Differences in Breast Cancer Screening Rates: An Issue of Ethnicity or Socioeconomics?

Qureshi, Mohsin Khalid; Thacker, Hemant; Litaker, David; Kippes, Christopher

doi:10.1089/15246090050200060

Cited by 65 publications

(46 citation statements)

References 12 publications

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“…Analyses of the BRFSS have consistently shown that lack of health insurance is associated with decreased rates of cancer screening. Qureshi et al 6 assessed the effects of insurance status on the likelihood of screening mammography utilization within the preceding 2 years among women ages 40 to 49 using data from the 1992-1993 BRFSS. Separate evaluations of the impact of health insurance on screening mammography utilization were performed for four racial/ethnic groups: non-Hispanic white, non-Hispanic black, Hispanic, and other.…”

Section: Studies Using Data From the Behavioral Risk Factor Surveillamentioning

confidence: 99%

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

Marlow¹,

Pavluck²,

Bian³

et al. 2009

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This paper summarizes key literature on the relationship between health care insurance status and screening, diagnosis, and medical care patterns and outcomes for individuals with cancer. All studies included for this literature synthesis were identified using the National Library of Medicine's Medline database; only English language articles published in the past 10 years were considered. Based on article titles and abstracts, we selected the most relevant studies for full review and inclusion in this manuscript. Although the summarized literature is mixed, individuals who are uninsured or have insurance coverage through programs for low-income persons (e.g., Medicaid coverage) are significantly less likely to use cancer screening services and significantly more likely to present with advanced stage cancer at diagnosis and to have significantly worse survival. The relationship between insurance status and cancer treatment patterns is less clear, as fewer studies have examined this relationship, but the available evidence suggests that uninsured patients are less likely to receive optimal cancer care. The research reviewed here suggests that the benefits of extending appropriate insurance coverage to uninsured and underinsured individuals could be substantial. These benefits are likely to include reduced morbidity, improved quality of life, and increased survival for cancer patients as well as a positive impact on overall health care and societal costs.

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Section: Studies Using Data From the Behavioral Risk Factor Surveillamentioning

confidence: 99%

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

Marlow¹,

Pavluck²,

Bian³

et al. 2009

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“…[27][28][29] Access to health care, insurance, and engaging in other healthy behaviors appear to influence a woman' s likelihood of obtaining a screening mammogram. 30 Roberts and Birch 31 found that factors affecting screening include insurance type, provider type, long waiting times, and poor communication among the physician, the staff, and the patient. In another mammography study, significant correlates of utilization included age, household income, and the type of managed care organization in which the member was enrolled.…”

Section: Other Factors Predicting Use Of Screeningmentioning

confidence: 99%

Screening Mammography and Pap Tests Among Older American Women 1996-2000: Results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD)

