Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women

Kerner, Jon; Yedidia, Michael J.; Padgett, Deborah K.; Muth, B J; Washington, Kathleen Shakira; Tefft, Mariella C.; Yabroff, K. Robin; Makariou, Erini; Freeman, Harold P.; Mandelblatt, Jeanne S.

doi:10.1016/s0091-7435(03)00087-2

Cited by 77 publications

(90 citation statements)

References 35 publications

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“…Relatively fewer studies have reported associations between beliefs and delays to follow-up care. [50][51][52][53] Studies showing associations between beliefs and delays cite poor health perceptions, 50 misconceptions about screening, 51 and fatalism. 51 Other studies have proposed that such health beliefs as degree of worry 52,53 do not influence adherence to recommendations or timely follow-up care, while patient-provider communication factors 52 and demographic factors 53 do impact timely care.…”

Section: Discussionmentioning

confidence: 99%

Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

Tejeda

Darnell

Cho

et al. 2013

Journal of Women's Health

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Background: Women with breast or cervical cancer abnormalities can experience barriers to timely follow-up care, resulting in delays in cancer diagnosis. Patient navigation programs that identify and remove barriers to ensure timely receipt of care are proliferating nationally. The study used a systematic framework to describe barriers, including differences between African American and Latina women; to determine recurrence of barriers; and to examine factors associated with barriers to follow-up care. Methods: Data originated from 250 women in the intervention arm of the Chicago Patient Navigation Research Program (PNRP). The women had abnormal cancer screening findings and navigator encounters. Women were recruited from a community health center and a publicly owned medical center. After describing proportions of African American and Latina women experiencing particular barriers, logistic regression was used to explore associations between patient characteristics, such as race/ethnicity, and type of barriers. Results: The most frequent barriers occurred at the intrapersonal level (e.g., insurance issues and fear), while institutional-level barriers such as system problems with scheduling care were the most commonly recurring over time (29%). The majority of barriers (58%) were reported in the first navigator encounter. Latinas (81%) reported barriers more often than African American women (19%). Differences in race/ethnicity and employment status were associated with types of barriers. Compared to African American women, Latinas were more likely to report an intrapersonal level barrier. Unemployed women were more likely to report an institutional level barrier. Conclusion: In a sample of highly vulnerable women, there is no single characteristic (e.g., uninsured) that predicts what kinds of barriers a woman is likely to have. Nevertheless, navigators appear able to easily resolve intrapersonal-level barriers, but ongoing navigation is needed to address system-level barriers. Patient navigation programs can adopt the PNRP barriers framework to assist their efforts in assuring timely follow-up care.

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Section: Discussionmentioning

confidence: 99%

Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

Tejeda

Darnell

Cho

et al. 2013

Journal of Women's Health

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“…Patient factors include perceived lack of urgency, competing health or other problems, lack of time, and cancer fear and anxiety (26). Kerner et al (27) found that Black women with high cancer anxiety were 50% less likely to complete a diagnostic evaluation within 90 days compared with Black women with lower cancer anxiety scores. Physician behaviors and quality of care also can contribute to disparities in breast cancer mortality, and minority women are more likely to receive a course of surgical and radiation treatment that does not meet the 2000 National Comprehensive Cancer Network standards (28).…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

Deshpande¹,

Jeffe²,

Gnerlich³

et al. 2009

Journal of Surgical Research

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Background-Black women often present with advanced-stage breast cancer compared with White women, which may result in the observed higher mortality among Black women. Agerelated factors (e.g., comorbidity) also affect mortality. Whether racial disparities in mortality are evident within age and/or stage groups has not been reported, and risk factors for greater mortality among Black women are not well defined.

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“…3,4 Delayed diagnosis from the point an abnormality is detected, either by the patient or by a healthcare provider, to the point of definitive diagnosis may contribute to these negative outcomes, as well as to costlier treatment options and higher recurrence rates. [5][6][7][8][9][10][11] Although delayed care is more likely to occur in low-income and medically indigent populations, [12][13][14][15][16][17][18] few studies have addressed diagnostic delay in low-income BC patients with regard to both self-detected and system-detected breast abnormalities, the former of which is particularly salient in this vulnerable group. 19 In research among general BC patient populations, patient characteristics associated with delay from the point an abnormality is detected to follow-up of tests or symptoms have included lower income level, 20 fewer screening mammograms before diagnosis, 13,21 lack of a personal physician, 17 and poorer health, 21,22 as well as patient attitudes and beliefs, such as fear of bad news and concerns about medical procedures and survival, 23,24 prior negative experiences with healthcare systems, 20,25 and desire to avoid disruptions of normal activities, particularly work.…”

mentioning

confidence: 99%

“…Some studies have documented greater delay in care seeking among ethnic minority women, [26][27][28][29] whereas others have reported no racial/ethnic differences. 30,31 Aspects of patient communication, such as asking questions 11 and understanding the need for follow-up of a breast abnormality on mammogram, 32 have been shown to be significantly associated with appropriate follow-up care. Further, although patient self-efficacy in communicating with physicians has not been investigated in the context of delayed care, it has been shown to predict receipt of BC knowledge, 33 receipt of breast reconstructive surgery, 34 decreased BC treatmentrelated symptoms, 35 and quality of life in low-income prostate cancer patients.…”

mentioning

confidence: 99%

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

Maly

Leake

Mojica

et al. 2011

Journal of Women's Health

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Background: Delayed diagnosis of breast cancer (BC) may contribute to adverse outcomes, such as reduced survival. The purpose of this study was to identify correlates of elapsed time between recognition of breast abnormalities and receipt of definitive diagnosis of BC among low-income women. Methods: Data were obtained from a cross-sectional study among a statewide sample of 921 low-income women with a new diagnosis of BC. Patients were grouped by whether their breast abnormalities were self-detected or healthcare system detected. Multivariate logistic regression analyses were used to examine associations between diagnostic delay and patient characteristics, patient communication, and system characteristics. Results: The self-detected group experienced much greater delay than the system-detected group (median intervals 80.5 vs. 31.5 days). African Americans had the longest intervals between symptom detection and diagnostic resolution; median delays in the self-detected and system-detected subgroups were 115 and 70 days, respectively, compared to 64 and 22 days for Caucasians. In multivariate analyses, African Americans had considerably greater odds of > 60-day delay than Caucasians in both the self-detected (odds ratio [OR] 3.51) and system-detected (OR 5.36) groups. Greater perceived self-efficacy in interacting with healthcare providers was significantly associated with shorter delay among the self-detected group (OR 0.86). Conclusions: Disparities in timely BC diagnosis between African Americans and Caucasians were pronounced in this uniformly low-income population of women. Women with self-detected abnormalities had markedly greater delays than those with healthcare system-detected abnormalities. Among this vulnerable group, increasing self-efficacy in interacting with healthcare providers may reduce diagnostic delays.

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Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women

Cited by 77 publications

References 35 publications

Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

Patient Barriers to Follow-Up Care for Breast and Cervical Cancer Abnormalities

Racial Disparities in Breast Cancer Survival: An Analysis by Age and Stage

What Influences Diagnostic Delay in Low-Income Women with Breast Cancer?

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