Mammography Screening Rates Research Articles

Using Public Claims Data for Neighborhood Level Epidemiologie Surveillance of Breast Cancer Screening: Findings from Evaluating a Patient Navigation Program in Chicago's Chinatown.

This study was designed to evaluate a patient navigation program undertaken with our community partners in Chicago's Chinatown. Inadvertently, the study collected data on two biannual mammography screening cycles that coincided almost exactly with implementation of the Affordable Care Act (ACA) in Illinois. The study uses claims data to profile mammography screening rates for residents of an 18 zip code, 398 census tract area on Chicago's near south and southwest side. Patient addresses were geocoded from biannual (August 2011 to July 2103 and August 2103 to July 2015) Illinois Medicaid and Illinois Breast and Cervical Cancer Program (IBCCP) claims. Screening rates are presented separately for low-income women ages 40 to 49 and 50 to 64 years. We compare change between 16 tracts with greater than 20% Chinese ancestry, 85 tracts with 1% to 20% Chinese ancestry, and 297 tracts with less than 1% Chinese ancestry. There were more than 65,000 low-income women age 40 to 64 in the study area (mammogram patients were 63% Black, 23% Hispanic, 10% White, 2.5% Asian, and 2.5% other/unknown race and ethnicity). The increase in screening was greatest in Chinatown, although mean rates were not significantly different across the three areas (p = .07). Our results demonstrate large increases in mammography screening after ACA implementation in 20132014. The greatest increase occurred in the Chinatown patient navigation program area. The study provides a template for programs aimed at using public community-area data to evaluate programs for improving access to care and health equity.

Long-term relationships between screening rates, breast cancer characteristics, and overdiagnosis in US counties, 1975-2009.

Effects of mammography screening in the general population are disputed. Screening rates differ greatly between US counties, providing a natural opportunity to investigate effects of screening. We compared mammography screening rates with the types and outcomes of breast cancers diagnosed in US counties. The county screening rate was defined as the proportion of women age ≥40 with ≥1 mammogram in the past 2 years (range, 34-91%). Two periods were analyzed: 1975-2009 (612,941 breast cancer cases, 195 counties) and 1996-2009 (645,057 cases, 211-547 counties). Multiple signs of overdiagnosis were observed: First, breast cancer incidence increased as screening became common. Second, incidence stopped increasing once screening rates stabilized. Third, the increases in incidence were limited to age groups receiving screening. Fourth, the increases were larger in counties where screening became more common. Fifth, the increases were limited to small and early-stage breast cancers (which are consistent with overdiagnosis). Sixth, compensatory reductions in large and advanced-stage breast cancers were much smaller than the increases. Difference-in-differences regression analysis suggested 31% (95% CI: 28-34%) of breast cancers diagnosed in 1996-2009 were overdiagnosed. Screening rates correlated with increased incidence for all hormone receptor statuses, HER2 statuses, and grades. Reductions in breast cancer mortality during 1975-2009 were similar in screened and unscreened age groups. Overall, we found repeated signs that breast cancer overdiagnosis is widespread in the US, but the biological nature of overdiagnosed tumors remains unclear. Mortality benefits of screening, though they may be present and substantial, could not be detected at the population level.

Impact of Mammography Screening Rates on Breast Cancer Mortality in Nevada (NV), California (CA) and US: Implications for Health Care Policy

Impact of Mammography Screening Rates on Breast Cancer Mortality in Nevada (NV), California (CA) and US: Implications for Health Care Policy

Factors Associated with Adherence to Mammography Screening Among Insured Women Differ by Income Levels.

