Breast cancer control among the underserved — An overview

Breen, Nancy; Kessler, Larry G.; Brown, Martin L.

doi:10.1007/bf01806006

Cited by 49 publications

(39 citation statements)

References 63 publications

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“…[61][62][63][64][65][66] Although intensive, a lay health advisor network intervention, supplemented by efforts to increase access and quality, appears effective and may be the best community-based approach for increasing mammography use among lower income, rural African American women. Such interventions should be carefully targeted to this group to achieve a maximum effect.…”

Section: Discussionmentioning

confidence: 99%

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

Earp

Eng²,

O’Malley³

et al. 2002

Am J Public Health

192

172

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Objectives. A community trial was undertaken to evaluate the effectiveness of the North Carolina Breast Cancer Screening Program, a lay health advisor network intervention intended to increase screening among rural African American women 50 years and older.Methods. A stratified random sample of 801 African American women completed baseline (1993-1994) and follow-up (1996-1997) surveys.The primary outcome was self-reported mammography use in the previous 2 years.Results. The intervention was associated with an overall 6 percentage point increase (95% confidence interval [CI] = −1, 14) in communitywide mammography use. Low-income women in intervention counties showed an 11 percentage point increase (95% CI = 2, 21) in use above that exhibited by lowincome women in comparison counties. Adjustment for potentially confounding characteristics did not change the results.Conclusions. A lay health advisor intervention appears to be an effective public health approach to increasing use of screening mammography among low-income, rural populations.

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Section: Discussionmentioning

confidence: 99%

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

Earp

Eng²,

O’Malley³

et al. 2002

Am J Public Health

192

172

View full text Add to dashboard Cite

show abstract

“…2 Low-income women without insurance have lower rates of mammography screening, 3,4 and they may experience additional burdens and barriers in receiving optimal diagnosis and treatment. 5 Furthermore, more socioeconomically disadvantaged regions of the country have a higher breast cancer mortality rate. 6 The benefits of mammography are well known, and it is generally accepted that breast cancers detected by mammography screening are of smaller size and have better histological features than tumors detected otherwise.…”

Section: Introductionmentioning

confidence: 99%

Method of Detection of Breast Cancer in Low-Income Women

Thind

Diamant

Hoq

et al. 2009

Journal of Women's Health

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Background: Breast cancer is the most common malignancy among women, and its timely diagnosis and treatment are of paramount importance, especially for vulnerable groups, such as low-income and uninsured women. Recent literature confirms that the method of breast cancer detection may be an important prognostic factor, but there are no studies that examine the method of breast cancer detection in low-income populations. We sought to analyze the determinants of method of detection (medical vs. self) in a cohort of low-income women with breast cancer receiving care through California's Breast and Cervical Cancer Treatment Program. Methods: This is a cross-sectional survey analysis of 921 low-income women interviewed within 6 months of definitive surgical treatment. The outcome analyzed was self vs. medical detection of breast cancer. Results: The mean age of the women was 53 years, with nearly 88% reporting an income of <$30,000 per year; 64% of women self-detected their breast cancer. Logistic regression analyses revealed that older women, Latinas, and women having any health insurance before diagnosis had lower odds of self-detecting their lesions. Conclusions: Patient age, ethnicity, and regular source of care were associated with method of breast cancer detection in a low-income underserved population. The rate of self-detection in our population correlates with the literature, but we need to improve efforts to increase mammography screening to ensure early detection of disease in this vulnerable group.

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“…These barriers include being uninsured or insured insufficiently through Medicaid or other public insurance programs 1,5,8 -14 ; lower levels of health literacy or education that may contribute to fears of cancer screening and/or diagnosis 2,10,12,14,15 ; cultural orientations that contribute to lack of trust in medical institutions or fatalism regarding cancer 2,5,[12][13][14][15][16][17] ; logistic barriers due to lack of transportation, child-care commitments, clinic schedules, and rural residence 1,2,5,8,12,15,16,18 ; and difficulties negotiating relationships with providers or healthcare organizations arising from language or cultural differences. 1,2,9,18 Patient navigator programs seek to reduce disparities by addressing these barriers. The first navigation program was established in New York in the early 1990s with support from the American Cancer Society (ACS).…”

mentioning

confidence: 99%

Using navigators to improve care of underserved patients

Dohan

Schrag

2005

Cancer

402

371

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BACKGROUNDLogistic, cultural, educational, and other barriers can impede the delivery of high‐quality cancer care to underserved patients. Patient navigation services represent one innovation for addressing perceived barriers to care encountered by disadvantaged patients. In this report, the authors have 1) defined patient navigation, distinguishing it from other cancer support services; 2) described how programs are organized; and 3) discussed the need for research on program effectiveness.METHODSInformation was examined on navigation programs published in the scientific literature and on line. Qualitative research also was conducted, consisting of direct observation of patient care in cancer clinics with and without navigators in northern California, in‐person interviews with personnel and patients in the clinics observed, and telephone interviews with navigators at four sites across the United States.RESULTSThe authors found that navigation services have been implemented at all stages of cancer care: prevention, screening, treatment, and survival. Navigators differ from other cancer support personnel in their orientation toward flexible problem solving to overcome perceived barriers to care rather than the provision of a predefined set of services. There are no rigorous demonstrations of the effects and effectiveness of navigation, although such studies are underway.CONCLUSIONSCurrently, patient navigation is understudied, and literature documenting its effects and effectiveness is scant. Rigorous studies are needed of the navigator role and program costs and benefits. Such studies will facilitate an assessment of program effectiveness, feasibility across a range of health care settings, and performance relative to alternative approaches for addressing barriers to care among the underserved. Cancer 2005. © 2005 American Cancer Society.

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Breast cancer control among the underserved — An overview

Cited by 49 publications

References 63 publications

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

Increasing Use of Mammography Among Older, Rural African American Women: Results From a Community Trial

Method of Detection of Breast Cancer in Low-Income Women

Using navigators to improve care of underserved patients

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