calculated. The age-standardized incidence rate ratio (ASIR) was also calculated using direct standardization to compare rate to the general population and for 4 periods of time. Yearly BC screening participation rate was measured from 1989–2009, as the percentage of screen-eligible women, aged 50–69, who completed at least one mammogram within the 24 months. We compared it to the rate in Quebec general population. The incidence rate of BC progressively increased with advancing age with 21% of cases < 50 y, 45% in 50–69 y. In our cohort, 1 out of 10 women (9.8%; 95% CI, 8.6–11.0) developed BC over the course of adulthood. The ASIR was less < 1 before 2006 and 1.25 (95% CI, 1.23–1.26) in 2006–2009 indicating an increased risk of BC among ACHD women than general population in the recent era. Compared to the general population, ACHD women had lower yearly BC screening participation rates from 1989 (18.3% vs. 22.1%) to 2009 (64.6% vs. 67.9%) and still inferior to the official target participation rate (70%). The incidence of BC in ACHD women has increased and is now higher than the general population. Primary care physicians and cardiologists should collaborate to ensure appropriate cancer screening for ACHD women among whom attention to cancer screening may be overlooked. Further analyses will assess the impact of radiation from cardiac imaging and BC risk in this high exposed population.

Spousal Interaction and Breast Cancer Screening Among Korean Americans

Breast cancer screening rates for Korean Americans (KA) are low, leading to higher morbidity and mortality of the screening interventions tested, almost none account for family interactions and communication between KA couples. The purpose of this study was to explore communication patterns between KA wives and husbands about breast cancer screening after attending an educational program on breast health. Couples were enrolled in a community RCT to increase mammography among KA women. A random 10% of couples audio-recorded their interactions at home regarding the education they received during the RCT. The transcribed and translated data were analyzed for communication content and patterns. Husbands typically took the lead in directing the conversation and the strategies for engaging their wives with screening. Some long-held cultural beliefs were discussed as were strategies for how husbands could help wives with remembering and completing regular mammography. This analysis of focused spousal discussions provides a unique picture of the interaction between KA husbands and wives around breast cancer screening. These data could inform further investigation of family-based interventions and spousal interaction to understand how to leverage spousal support to encourage KA women’s completion of mammography.

Effects of Perceived Discrimination and Trust on Breast Cancer Screening among Korean American Women

ObjectiveKorean American (KA) women continue to have lower breast cancer screening rates than other racial groups. Perceived discrimination and trust have been associated with breast cancer screening adherence, but little is known about the associations in KA women. MethodsSurveys were completed by 196 KA women in the Chicago metropolitan area. Multiple and Firth logistic regression analyses were performed to identify factors (perceived discrimination, trust, acculturation, cultural beliefs, health care access) influencing breast cancer screening adherence (mammogram). In addition, SPSS macro PROCESS was used to examine the mediating role of trust between perceived discrimination and breast cancer screening adherence. ResultsNinety-three percent of the women surveyed had health insurance and 54% reported having a mammogram in the past 2 years. Predictors of having a mammogram were knowing where to go for a mammogram, having a regular doctor or usual place for health care, greater trust in health care providers, and lower distrust in the health care system. Perceived discrimination had an indirect effect on breast cancer screening through trust. ConclusionsThe breast cancer screening rate among KA women is low. Perceived discrimination in health care, trust in health care providers, and distrust in the health care system directly or indirectly influenced breast cancer screening adherence in KA women. Trust is a factor that can be strengthened with educational interventions.

Impact of Patient-Provider Race, Ethnicity, and Gender Concordance on Cancer Screening: Findings from Medical Expenditure Panel Survey.