Breast cancer is the second leading cause of cancer mortality, yet mammography screening rates remain less than optimal and differ by income levels. The purpose of this study was to compare factors predicting mammography adherence across income groups. Women 41 to 75years of age (N=1,681) with health insurance and with no mammogram in the last 15months were enrolled to participate in an interventional study. Binary logistic regression was used to estimate multivariable-adjusted odds ratios (ORs) for demographic and health belief factors predicting mammography adherence for each income group: 1) low, less than $30,000, 2) middle, $30,000 to 75,000, and 3) high, greater than $75,000 per year. Being in the contemplation stage (vs. precontemplation) of obtaining a mammogram predicted mammography adherence across all income groups and was the only predictor in the middle-income group (OR, 3.9; 95% CI, 2.61-5.89). Increase in age was associated with 5% increase (per year increase in age) in mammography adherence for low-income (OR, 1.05; 95% CI, 1.01-1.09) and high-income (OR, 1.05; 95% CI, 1.02-1.08) women. Having a doctor recommendation predicted mammography adherence only in low-income women (OR, 10.6; 95% CI, 2.33-48.26), whereas an increase in perceived barriers predicted mammography adherence only among high-income women (OR, 0.96; 95% CI, 0.94-0.99). In a post hoc analysis, high-income women reported difficulty in remembering appointments (53%) and lack of time to get a mammogram (24%) as key barriers. For all income groups, being in contemplation of obtaining a mammogram predicted mammography adherence; however, age predicted mammography adherence for low- and high-income groups, whereas doctor recommendation and perceived barriers were unique predictors for low- and high-income women, respectively. Health care providers should be aware of differences in factors and emphasize strategies that increase mammography adherence for each income group.

Abstract IA15: Neighborhood factors and changes in mammography screening rates in response to promotora intervention in Latinas

Abstract Latinas have relatively low rates of mammography screening participation, which may contribute to later stage of breast cancer at diagnosis for Latinas, and also higher mortality rates following cancer diagnosis. We conducted a multilevel intervention study (¡Fortaleza Latina!) to increase breast cancer screening among Latinas in Western Washington who seek care at a safety net health center. We were also interested in discovering if and how neighborhood factors may be associated with Latinas' barriers to or uptake of cancer screening, including mammography. We examined neighborhood racial/ethnic composition and socioeconomic status in relation to these factors. The study enrolled 536 Latinas ages 42 to 74 who had a primary care clinic visit in the previous 5 years and had not obtained a mammogram in the previous 2 years. Participants were block randomized within clinic to either (i) a control arm (usual care) or (ii) a promotora-led, motivational interviewing intervention that included a home visit and telephone follow-up. At the clinic level, two of four participating clinics were provided additional mammography services delivered by a mobile mammography unit. Barriers to obtaining mammography were categorized into knowledge, psychocultural, and economic. American Community Survey (2007-2011) data were used to calculate four neighborhood measures: socioeconomic-based concentration, socioeconomic-based segregation, Latino-based concentration, and Latino-based segregation. Rates of screening mammography one year post-randomization were 19.6% in the intervention group and 11.0% in the usual care group (P < 0.01), based on medical record data. No significant differences in participants' mammography screening were observed in clinics assigned to additional mammography services versus usual care (15.8% vs. 14.4%; P = 0.68). Thirty-five percent and 31% of women attributed failure to complete mammography screening to knowledge-based or economic reasons, respectively. These attribution percentages varied significantly by Latino-based segregation (P<0.05). In addition, relative to women residing in areas with greater concentration of Latinos, women in areas with the lowest concentrations were less likely to report knowledge-based reasons for not obtaining a mammogram (p ≤ 0.05). In conclusion, the multilevel intervention of promotora-delivered motivational interviewing and free mammography services modestly raised rates of participation in breast cancer screening among Latinas. Future research might examine the mediating role of neighborhood characteristics in the efficacy of mammography screening interventions. Citation Format: Shirley A.A. Beresford, Yamile Molina, Jesse J. Plascak, Donald L. Patrick, Gloria D. Coronado. Neighborhood factors and changes in mammography screening rates in response to promotora intervention in Latinas [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr IA15.