Østbye

Greenberg²,

Taylor³

et al. 2003

The Annals of Family Medicine

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BACKGROUND We wanted to determine the frequency of self-reported receipt of screening mammography and Papanicolaou (Pap) tests in older women and investigate important predictors of utilization, based on 2 national longitudinal surveys. (1994)(1995)(1996)(1997)(1998)(1999)(2000) of the Health and Retirement Study (HRS)-5,942 women aged 50 to 61 years, and 4 waves (1993)(1994)(1995)(1996)(1997)(1998)(1999)(2000) of the Asset and Health Dynamics Among the Oldest Old (AHEAD) survey-4,543 women aged 70 years and older. The self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1996 and 2000 for HRS, with predictors of receipt measured in 1994 and 1998. In AHEAD, the self-reported receipt of screening mammograms and Pap smears in the most recent 2 years were reported in 1995 and 2000, with predictors of receipt measured in 1993 and 1998. METHODS This cohort study includes participants from 4 waves RESULTSReceipt of mammography is stable at 70% to 80% among women aged 50 to 64 years, then declines to around 40% among those aged 85 to 90 years. For Pap tests there is a decline from 75% among women aged 50 to 54 years to 25% in those aged 85 to 90 years. For both mammography and Pap tests, the rates increased in all groups from 1995/1996 to 2000. Higher education, being married, higher income, not smoking, and vigorous exercise were consistently associated with higher rates of receipt.CONCLUSIONS Although the use of mammography and Pap tests for screening declines into old age, use has been increasing recently. The large and increasing number of tests performed might not be justified given the lack of evidence of effect in older age-groups. INTRODUCTIONH ealth maintenance care for young adults is focused on identification and reduction of long-term health risks, whereas care for elderly patients is generally focused on case finding. Early discovery of treatable, asymptomatic cancers is an important motive for patients and clinicians, but an important question persists: Is it reasonable to screen for common cancers in the elderly?Truls Østbye, MD, MPH, MBA, PhD 1 Gary N. Greenberg, MD 210The exponential age-related increase in incidence of some cancer types argues in favor of increased screening. Furthermore, case fatality rates also increase with age.1 There is also evidence that increasing age is associated with an increasing "sojourn time," which begins when cancer might first be detected by screening and ends when cancer is detected through the appearance of symptoms. Given a certain screening interval, increased sojourn time allows a larger proportion of cancers to be detected in a preclinical stage.Life expectancy obviously decreases with age, however, and the competing risk of dying from other diseases increases rapidly, reducing the number of years that can be saved through screening. There is also a selection problem: the healthiest elderly, with lower risk of disease, are more likely to be screened. For example, in a Dutch breast cancer-screening ...

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“…Multiple sociodemographic factors affect cancer care patterns, including age, sex, race or ethnicity, insurance status, household income, level of education, and usual source of health care [1][2][3][4][5][6][7][8][9] . Timeliness of care (that is, rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment.…”

Section: Introductionmentioning

confidence: 99%

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

Halpern

Holden

2012

Current Oncology

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Background: Timeliness of care (rapid initiation of treatment after definitive diagnosis) is a key component of high-quality cancer treatment. The present study evaluated factors influencing timeliness of care for U.S. Medicare enrollees. Methods: Data for Medicare enrollees diagnosed with breast, colorectal, lung, or prostate cancer while living in U.S. seer (Surveillance, Epidemiology and End Results) regions in 2000–2002 were analyzed. Patients were classified as experiencing delayed treatment if the interval between diagnosis and treatment was greater than the 95th percentile for each cancer site. The impacts of patient sociodemographic, clinical, and area-based factors on the likelihood of delayed treatment were analyzed using multivariate logistic regression. Results: Black patients (compared with white patients) and patients initially treated with radiation therapy or chemotherapy (rather than surgery) had a greater likelihood of treatment delays across all four cancer sites. Hispanic status, dual Medicare–Medicaid status, location of initial treatment (inpatient vs. outpatient), and stage at diagnosis also affected timeliness of care for some cancer sites. Surprisingly, area-based factors reflecting availability of cancer care services were not significantly associated with timeliness of care or were associated with greater delays in areas with greater numbers of service providers. Conclusions: Multiple factors affected receipt of timely cancer care for members of the study population, all of whom had coverage of medical care services through Medicare. Because delays in treatment initiation can increase morbidity, decrease quality of life, shorten survival, and result in greater costs, prospective studies and tailored interventions are needed to address those factors among at-risk patient groups.

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Differences in Breast Cancer Screening Rates: An Issue of Ethnicity or Socioeconomics?

Cited by 65 publications

References 12 publications

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

The Relationship Between Insurance Coverage and Cancer Care: A Literature Synthesis

Screening Mammography and Pap Tests Among Older American Women 1996-2000: Results from the Health and Retirement Study (HRS) and Asset and Health Dynamics Among the Oldest Old (AHEAD)

Disparities in Timeliness of Care for U.S. Medicare Patients Diagnosed with Cancer

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