Background: Racial and ethnic minorities experience lower rates of cancer screening compared with non-Hispanic whites (NHWs). Previous studies evaluating the role of patient-provider race, ethnicity, or gender concordance in cancer screening have been inconclusive.Methods: In a cross-sectional analysis using the Medical Expenditure Panel Survey (MEPS), data from 2003 to 2010 were assessed for associations between patient-provider race, ethnicity, and/or gender concordance and, screening (American Cancer Society guidelines) for breast, cervical, and colorectal cancer. Multivariable logistic analyses were conducted to examine associations of interest.Results: Of the 32,041 patient-provider pairs in our analysis, more than 60% of the patients were NHW, 15% were non-Hispanic black (NHB), and 15% were Hispanic. Overall, patients adherent to cancer screening were more likely to be non-Hispanic, better educated, married, wealthier, and privately insured. Patient-provider gender discordance was associated with lower rates of breast [OR, 0.83; 95% confidence interval (CI), 0.76-0.90], cervical (OR, 0.83; 95% CI, 0.76-0.91), and colorectal cancer (OR, 0.84; 95% CI, 0.79-0.90) screening in all patients. This association was also significant after adjusting for racial and/or ethnic concordance. Conversely, among NHWs and NHBs, patient-provider racial and/or ethnic concordance was not associated with screening. Among Hispanics, patient-provider ethnic discordant pairs had higher breast (58% vs. 52%) and colorectal cancer (45% vs. 39%) screening rates compared with concordant pairs.Conclusions: Patient-provider gender concordance positively affected cancer screening. Patient-provider ethnic concordance was inversely associated with receipt of cancer screening among Hispanics. This counter-intuitive finding requires further study.Impact: Our findings highlight the importance of gender concordance in improving cancer screening rates. Cancer Epidemiol Biomarkers Prev; 26(12); 1804-11. ©2017 AACR.

Abstract 21372: Women Undergoing Coronary Artery Bypass Graft Surgery Do Not Follow Any Recommended Guidelines for Breast Cancer Screening

Introduction: In the United States, 1 in 4 women dies of heart disease. Severe coronary artery disease is usually treated with coronary artery bypass graft (CABG) surgery to prolong a patient’s life span. To maintain the significant survival benefit derived from this procedure, vigilant post-care counseling is performed to prevent further health complications. Current post-CABG care guidelines include counseling on exercise, diet, and medical management but do not explicitly contain recommendations for other primary preventative care. Screening mammography (SM) for primary prevention is an effective measure that reduces women's mortality due to breast cancer by ~30%. Hypothesis: We hypothesize that women change the frequency of screening mammography following CABG surgery. Methods and Results: Using electronic medical record data, we identified a retrospective cohort of 170 women who underwent CABG surgery and SMs between 2002-2012. Recommended guidelines during these years varied between 0.5-1 SM per year (SM/year). The rate of SM/year prior to- and following CABG were calculated. We performed the same analysis on a second cohort of 400 women who underwent a cardiac catheterization (Cath) during the same time period and were found to have preserved heart function without CAD as a control group. The mean (95% CI) age of the CABG women at first screening mammogram, CABG procedure and last follow-up was, respectively, 61 (60-63), 67 (65-68), and 73 (71-74). The median SM/year before CABG procedure was 0.51 compared to 0.28 following CABG procedure (p&lt;0.0001). The median SM/year for Cath women ranged from 0.64 to 0.45 following Cath procedure. Conclusion: Women following CABG have the lowest breast cancer screening rates and are not meeting any recommended screening guidelines for mammography. These results indicate that further study of patient, provider, and/or system-related factors resulting in this change of preventative care is warranted.

Mobile Phone Multilevel and Multimedia Messaging Intervention for Breast Cancer Screening: Pilot Randomized Controlled Trial.