Abstract 4241: Associations between perceived medical device-related radiation harm and adherence to mammography screening guidelines

Abstract Introduction: Many forms of cancer screening involve imaging technologies utilizing radiation. Broad media coverage of radiation-related health risks may shape the public's perceptions of imaging-based cancer screening, such as mammography. In turn, this may impact patient outcomes by affecting cancer screening decisions. Our primary aim was to evaluate population differences in beliefs about medical radiation exposure in the United States and associations with mammography screening rates in women. Methods: We analyzed data from the National Cancer Institute's Health Information National Trends Survey (HINTS) 2012 administration. Bivariate and multivariate regression analyses were used to evaluate associations of sex, ethnicity, age, annual income, and education with perceptions of harm from medical test radiation exposure. Additional analyses evaluated the role of radiation perception on compliance with current mammography screening recommendations from the United States Preventive Services Task Force. Results: Approximately one-third of respondents indicated that they worried about medical imaging-related radiation exposure. Respondents who perceived medical imaging radiation as harmful to health were more likely to be female, be diagnosed with cancer, have less formal education, report lower socioeconomic status, and identify as an ethnic minority. Most female participants were not in compliance with current breast cancer screening recommendations (weighted percentage = 83.8%). Annual income (p = 0.042) and ethnicity (p = 0.0478) were two variables that were significantly associated with adherence to the recommended mammography screening paradigm. Women without health insurance were more likely to worry about medical imaging-related radiation (p=0.073). Neither health insurance (95%CI = 0.29, 4.99) nor excess worry about radiation exposure from medical imaging devices (95%CI=0.42, 1.89) predicted compliance to mammography screening, after adjusting for relevant sociodemographic variables. Conclusions: These results indicate that some populations may be more concerned about harm from medical device-related radiation than others. Identifying these populations may help improve future cancer patient outcomes by promoting targeted health interventions and communication strategies for these individuals. Women may be more likely to perceive medical imaging radiation exposure as harmful to health, however this alone could not account for why the majority of female respondents were not adhering to recommended mammograms screening guidelines. Future studies are needed to identify the major contributor to low breast cancer screening rates in the United States. Citation Format: Kekoa Taparra, Kay M. Pepin, Alexandra J. Greenberg-Worisek. Associations between perceived medical device-related radiation harm and adherence to mammography screening guidelines [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4241.

Geographic Variation in Gender Disparities in the US Radiologist Workforce

PurposeTo assess geographic variation in gender disparities in the US radiologist workforce. MethodsGender, location, and practice affiliation of all radiologists and gender of all nonradiologists were identified for all providers listed in the Medicare Physician Compare database. Variation in female representation among radiologists was summarized at state, county, and individual practice levels, and associations with a variety of county-level population characteristics were explored. ResultsNationally, 23.1% (7,501 of 32,429) of all radiologists were women versus 46.6% (481,831 of 1,034,909) of Medicare-participating nonradiologists. At the state level, female representation among radiologists was overall highest in the Northeast and Mid-Atlantic regions (Washington DC, 39.3%; Massachusetts, 34.3%; Maryland, 31.5%) and lowest in the West and Midwest (Wyoming, 9.0%; Montana, 10.7%; Idaho, 11.7%). At the county level, female representation varied from 0.0% to 100.0%, with weak positive correlations with county-level population (r = +0.39), median household income (r = +0.25), college education (r = +0.23), English nonproficiency (r = +0.21), mammography screening rates (r = +0.12), Democratic voting in the 2016 presidential election (r = +0.28), and weak negative correlation with county-level rural population percentage (r = −0.32). Among practices with ≥10 members, female representation varied greatly (0.0% to 100.0%). Female representation was higher among academic (32.3%) than nonacademic (20.6%) radiologists, and in states with higher female-to-male relative earnings (r = +0.556). ConclusionCompared with nonradiologists, women are underrepresented in the national radiologist workforce. This underrepresentation is highly variable at state, county, and practice levels and is partially explained by a variety of demographic, socioeconomic, and political factors. These insights could help inform and drive initiatives to reduce gender disparities and more actively engage women in the specialty.

