Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012

Howard, David H.; Tangka, Florence; Royalty, Janet; Dalzell, Lucinda P.; Miller, Jacqueline W.; O’Hara, Brett; Joseph, Kristy; Kenney, Kristy; Guy, Gery P.; Hall, Ingrid J.

doi:10.1007/s10552-015-0553-0

Cited by 47 publications

(67 citation statements)

References 18 publications

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“…We used data on the number of women eligible and number of women screened to calculate the proportion of eligible women screened through the NBCCEDP. The complete methods for calculating the screening proportions are described elsewhere [5, 6]. …”

Section: Methodsmentioning

confidence: 99%

“…Women aged 18–64 receive cervical cancer screening (the age of eligibility was increased to 21 years in 2012 to align with updated clinical recommendations), and women aged 40–64 receive breast cancer screening [2–4]. About 11 % of US women were eligible for NBCCEDP cervical cancer screening and about 10 % for breast cancer screening [5, 6]. Since 1991, the NBCCEDP-funded programs in the states, District of Colombia (DC), territories, and tribes have screened more than 4.6 million women, provided more than 11.6 million breast and cervical cancer screening examinations, and diagnosed more than 64,718 breast cancers, 3,576 invasive cervical cancers, and 167,169 premalignant cervical lesions, of which 40 % were high grade (http://www.cdc.gov/cancer/nbccedp/about.htm).…”

Section: Introductionmentioning

confidence: 99%

“…Based on NBCCEDP data from selected years during the period from 2010 to 2012, it is estimated that the NBCCEDP screened on average 10.6 % of eligible women for breast cancer and 6.5 % of those eligible for cervical cancer using federal funds [5, 6]. In addition, there was substantial variation across grantees, with screening proportions for NBCCEDP-funded services varying from 1.6 to 52.8 % for breast cancer and 1.5 to 32.7 % for cervical cancer.…”

Section: Introductionmentioning

confidence: 99%

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Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

Subramanian

Tangka

Ekwueme

et al. 2015

Cancer Causes Control

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Purpose There is substantial variation across the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) grantees in terms of the proportion of the eligible population served by the grantees each year (hereafter referred to as the screening proportion). In this paper, we assess program- and state-level factors to better understand the reason for this variation in breast and cervical cancer screening proportions across the NBCCEDP grantees. Methods We constructed a longitudinal data set, consisting of data from NBCCEDP grantees for each of the three study years (program-years 2006–2007, 2008–2009, and 2009–2010). We performed multivariate analysis to explain the variation in breast and cervical cancer screening proportions across the grantees. The program-level factors studied were the total federal funds received, average cost of screening women by grantee, and the overall organizational structure. The state-level variables included were urban versus rural mix, access to care, and the size of the eligible population. Results Of the 48 grantees included in the study, those that serve larger populations, as measured by the size of the population and the percentage of women eligible for services, had lower screening proportions. Higher average cost of service delivery was also associated with lower screening proportions. In addition, grantees whose populations were more concentrated in urban areas had lower screening proportions. Conclusions Overall, the average cost of screening, the overall size of the population eligible, and the concentration of population in urban areas all had a negative relationship to the proportion of eligible women screened by NBCCEDP grantees.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

Subramanian

Tangka

Ekwueme

et al. 2015

Cancer Causes Control

Self Cite

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“…By providing both screening and diagnostic mammograms, the NBCCEDP offers much-needed services to this high-risk population. However, the NBCCEDP only reaches about 11 % of all eligible women [9]. More targeted public health efforts are needed to improve access to screening, timely follow-up, and treatment for breast cancer for all women in the USA.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009–2012

