Breast and Cervical Cancer Screening of Poor, Elderly, Black Women: Clinical Results and Implications

Mandelblatt, Jeanne; Traxler, Maryann; Lakin, Patricia; Kanetsky, Peter A.; Thomas, Louis B.; Chauhan, Prem M. S.; Matseoane, Stephen; Ramsey, Elizabeth E.

doi:10.1016/s0749-3797(18)30728-1

Cited by 39 publications

(24 citation statements)

References 31 publications

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“…Overall, an estimated 2-3%, or 20-30 per 1000 Pap smears are abnormal among women over age 60. 26 In small studies in the USA [27][28][29] and Great Britain, 30 similar proportions of elderly women -between 20 and 60 per 1000 -required further evaluation after a Pap smear. In the only previous population-based study of downstream interventions, 7.6 per 1000 Australian women age 65 and older undergoing a Pap smear required colposcopy 31 -nearly identical to the proportion undergoing colposcopy among our Medicare Screening cohort.…”

Section: Discussionmentioning

confidence: 99%

“…Rates of refusal of follow-up were high, and not uncommonly, some participants went to hysterectomy only to nd no malignancy detected, while others died of unrelated causes while undergoing evaluation. [27][28][29] Medicare has provided reimbursement for Pap smear screening only since 1990, largely motivated by ndings that up to 40% of elderly women in the United States had never had a Pap smear. [34][35][36][37] Women never screened, who have the highest incidence of and mortality from cervical cancer and the lowest likelihood of future screening 38 , bene t the most from screening.…”

Section: Discussionmentioning

confidence: 99%

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The burden of prevention: downstream consequences of Pap smear testing in the elderly

2003

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Context:Although cervical cancer is an unusual cause of death among women 65 and older, most elderly women in the US report continuing to undergo periodic Pap smear screening. Objective: Conclusion:Cervical cancer screening is widespread among elderly American women, and follow-up testing is not uncommon, particularly among the ten percent of women who appear to be in a cycle of repeated testing. This substantial volume of testing occurs despite the rarity of cervical cancer deaths and unknown bene ts of screening in this age group.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The burden of prevention: downstream consequences of Pap smear testing in the elderly

2003

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“…cancer screening) that are desired and appreciated by the underserved population of interest. Thus, collecting molecular markers from medically underserved patients recruited for a cancer screening trial [7], with full informed consent, can provide an excellent opportunity to study biological variation in a high-risk population which would be unlikely to consent to a strictly obser-vational study alone.…”

Section: Epidemiology and Preventionmentioning

confidence: 99%

“…With respect to patient delay, she reviews two studies [15,16] which indicate that misunderstanding mammography findings, nonspecific fears, low perceived risk of breast cancer, and the perception that nothing was wrong may have all contributed to patient delay. Provider delay can be overcome with the use of computerized reminder systems to patients and providers.…”

Section: Early Detectionmentioning

confidence: 99%

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Breast cancer prevention and control among the medically underserved

Kerner

1996

Breast Cancer Res Tr

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In 1986, the National Cancer Institute published its cancer control objectives for the nation, which included projected reductions in breast cancer mortality. The reductions were estimated to be 25.0% from reducing fat, 16.0% from expanding use of breast cancer screening services, and 14.3% from expanding access to state-of-the-art breast cancer treatment. During the same decade, the U.S. population aged and became significantly more ethnically diverse, and accompanying this increase in ethnic diversity was endemic poverty, disproportionately experienced by black and Hispanic minorities. These populations may be seen as medically underserved. With respect to breast cancer, as well as many other cancers, the medically underserved are understudied, not well understood by many in the medical and academic research community, and attended by health care institutions that are under-funded and often do not have the resources necessary to ensure access to state-of-the-art cancer screening, clinical follow-up, diagnosis, and treatment. At the same time, medically underserved women are more likely to be diagnosed with late-stage breast cancer, and some groups (e.g. black women) bear the greatest breast cancer mortality burden in the nation. In this special issue of Breast Cancer Research and Treatment, eight papers describe what we know and what we don't about breast cancer prevention and control in medically underserved populations.

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