Breast cancer screening and outcomes: an ecological study of county-level female Veteran population density and social vulnerability

Introduction: Previous studies have shown that breast cancer incidence rates are higher among female Veterans than the general population due to factors such as increased lifetime exposure to breast cancer risk factors or more accurate detection and surveillance. The present study explored relationships between nationally representative county-level breast cancer outcomes, mammography screening rates, female Veteran population density, and social vulnerability. Methods: Data for the present ecological study were obtained at the county level from the United States Census Bureau, the University of South Carolina's Hazards and Vulnerability Research Institute (HVRI), and the National Cancer Institute. We conducted ordinary least squares (OLS) multiple regression analyses to determine the relative influence of female Veteran population density, social vulnerability, and mammography screening rates on breast cancer incidence and mortality rates between 2010 and 2014. County-level covariates such as liquor store density, cigarette smoking prevalence, air pollution, and access to healthy foods, were entered into each model to determine the unique influence of each of the main study variables on breast cancer outcomes. Results: County-level breast cancer incidence rates were higher in counties with greater female Veteran population density, lower social vulnerability, and higher mammography screening rates ( n=2,698, F=33.669, p<0.001). County-level breast cancer mortality rates were higher in counties with lower female Veteran population density, higher social vulnerability, and lower mammography screening rates ( n=1,803, F=18.180, p<0.001). Discussion: The results of the present exploratory study were preliminary, and thus further research on relationships examined in this study are needed. However, because female Veterans were shown to live in counties with relatively high mammography screening rates and lower social vulnerability, their risk for mortality from breast cancer may be lower than for the general population – in particular due to early detection and treatment.

Lack of Impact of the 2009 USPSTF Guidelines on Rates of Mammography Screening.

In November 2009, the United States Preventive Services Task Force (USPSTF) changed their mammography screening guidelines from recommending a screen every 1-2 years for women older than 40 years. The revised guideline recommends against regular screening for women aged 40-49 and recommends biennial screening for women aged 50-74. We used autoregressive integrated moving-average (ARIMA) time series modeling to estimate the effect of the USPSTF 2009 guidelines on trends in screening rates. Enrollment and encounter files from the PharMetrics LifeLink+ commercial insurance claims database, years 2006-2014, were linked to determine monthly screening rates. The main outcome measure was mammography screening rates per 1,000 commercially insured women aged 40-49 or aged 50-64. The study sample included 493,347 women aged 40-49 years with at least 1 month of eligibility and 658,052 women aged 50-64 years with at least 1 month of eligibility. There were 1,305,375 total screening mammograms from 2007 to 2014. Average monthly mammography screening rates from 2007 to 2014 were 40.4 per 1,000 women aged 40-49 and 54.8 per 1,000 women aged 50-64. There was a temporary decline in monthly screening rates of 11.8% and 11.2% for the 40-49 and 50-64 age groups, respectively, in the 2-month period after the guideline change (January and February 2010), but the rates quickly returned to pre-USPSTF trend levels afterward. Implementation of the USPSTF 2009 guidelines was not associated with a persistent long-term change in mammography screening rates over the next 5 years, despite a temporary decline of 2 months immediately following the guidelines.

Screening Mammography and Digital Breast Tomosynthesis: Utilization Updates

There have been many recent developments in breast imaging, including the 2009 revision of the U.S. Preventive Services Task Force's breast cancer screening guidelines and the approval of digital breast tomosynthesis (DBT) for clinical use in 2011. The objective of this study is to evaluate screening mammography utilization trends among the Medicare population from 2005 to 2015 and examine the volume of DBT studies performed in 2015, the first year for which procedural billing codes for DBT are available. We reviewed national Medicare Part B Physician/Supplier Procedure Summary master files from 2005 to 2015, to determine the annual utilization rate of screening mammography on the basis of procedure codes used for film-screen and digital screening mammography. We also used the Physician/Supplier Procedure Summary master files to determine the volume of screening and diagnostic DBT studies performed in 2015. The utilization rate of screening mammography per 1000 women in the Medicare fee-for-service population increased gradually every year, from 311.5 examinations in 2005 to a peak of 322.9 examinations in 2009, representing a compound annual growth rate of 0.9%. In 2010, the utilization rate abruptly decreased by 4.3% to 309.2 examinations, and it has not since recovered to pre-2010 levels. In 2015, 18.9% of screening and 16.2% of diagnostic digital mammography examinations included DBT as an add-on procedure. In contrast to the annual increase in screening mammography utilization from 2005 to 2009, an abrupt sustained decline in screening occurred beginning in 2010, coinciding with the release of U.S. Preventive Services Task Force recommendations. DBT utilization was somewhat limited in 2015, occurring in conjunction with less than 20% of digital mammography examinations.

