Barriers to mammography screening among racial and ethnic minority women

Miller, Brittany C.; Bowers, Jennifer Muir; Payne, Jackelyn B.; Moyer, Anne

doi:10.1016/j.socscimed.2019.112494

Cited by 92 publications

(62 citation statements)

References 56 publications

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“…Indicated by this review, research efforts to address mammography screening inequities continue to prioritize underuse among racial/ethnic minority groups. Consistent with published research, older racial/ethnic minority women experience a variety of attitudinal, personal, and structural barriers to screening mammography [14,79,80]. Mammography underuse among population groups experiencing inequities in late stage breast cancer and mortality risk remains an important priority area.…”

Section: Discussionmentioning

confidence: 70%

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

et al. 2020

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Purpose of Review Examining what older women know and perceive about mammography screening is critical for understanding patterns of under- and overuse, and concordance with screening mammography guidelines in the USA. This narrative review synthesizes qualitative and quantitative evidence around older women’s perspectives toward mammography screening. Recent Findings The majority of 43 identified studies focused on promoting mammography screening in women of different ages, with only four studies focusing on the overuse of mammography in women ≥ 70 years old. Older women hold positive attitudes around screening, perceive breast cancer as serious, believe the benefits outweigh the barriers, and are worried about undergoing treatment if diagnosed. Older women have limited knowledge of screening guidelines and potential harms of screening. Summary Efforts to address inequities in mammography access and underuse need to be supplemented by epidemiologic and interventional studies using mixed-methods approaches to improve awareness of benefits and harms of mammography screening in older racially and ethnically diverse women. As uncertainty around how best to approach mammography screening in older women remains, understanding women’s perspectives along with healthcare provider and system-level factors is critical for ensuring appropriate and equitable mammography screening use in older women.

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Section: Discussionmentioning

confidence: 70%

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

et al. 2020

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“…But unlike those with advanced age and/or Medicare, underserved women were already more likely to cancel and less likely to reschedule their missed screening mammogram before the pandemic; these findings were confirmed by our data and reported in previous literature 1. , 5. , [6] , [22] , 23.…”

Section: Discussionmentioning

confidence: 99%

Patients characteristics related to screening mammography cancellation and rescheduling rates during the COVID-19 pandemic

et al. 2021

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Purpose To identify patient characteristics associated with screening mammography cancellations and rescheduling during the COVID-19 pandemic. Methods Scheduled screening mammograms during three time periods were retrospectively reviewed: state-mandated shutdown (3/17/2020-6/16/2020) during which screening mammography was cancelled, a period of 2 months immediately after screening mammography resumed (6/17/2020-8/16/2020), and a representative period prior to COVID-19 (6/17/2019-8/16/2019). Relative risk of cancellation before COVID-19 and after reopening was compared for age, race/ethnicity, insurance, history of chronic disease, and exam location, controlling for other collected variables. Risk of failure to reschedule was similarly compared between all 3 time periods. Results Overall cancellation rate after reopening was higher than before shutdown (7663/16595, 46% vs 5807/15792, 37%; p < 0.001). Relative risk of cancellation after reopening increased with age (1.20 vs 1.27 vs 1.36 for ages at 25th, 50th, and 75th quartile or 53, 61, and 70 years, respectively, p < 0.001). Relative risk of cancellation was also higher among Medicare patients (1.41) compared to Medicaid and those with other providers (1.26 and 1.21, respectively, p < 0.001) and non-whites compared to whites (1.34 vs 1.25, p = 0.03). Rescheduling rate during shutdown was higher than before COVID-19 and after reopening for all patients (10,658/13593, 78%, 3569/5807, 61%, and 4243/7663, respectively, 55%, p < 0.001). Relative risk of failure to reschedule missed mammogram was higher in hospitals compared to outpatient settings both during shutdown and after reopening (0.62 vs 0.54, p = 0.005 and 1.29 vs 1.03, p < 0.001, respectively). Conclusion Minority race/ethnicity, Medicare insurance, and advanced age were associated with increased risk of screening mammogram cancellation during COVID-19.

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“… 2 , 3 There are multiple barriers to both initial access and follow-up in these populations, including lack of insurance coverage and transportation, incomplete education and knowledge about health care screening guidelines, and language and cultural barriers. 12 Many of these barriers are not easily addressed at the level of health care delivery and will require changes in health care policy. However, removing as many barriers as possible at the level of the patient’s initial interface with the health care system is crucial to promoting access for vulnerable populations.…”

Section: Discussionmentioning

confidence: 99%

Assessing Biomarkers of Breast Cancer Risk in Underserved Women in a Midwestern County

DeWitt

Croghan

Vachon

et al. 2021

J Prim Care Community Health

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Objective: The primary aim of this study was to evaluate the feasibility of collecting risk factor information and accessing digitized mammographic data in a medically marginalized population. A secondary aim was to examine the association between vitamin D status and mammographic density. Methods: Breast-screening examinations were provided for age-appropriate patients, and a referral for no-cost screening mammography was offered. Study participants were asked to undergo 25-hydroxyvitamin D testing at mammography and 1-year follow-up. Results: Of 62 women approached, 35 (56%) consented to participate. Of 32 participants who had baseline mammography, the median mammographic density measured by VolparaDensity (Volpara Solutions Limited) was 5.7%. After 1 year, 9 women obtained follow-up mammograms, with a median density of 5.7%. Vitamin D status was measured for 31 participants at baseline and 13 participants in the following year. Insufficient vitamin D status (<30 ng/mL) was noted in 77% at each time point. Mammographic density was not significantly correlated with vitamin D status ( P = .06). Conclusions: On the basis of this small pilot study, vitamin D insufficiency is common in this study population. Owing to the small sample size, an association between vitamin D insufficiency and breast density was not clear. Additional unexpected findings included substantial barriers in initial access to care and longitudinal follow-up in this population. Further study of these issues is needed.

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Barriers to mammography screening among racial and ethnic minority women

Cited by 92 publications

References 56 publications

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

Older Women’s Perspectives Driving Mammography Screening Use and Overuse: a Narrative Review of Mixed-Methods Studies

Patients characteristics related to screening mammography cancellation and rescheduling rates during the COVID-19 pandemic

Assessing Biomarkers of Breast Cancer Risk in Underserved Women in a Midwestern County

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