Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002

Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

“…Recent studies also indicated women residing in areas with higher percentage of non-Hispanic African American women were more likely to have mammograms. 7,8 Additionally, our study also indicated that white women residing within the geographic cluster of late-stage breast cancer diagnosis had lower mammography screening relative to the rest of the city. These findings suggest a need to increase routine-screening mammography use among white women, especially for those living within the cluster area.…”

“…For example, it has been reported that rural residents were less likely to receive preventive healthcare services than urban residents. 7,8,48 Our findings, however, suggest that a historic geographic cluster of late-stage breast cancer may serve as a geographic marker for nonadherence to recommended breast cancer screening, so we can better target interventions to improve mammography screening in areas of greater need. Since the proportion of cases of late-stage (distant) breast cancers changed little over time in the City of St. Louis according to the Missouri Cancer Registry (from 40.2% in 1996-1998 to 43.3% in 2002-2004), 49 it is unlikely that the cluster of late-stage breast cancer has disappeared.…”

“…Previous studies have reported individual-level risk factors and census-tract socioeconomic effect on mammography use. 7,8,[22][23][24][25][26][27]29,30,[32][33][34]43 In our study, system-level barriers to mammography and heavy smoking were associated with mammography use among white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography screening among white women.…”

“…5 Recently, it has been shown that racial disparities in screening mammography have largely disappeared. [6][7][8] While trends in disparities over time in the USA or specific states are important to monitor, they may mask disparities in screening practices for much smaller areas. Evidence of declining mammography rates from 2000 to 2005 also may be cause for concern.…”

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

“…15 Physicians who do not offer mammography or who offer extra, nonrecommended breast imaging modalities for screening women not at high risk of breast cancer, such as MRI or ultrasound, are providing care that is inconsistent with these recommendations. Numerous studies have assessed how often women are receiving age-appropriate breast cancer screening, [18][19][20] and a national survey has assessed physician mammography and breast exam recommendations, 21 but to our knowledge, no previous study has examined how often physicians offer breast cancer screening via modalities other than mammography.…”