Impact of the National Breast and Cervical Cancer Early Detection Program on mammography and pap test utilization among white, Hispanic, and African American women: 1996–2000

Abstract

Prevention, including routine cancer screening, is key to meeting national goals for the elimination of death and suffering due to cancer. Since 1991, the U.S. government has invested in programs such as the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) to detect breast and cervical cancer early among uninsured low-income women. A concomitant goal is reducing racial disparities in screening and early detection, and the NBCCEDP program targets lowincome women who are more often racial and ethnic minorities. This paper analyzes data to test for effects of the NBCCEDP and other determinants of screening across racial/ethnic groups. We used data from the Behavioral Risk Factor Surveillance System (BRFSS) for 1996 through 2000. These data indicate that gaps in testing for breast and cervical cancers between African American and non-Hispanic white women aged 40-64 years have closed but remain for Hispanics. Multivariate findings indicate that the longevity of free screening sites through the NBCCEDP significantly increased both tests for non-Hispanic white women. The data do not confirm this effect for other racial and ethnic groups. Analysis did indicate that public insurance, or Medicaid, was equal to private insurance in promoting increased testing for African Americans and Hispanics, but not for non-Hispanic whites. Assuring that Medicaid remains available for women in this nonelderly group and increasing access to free screening sites can lead us closer to national screening goals, yet policies still need to address racial/ethnic disparities in insurance and service delivery. Cancer 2007;109(2 Suppl):348-58.

The Role of Behavioral Science Theory in Development and Implementation of Public Health Interventions

“…The program screens hundreds of thousands of women each year (19). The program has narrowed the gap in early detection for breast and cervical cancers between white women and African Americans but not for Hispanics (1).…”

Breast Cancer Screening Practices Among First-Generation Immigrant Muslim Women

“…[2][3][4][5][6][7][8] Despite these advances, segments of our population have not benefited from cancer prevention and control efforts, and disparities in breast cancer screening and health outcomes persist for minority groups. 1,[9][10][11][12][13][14][15] Low mammography use has been associated with a variety of factors, including not having a medical home, not having health insurance, being a recent immigrant, and having low levels of knowledge and awareness about breast cancer. [16][17][18] Migration to Western countries and increased length of stay are associated with increased risk of breast cancer, 19 which in turn is attributed to a number of factors and is compounded by barriers to timely screening.…”

Lack Of Access Due To Costs Remains A Problem For Some In Massachusetts Despite The State’s Health Reforms

“…Our analysis could not tease out the impact of earlier legislation designed to improve women's access to screening tests, such as the National Breast and Cervical Cancer Early Detection Program, known as the Women's Health Network in Massachusetts. 25 An additional limitation of our analysis is that we chose to examine only one aspect of access: the inability to see a doctor because of cost. Even with near-universal coverage, access to care can be affected by delivery-system factors such as shortages of primary care providers.…”