Psychosocial predictors of mammography history among Chinese American women without a recent mammogram

ABSTRACT Chinese American women have lower rates of mammography screening compared with non-Hispanic White women. Although the extent of perceived barriers, as conceptualized by the Health Belief Model, have been shown to distinguish between currently non-adherent Chinese American women who have ever and never had a mammogram, it is less clear which types of perceived barriers differentiate them. One hundred twenty-eight Chinese American women in the New York metropolitan area who had not had a mammogram in the past year completed baseline assessments for a mammography framing intervention study. Demographics, medical access variables, and perceived barriers to mammography (lack of access, lack of need for screening, and modesty) were used to predict mammography history (ever versus never screened). Fifty-five women (43%) reported having been screened at least once. A sequential logistic regression showed that English speaking ability and having health insurance significantly predicted mammography history. However, these control variables became non-significant when the three barrier factors were included in the final model. Women who reported a greater lack of access (OR = 0.36, p < .05) and greater lack of need (OR = 0.27, p < .01) were less likely to be ever screeners. Unexpectedly, women who reported greater modesty were more likely to be ever screeners (OR = 4.78, p < .001). The results suggest that interventions for Chinese American women should identify and target specific perceived barriers with consideration of previous adherence.

Elimination of Cost Sharing for Screening Mammography in Medicare Advantage Plans

BackgroundThe Affordable Care Act (ACA) required most insurers and the Medicare program to eliminate cost sharing for screening mammography.MethodsWe conducted a difference-in-differences study of biennial screening mammography among 15,085 women 65 to 74 years of age in 24 Medicare Advantage plans that eliminated cost sharing to provide full coverage for screening mammography, as compared with 52,035 women in 48 matched control plans that had and maintained full coverage.ResultsIn plans that eliminated cost sharing, adjusted rates of biennial screening mammography increased from 59.9% (95% confidence interval [CI], 54.9 to 65.0) in the 2-year period before cost-sharing elimination to 65.4% (95% CI, 61.8 to 69.0) in the 2-year period thereafter. In control plans, the rates of biennial mammography were 73.1% (95% CI, 69.2 to 77.0) and 72.8% (95% CI, 69.7 to 76.0) during the same periods, yielding a difference in differences of 5.7 percentage points (95% CI, 3.0 to 8.4). The difference in differences was 9.8 percentage points (95% CI, 4.5 to 15.2) among women living in the areas with the highest quartile of educational attainment versus 4.3 percentage points (95% CI, 0.2 to 8.4) among women in the lowest quartile. As indicated by the difference-in-differences estimates, after the elimination of cost sharing, the rate of biennial mammography increased by 6.5 percentage points (95% CI, 3.7 to 9.4) for white women and 8.4 percentage points (95% CI, 2.5 to 14.4) for black women but was almost unchanged for Hispanic women (0.4 percentage points; 95% CI, −7.3 to 8.1).ConclusionsThe elimination of cost sharing for screening mammography under the ACA was associated with an increase in rates of use of this service among older women for whom screening is recommended. The effect was attenuated among women living in areas with lower educational attainment and was negligible among Hispanic women. (Funded by the National Institute on Aging.)

Associations of County-level Radiologist and Mammography Facility Supply with Screening Mammography Rates in the United States

The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%-88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22-0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06-0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.

Systematic Review of Mammography Screening Educational Interventions for Hispanic Women in the United States.