BackgroundDespite the increasing breast cancer incidence and mortality rates, Korean American immigrant women have one of the lowest rates of breast cancer screening across racial groups in the United States. Mobile health (mHealth), defined as the delivery of health care information or services through mobile communication devices, has been utilized to successfully improve a variety of health outcomes.ObjectiveThis study adapted the principles of mHealth to advance breast cancer prevention efforts among Korean American immigrant women, an underserved community.MethodsUsing a randomized controlled trial design, 120 Korean American women aged 40 to 77 years were recruited and randomly assigned to either the mMammogram intervention group (n=60) to receive culturally and personally tailored multilevel and multimedia messages through a mobile phone app along with health navigator services or the usual care control group (n=60) to receive a printed brochure. Outcome measures included knowledge, attitudes, and beliefs about breast cancer screening, readiness for mammography, and mammogram receipt. The feasibility and acceptability of the mMammogram intervention was also assessed.ResultsThe intervention group showed significantly greater change on scores of knowledge of breast cancer and screening guidelines (P=.01). The intervention group also showed significantly greater readiness for mammography use after the intervention compared with the control group. A significantly higher proportion of women who received the mMammogram intervention (75%, 45/60) completed mammograms by the 6-month follow-up compared with the control group (30%, 18/60; P<.001). In addition, the intervention group rated satisfaction with the intervention (P=.003), effectiveness of the intervention (P<.001), and increase of knowledge on breast cancer and screenings (P=.001) significantly higher than the control group.ConclusionsA mobile phone app–based intervention combined with health navigator service was a feasible, acceptable, and effective intervention mechanism to promote breast cancer screening in Korean American immigrant women. A flexible, easily tailored approach that relies on recent technological advancements can reach underserved and hard-to-recruit populations that bear disproportionate cancer burdens.Trial RegistrationClinicaltrials.gov NCT01972048; https://clinicaltrials.gov/show/NCT01972048 (Archived by WebCite at https://clinicaltrials.gov/archive/NCT01972048/2013_10_29)

Development and evaluation of multimedia interventions to promote breast and cervical health among South Asian women in Hong Kong: A project protocol

Recent studies conducted in the local community indicate that the uptake rates of breast and cervical cancer screening among South Asian ethnic minorities are lower than those of the general population. The development of interventions to promote these minorities’ awareness of breast and cervical health and the importance of cancer screening is therefore required. This study protocol aims to develop culturally sensitive multimedia interventions to promote awareness of breast and cervical cancer prevention among South Asian women in Hong Kong, and to evaluate the outcomes of such interventions using a Reach-Effectiveness-Adoption-Implementation-Maintenance framework. By using a multimedia approach and developing socio-culturally relevant and linguistically appropriate educational materials, information related to cancer and accessible preventive measures for breast and cervical cancer is expected to be disseminated more effectively among South Asian women and ultimately increase their awareness of engaging in healthy lifestyles and taking part in cancer screening tests. Successful engagement of community partners will enhance the future sustainability of the project.

Mammography Among Women With Severe Mental Illness: Exploring Disparities Through a Large Retrospective Cohort Study

This study examined mammogram screening rates among women with severe mental illness by using a socioecological framework. Because it has been shown that people with severe mental illness receive less preventive health care overall, the analysis included psychosocial predictors of mammogram screening rates in a cohort of women with severe mental illness. This retrospective cohort study (N=14,651) used existing statewide data for women ages 48-67 in California with Medicaid insurance who received treatment in the specialty mental health care system. The primary outcome of interest was evidence of breast cancer screening via mammogram. The associations of each predictor of interest with mammogram screening were evaluated by using Poisson models with robust standard errors. Across all demographic and diagnostic categories, rates of breast cancer screening in this cohort of women with severe mental illness fell below the national average. Only 26.3% (3,859/14,651) of women in the cohort received breast cancer screening in the past year. This study replicated previous findings that women with schizophrenia spectrum disorder and those with a comorbid substance use disorder are less likely to receive screening than those with other types of mental illness. In this cohort of women with severe mental illness, evidence of nonpsychiatric health care utilization was strongly associated with breast cancer screening (adjusted risk ratio=3.30, 95% confidence interval=2.61-4.16, p<.001). The findings can inform efforts to improve breast cancer screening among women with severe mental illness, such as targeted outreach to population subsets and colocation of primary care services in mental health treatment settings.

Association of the severity of diabetes-related complications with stage of breast cancer at diagnosis among elderly women with pre-existing diabetes.