White

Miller

Royalty

et al. 2015

Cancer Causes Control

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Purpose The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) enrolls asymptomatic women for cancer screening and symptomatic women for diagnostic services. Tiris study describes the results of mammograms provided by the NBCCEDP, by examination indication (screening or diagnostic), and by age group. Methods For the first NBCCEDP-funded mammogram received during 2009–2012, we calculated age-specific percentages of abnormal findings, rates of follow-up testing, and invasive and in situ breast cancer diagnoses per 1,000 mammograms. Logistic regression was used to estimate the odds for each of these outcomes by examination indication. Results The NBCCEDP provided 941,649 screening, 175,310 diagnostic, and 30,434 unknown indication mammograms to 1,147,393 women. The percentage with abnormal mammograms was higher for diagnostic mammograms (40.1 %) than for screening mammograms (15.5 %). Compared with women aged 40–49 years, fewer women aged 50–64 years had abnormal results for screening (13.7 vs. 19.7 %) and diagnostic mammograms (37.7 vs. 42.7 %). Follow-up rates per 1,000 mammograms were lower among women aged 50–64 compared to those aged 40–49 (screening: 143.9 vs. 207.5; diagnostic: 645.3 vs. 760.9); biopsy rates exhibited a similar pattern (screening: 24.1 vs. 32.9; diagnostic: 167.7 vs. 169.7). For screening mammograms, older women had more cancers detected than younger women (invasive: 3.6 vs. 2.2; in situ: 2.3 vs. 2.0). Similarly, for diagnostic mammograms, cancer detection was higher for older women (invasive: 67.8 vs. 36.6; in situ: 17.4 vs. 11.1). Conclusions Abnormal mammograms and diagnostic follow-up procedures were less frequent in women aged 50–64 years compared to women aged 40–49 years, while breast cancer detection was higher, regardless of indication for the mammogram. Some of these differences between age groups were greater for screening mammograms than for diagnostic mammograms. Cancer detection rates were higher for diagnostic mammograms compared with screen ing mammograms. These findings support the NBCCEDP's priority of serving women aged 50–64 years and providing both screening and diagnostic mammograms.

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“…Further, there are limited numbers of primary care providers and specialists to care for patients spread across vast geographic areas [3]. Many providers have limited financial and staff resources to meet the requirements needed to participate in federal programs like the National Breast and Cervical Cancer Early Detection Program (NBCCEDP), a federalstate partnership to increase access to screening among underinsured and uninsured women [2,4,5]. As a result of these factors, penetration of the NBCCEDP program is low and access is poor in rural areas, particularly in Texas [6].…”

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confidence: 99%

County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

Lee

Higashi

Inrig

et al. 2016

Behav. Med. Pract. Policy Res.

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Rural mammography screening remains suboptimal despite reimbursement programs for uninsured women. Networks linking non-clinical community organizations and clinical providers may overcome limited delivery infrastructure in rural areas. Little is known about how networks expand their service area. To evaluate a hub-andspoke model to expand mammography services to 17 rural counties by assessing county-level delivery and local stakeholder conduct of outreach activities. We conducted a mixed-method evaluation using EMR data, systematic site visits (73 interviews, 51 organizations), 92 patient surveys, and 30 patient interviews. A two-sample t test compared the weighted monthly average of women served between hub-and spoke-led counties; nonparametric trend test evaluated time trend over the study period; Pearson chi-square compared sociodemographic data between hub-and spoke-led counties. From 2013 to 2014, the program screened 4603 underinsured women. Counties where local Bspoke^organizations led outreach activities achieved comparable screening rates to hub-led counties (9.2 and 8.7, respectively, p = 0.984) and did not vary over time (p = 0.866). Qualitative analyses revealed influence of program champions, participant language preference, and stakeholders' concerns about uncompensated care. A program that leverages local organizations' ability to identify and reach rural underserved populations is a feasible approach for expanding preventive services delivery. KeywordsRural, Breast cancer, Healthdisparities, Health services delivery, Mixed methods, Program implementation BACKGROUND Despite the Affordable Care Act's emphasis on preventive services, many rural communities face significant challenges in linking women to the full continuum of breast cancer screening services (e.g., screening and diagnostic mammography, breast biopsy, and referral to cancer treatment) [1]. Rural populations, when adjusted for age, are more likely than their urban counterparts to lack health insurance [2], such that women are significantly less likely to meet

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Breast cancer screening of underserved women in the USA: results from the National Breast and Cervical Cancer Early Detection Program, 1998–2012

Cited by 47 publications

References 18 publications

Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

Explaining variation across grantees in breast and cervical cancer screening proportions in the NBCCEDP

Clinical outcomes of mammography in the National Breast and Cervical Cancer Early Detection Program, 2009–2012

County-level outcomes of a rural breast cancer screening outreach strategy: a decentralized hub-and-spoke model (BSPAN2)

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