In the United States (U.S.), Hispanics experience breast cancer disparities. Breast cancer is the leading cause of cancer-related death among Hispanic women, and Hispanic women receive mammography screening at lower rates than some other ethnic groups. This low rate of screening mammography is associated with increased risk for possible late-stage diagnosis and lower survival rates. Educational interventions could play a role in increasing screening mammography rates among Hispanic women. This systematic review synthesized the current literature on educational interventions to increase mammography screening among Hispanic women. The review included studies published between May 2003 and September 2017 with experimental and quasi-experimental interventions to increase mammography screening among Hispanics in the U.S. Five studies out of an initial 269 studies met inclusion criteria for the review. All studies employed an interpersonal intervention strategy with community health workers, or promotoras, to deliver the mammography screening intervention. For each study, odds ratios (OR) were calculated to estimate intervention effectiveness based on similar follow-up time periods. The study ORs resulted in a narrow range between 1.02 and 2.18, indicating a low to moderate intervention effect for these types of interpersonal cancer education interventions. The summary OR for the random effects model was 1.67 (CI 1.24-2.26). Hispanics exhibit lower levels of adherence to screening mammography than non-Hispanic whites. Interpersonal cancer education interventions such as the use of promotoras may help to mediate the impact of barriers to receiving a mammogram such as low health literacy, deficits in knowledge about the benefits of screening, and low awareness of the availability of screening services.

A County-Level Analysis of the US Radiologist Workforce: Physician Supply and Subspecialty Characteristics

PurposeTo explore associations between county-level measures of radiologist supply and subspecialization and county structural and health-related characteristics. MethodsMedicare Physician and Other Supplier Public Use Files were used to subspecialty characterize 32,844 radiologists participating in Medicare between 2012 and 2014. Measures of radiologist supply and subspecialization were computed for 3,143 US counties. Additional county characteristics were identified using the 2014 County Health Rankings database. Mann-Whitney tests and Spearman correlations were performed. ResultsCounties with at least one (versus no) Medicare-participating radiologist had significantly (P < .001) larger populations (197,050 ± 457,056 versus 20,253 ± 23,689), lower rural percentages (39.5% ± 26.5% versus 74.6% ± 25.6%), higher household incomes ($47,608 ± $12,493 versus $42,510 ± $9,893), higher mammography screening rates (62.4% ± 7.0% versus 56.6% ± 15.3%), and lower premature deaths (7,581 ± 2,085 versus 7,784 ± 3,409 years of life lost). Counties’ radiologists per 100,000 population and percent of subspecialized radiologists showed moderate positive correlations with counties’ population (r = +0.505-+0.599) and moderate negative correlations with counties’ rural percentage (r = −0.434 to −0.523). Radiologist supply and degree of subspecialization both showed concurrent positive or negative weak associations with counties’ percent age 65+ (r = −0.256 to −0.271), percent Hispanic (r = +0.209-+0.234), and income (r = +0.230-+0.316). Radiologists per 100,000 population showed weak positive correlation with mammography screening (r = +0.214); percent of radiologists subspecialized showed weak negative correlation with premature death (r = −0.226). ConclusionGeographic disparities in radiologist supply at the community level are compounded by superimposed variation in the degree of subspecialization of those radiologists. The potential impact of such access disparities on county-level health warrants further investigation.

Developing a Mass Media Campaign to Promote Mammography Awareness in African American Women in the Nation's Capital.

This study developed and examined the reach and impact of a culturally appropriate mass media campaign pilot, designed to increase awareness about the importance of mammography screening and the available community mammography services for low-income African American women ages 40 and above. We conducted formative research using focus groups to inform campaign development, resulting in five emergent themes-good breast health, holistic views of healthiness, cancer fatalism, fear of mammogram machines, and mammogram affordability. The campaign targeted specific low-income African American communities in the District of Columbia via print ads in Metro stations and on buses, print ads in the Washington Informer, and online ads on a local TV network website. Data were collected before, during, and after campaign implementation to assess reach and impact. Reach was measured by number of impressions (number of people exposed to the campaign), while impact was assessed via online ad click-through rates, website use and referrals, and mammography center calls. The campaign was successful in reaching the target audience, with a total combined reach from all media of 9,479,386 impressions. In addition, the mammography center received significant increases in new website visitors (1482 during the campaign, compared to 24 during the preceding period) as well as 97 calls to the dedicated phone line. Further research involving a more long-term investment in terms of funding and campaign run time, coupled with a more robust evaluation, is needed to assess if culturally appropriate mass media campaigns can generate increased mammography screening rates and decrease breast-cancer-related mortality.

