TY - JOUR
T1 - Realizing the promise of breast cancer screening
T2 - Clinical follow-up after abnormal screening among Black women
AU - Kerner, Jon F.
AU - Yedidia, Michael
AU - Padgett, Deborah
AU - Muth, Barbara
AU - Washington, Kathleen Shakira
AU - Tefft, Mariella
AU - Yabroff, K. Robin
AU - Makariou, Erini
AU - Freeman, Harold
AU - Mandelblatt, Jeanne S.
N1 - Funding Information:
The study investigators thank the dedication and hard work of members of the research team, particularly the clinical and administrative staff from the Breast Examination Center of Harlem, the Cancer Control Center of Harlem, and the Catholic Medical Center, without whom the completion of this study would not have been possible. A special thanks is directed to Ms. Joscelyn Silsby, M.P.H., who served as the research project coordinator for the study in Washington DC. Dr. Dana-Ain Davis and Ms. Jannette Walker, M.P.H., played key roles by providing able research assistance and conducting the interviews at NYU. Leka Murdoch, from Harlem Hospital, whose efforts to track down and abstract medical records from multiple hospitals and physician office practices were essential. Dr. David Dershaw, in the Department of Diagnostic Radiology at Memorial Sloan-Kettering Cancer Center, was instrumental in assisting the investigators in obtaining lists of names of Breast Examination Center of Harlem patients with abnormal mammograms. Finally, we express our special thanks to the women who agreed to share with us their experiences of following up on their abnormal mammograms. This work was supported by NCI Grant R01 CA 65881 (Dr. Kerner), Agency for Health Care Research and Quality Grant RO1 HS 08395 (Dr. Mandelblatt), and National Cancer Institute Grant RO1 CA72908 (Dr. Mandelblatt). Portions of this work were completed while Drs. Kerner and Mandelblatt were at Memorial Sloan-Kettering Cancer Center, New York, New York, and while Dr. Kerner was at the Lombardi Cancer Center, Washington, DC.
PY - 2003/8/1
Y1 - 2003/8/1
N2 - Background. Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics. Methods. We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding. Results. Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92). Conclusions. Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.
AB - Background. Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics. Methods. We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding. Results. Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92). Conclusions. Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.
KW - Adherence
KW - Follow-up studies
KW - Mammography
KW - Mass screening
KW - Social class
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U2 - 10.1016/S0091-7435(03)00087-2
DO - 10.1016/S0091-7435(03)00087-2
M3 - Article
C2 - 12855208
AN - SCOPUS:0038011588
SN - 0091-7435
VL - 37
SP - 92
EP - 101
JO - Preventive Medicine
JF - Preventive Medicine
IS - 2
ER -