This study assessed the association between the severity of diabetes complications using diabetes complications severity index (DCSI) and stage of breast cancer (BC) at diagnosis among elderly women with pre-existing diabetes and incident BC. Using Surveillance, Epidemiology and End Results-Medicare data, we identified women with incident BC during 2004-2011 and pre-existing diabetes (N=7729). Chi-square tests were used to test for group differences in stage of BC at diagnosis. Multinomial logistic regression was used to examine the associations between the severity of diabetes complications and stage of BC at diagnosis. Overall, women with a DCSI=2 and aDCSI≥3 were more likely to be diagnosed at advanced stages as compared to those with no diabetes complications. In full adjusted association (after adding BC screening to the analysis model), the severity of diabetes complications was no longer an independent predictor of advanced stages at diagnosis. However, women with aDCSI=2 were 26% more likely to be diagnosed at stage I (versus stage 0) of BC at diagnosis as compared to those without diabetes complications (OR 1.26, 95% CI 1.03-1.53). The increased likelihood of having advanced-stage BC at diagnosis associated with severity of diabetes-related complications appears to be mediated by lower rates of breast cancer screening among elderly women with pre-existing diabetes complications. Therefore, reducing disparity in receiving breast cancer screening among elderly women with diabetes may reduce the risk of advanced-stage breast cancer diagnosis.

Breast Cancer Screening for Patients of Rural Accountable Care Organization Clinics: A Multi-Level Analysis of Barriers and Facilitators.

Not all women 50-74years received biennial mammography and the situation is worse in rural areas. Accountable care organizations (ACO) emphasize coordinated care, use of electronic health system, and preventive quality measures and these practices may improve their patients' breast cancer screening rate. Using medical record data of 8,347 women patients aged 50-74years from eight rural ACO clinics in Nebraska, this study examined patient-, provider-, and county-level barriers and facilitators for breast cancer screening. A generalized estimating equations model was used to account for the correlation among patients from the same provider and county. The multi-level logistic regression results suggest that uninsured non-Hispanic Black patients were less likely to meet the biennial mammography screening guideline. Patients whose preferred language being English, having a preventive visit in the past 12 months, having one or more chronic conditions were more likely to meet the biennial mammography screening guideline. Patients with a primary care provider (PCP) that was male, without a medical doctor degree were less likely to screen biennially. Patients with a PCP that reviewed performance report quarterly, or manually checked patients' mammography screening status during visits were more likely to screen biennially. Interestingly, patients whose PCP reported being reminded by a care coordination team were less likely to screen biennially. Patients living in counties with more PCPs were also more likely to screen biennially. The study findings suggest that efforts targeting individual and practice-level barriers could be most effective in improving mammography screening for these rural ACO patients.

Text Messaging Interventions on Cancer Screening Rates: A Systematic Review.

BackgroundDespite high-quality evidence demonstrating that screening reduces mortality from breast, cervical, colorectal, and lung cancers, a substantial portion of the population remains inadequately screened. There is a critical need to identify interventions that increase the uptake and adoption of evidence-based screening guidelines for preventable cancers at the community practice level. Text messaging (short message service, SMS) has been effective in promoting behavioral change in various clinical settings, but the overall impact and reach of text messaging interventions on cancer screening are unknown.ObjectiveThe objective of this systematic review was to assess the effect of text messaging interventions on screening for breast, cervical, colorectal, and lung cancers.MethodsWe searched multiple databases for studies published between the years 2000 and 2017, including PubMed, EMBASE, and the Cochrane Library, to identify controlled trials that measured the effect of text messaging on screening for breast, cervical, colorectal, or lung cancers. Study quality was evaluated using the Cochrane risk of bias tool.ResultsOur search yielded 2238 citations, of which 31 underwent full review and 9 met inclusion criteria. Five studies examined screening for breast cancer, one for cervical cancer, and three for colorectal cancer. No studies were found for lung cancer screening. Absolute screening rates for individuals who received text message interventions were 0.6% to 15.0% higher than for controls. Unadjusted relative screening rates for text message recipients were 4% to 63% higher compared with controls.ConclusionsText messaging interventions appear to moderately increase screening rates for breast and cervical cancer and may have a small effect on colorectal cancer screening. Benefit was observed in various countries, including resource-poor and non-English-speaking populations. Given the paucity of data, additional research is needed to better quantify the effectiveness of this promising intervention.