Mobile Versus Fixed Facility: Latinas’ Attitudes and Preferences for Obtaining a Mammogram

PurposeMobile mammographic services have been proposed as a way to reduce Latinas’ disproportionate late-stage presentation compared with white women by increasing their access to mammography. The aims of this study were to assess why Latinas may not use mobile mammographic services and to explore their preferences after using these services. MethodsUsing a mixed-methods approach, a secondary analysis was conducted of baseline survey data (n = 538) from a randomized controlled trial to improve screening mammography rates among Latinas in Washington. Descriptive statistics and bivariate regression were used to characterize mammography location preferences and to test for associations with sociodemographic indices, health care access, and perceived breast cancer risk and beliefs. On the basis of these findings, a qualitative study (n = 18) was used to explore changes in perceptions after using mobile mammographic services. ResultsMore Latinas preferred obtaining a mammogram at a fixed facility (52.3% [n = 276]) compared with having no preference (46.3% [n = 249]) and preferring mobile mammographic services (1.7% [n = 9]). Concerns about privacy and comfort (15.6% [n = 84]) and about general quality (10.6% [n = 57]) were common reasons for preferring a fixed facility. Those with no history of mammography preferred a fixed facility (P < .05). In the qualitative study, Latinas expressed similar initial concerns but became positive toward the mobile mammographic services after obtaining a mammogram. ConclusionsAlthough most Latinas preferred obtaining a mammogram at a fixed facility, positive experiences with mobile mammography services changed their attitudes toward them. These findings highlight the need to include community education when using mobile mammographic service to increase screening mammography rates in underserved communities.

Recall Rate of Opportunistic Screening Mammography in a University Referral Breast Center in Iran

Background: No information has been published on the effectiveness of digital non-diagnostic opportunistic screening mammography in Iran that is measured by recall rate as one of its indices. Objectives: In this longitudinal study, we measured recall rate of non-diagnostic mammography at a tertiary referral university hospital and made a comparison with reported international data. Methods: We examined 9395 digital mammograms performed in 2014 - 2015 from which, 2930 were the first-time and 6465 were subsequent mammography. The patients were referred to the university hospital by their clinicians during annual check-ups while none of them had any chief complaint. The mean age was 49 years. We calculated recall rate, sensitivity, specificity, and cancer detection rate. Results: Breast cancer was diagnosed in 80 patients. Recall rates were 29% for the first-time and 22% for subsequent mammography, and the overall rate of cancer incidence was 8.5 per 1000 mammograms (80/9395) with specificity of 75.9%, sensitivity of 97.5%, PPV of 3.4%, and NPV of 99%. Conclusions: The recall rate was much higher in this setting than the acceptable range reported in literature. However, the sensitivity and detection rate were higher; thus, the higher recall rate could be due to some differences in the patient population such as being at younger ages and higher risks.

Healthcare Access and Cancer Screening Among Victims of Intimate Partner Violence.

Intimate partner violence (IPV) victims often experience substantial and persistent mental and physical health problems, including increased risk for chronic disease and barriers to healthcare access. This study investigated the association between IPV and cancer screening. Behavioral Risk Factor Surveillance System data from the eight states and one U.S. territory that administered the optional IPV module in 2006 were analyzed to examine demographic characteristics, health behaviors, health status, healthcare coverage, use of health services, and cancer screening among men and women who reported IPV victimization compared with those among men and women who did not. IPV victimization included physical violence, threats, and sexual violence. In the nine jurisdictions that administered the IPV module, 23.6% of women and 11.3% of men experienced IPV. Fewer women and men reporting IPV victimization had health insurance, a personal doctor or healthcare provider, or regular checkups within the past 2 years than nonvictims. More male and female IPV victims were current tobacco users and engaged in binge drinking in the past month. IPV victims of both sexes also had poorer health status, lower life satisfaction, less social and emotional support, and more days with poor physical and mental health in the past month than nonvictims. IPV victimization was associated with lower rates of mammography and colorectal cancer screening but not cervical cancer screening in women and was not associated with colorectal cancer screening in men. In multivariable logistic regression results presented as adjusted proportions controlling for demographics, health status, and healthcare access, only the association with mammography screening remained significant, and the magnitude of this association was modest. There were consistent differences between IPV victims and nonvictims in nearly every measure of healthcare access, health status, and preventive service use. Much of this association seems explained by population characteristics associated with both IPV and lower use of preventive service use, including differences in demographic characteristics, health status, and healthcare access. Healthcare providers could take steps to identify populations at high risk for lack of access or use of preventive services and IPV victimization.

Effectiveness of a Mobile Mammography Program.

Mobile mammography units have increasingly been used to address patient health care disparities; however, there are limited data comparing mobile units to stationary sites. This study aims to evaluate the characteristics of women who underwent mammography screening in a mobile unit versus those who underwent mammography screening at a cancer center. In this retrospective study, we analyzed all screening mammography examinations performed in a mobile unit in 2014 (n = 1433 examinations). For comparison, we randomized and reviewed an equivalent number of screening mammography examinations performed at our cancer center in 2014 (n = 1434 examinations). BI-RADS assessment, adherence to follow-up, biopsies performed, cancer detection rate, and sociodemographic variables were recorded. An independent-samples t test was conducted to identify potential differences in age between cancer center patients and mobile unit patients. Chi-square analyses were used to test for associations between location and factors such as health insurance, race, marital status, geographic area, adherence to screening guidelines, recall rate, adherence to follow-up, and cancer detection rates. Patients visiting our cancer center (mean = 57.74 years; SD = 10.55) were significantly older than those visiting the mobile unit (mean = 52.58 years; SD = 8.19; p < 0.001). There was a significant association between location and health insurance status (χ2 = 610.92; p < 0.001) with more uninsured patients undergoing screening in the mobile van (cancer center = 3.70%, mobile unit = 38.73%). There was a significant association between screening location and patient race (χ2 = 118.75, p < 0.001), with more white patients being screened at the cancer center (cancer center = 47.28%, mobile unit = 33.30%), more black patients being screened in the mobile van (cancer center = 49.30%, mobile unit = 54.15%), and more Hispanic patients being screened in the mobile van (cancer center = 1.05%, mobile unit = 6.77%). There was a significant association between location and patient marital status (χ2 = 135.61, p < 0.001), with more married patients screened at the cancer center (cancer center = 49.16%, mobile unit = 38.31%), more single patients screened in the mobile van (cancer center = 25.17%, mobile unit = 34.47%), and more widowed patients being screened at the cancer center (cancer center = 8.09%, mobile unit = 4.47%). There was a significant association between location and geographic area (χ2 = 33.33, p < 0.001), with both locations reaching more urban than rural patients (cancer center = 79.99%, mobile unit = 70.62%). There was a significant association between location and adherence to screening guidelines (χ2 = 179.60, p < 0.001), with patients screened at the cancer center being more compliant (cancer center = 56.90%, mobile unit = 34.47%). Finally, there was a significant association between location and recall rate (χ2 = 4.06, p < 0.001). The cancer center had a lower recall rate (13.32%) than the mobile van (15.98%). Of those patients with BI-RADS 0, there was a significant association between location and adherence to follow-up (χ2 = 22.75, p < 0.001) with patients using the mobile unit less likely to return for additional imaging (cancer center = 2.65%, mobile unit = 17.03%). Significant differences were found among patients visiting the cancer center versus the mobile mammography van. The cancer center's population is older and more adherent to guidelines, whereas the mobile mammography population exhibited greater racial and marital diversity, higher recall rate, and lack of adherence to follow-up recommendations. By identifying these characteristics, we can develop programs and materials that meet these populations' needs and behaviors, ultimately increasing mammography screening and follow-up rates among underserved populations.