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

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Abstract

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.

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Annual report to the nation on the status of cancer, 1975-2001, with a special feature regarding survival.

Ahmedin Jemal, Limin Clegg, Elizabeth Ward … (2004)

The American Cancer Society (ACS), the Centers for Disease Control and Prevention (CDC), the National Cancer Institute (NCI), and the North American Association of Central Cancer Registries (NAACCR) collaborate annually to provide updated information regarding cancer occurrence and trends in the U.S. This year's report features a special section on cancer survival. Information concerning cancer cases was obtained from the NCI, CDC, and NAACCR and information concerning recorded cancer deaths was obtained from the CDC. The authors evaluated trends in age-adjusted cancer incidence and death rates by regression models and described and compared survival rates over time and across racial/ethnic populations. Incidence rates for all cancers combined decreased from 1991 through 2001, but stabilized from 1995 through 2001 when adjusted for delay in reporting. The incidence rates for female lung cancer decreased (although not statistically significant for delay adjusted) and mortality leveled off for the first time after increasing for many decades. Colorectal cancer incidence rates also decreased. Death rates decreased for all cancers combined (1.1% per year since 1993) and for many of the top 15 cancers occurring in men and women. The 5-year relative survival rates improved for all cancers combined and for most, but not all, cancers over 2 diagnostic periods (1975-1979 and 1995-2000). However, cancer-specific survival rates were lower and the risk of dying from cancer, once diagnosed, was higher in most minority populations compared with the white population. The relative risk of death from all cancers combined in each racial and ethnic population compared with non-Hispanic white men and women ranged from 1.16 in Hispanic white men to 1.69 in American Indian/Alaska Native men, with the exception of Asian/Pacific Islander women, whose risk of 1.01 was similar to that of non-Hispanic white women. The continued measurable declines for overall cancer death rates and for many of the top 15 cancers, along with improved survival rates, reflect progress in the prevention, early detection, and treatment of cancer. However, racial and ethnic disparities in survival and the risk of death from cancer, and geographic variation in stage distributions suggest that not all segments of the U.S. population have benefited equally from such advances. Published 2004 by the American Cancer Society.

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Race, socioeconomic status, and breast cancer treatment and survival.

C. Roberts, J. Bradley, Charles W Given (2002)

Previous studies have found that African-American women are more likely than white women to have late-stage breast cancer at diagnosis and shortened survival. However, there is considerable controversy as to whether these differences in diagnosis and survival are attributable to race or socioeconomic status. Our goal was to disentangle the influence of race and socioeconomic status on breast cancer stage, treatment, and survival. We linked data from the Metropolitan Detroit Surveillance, Epidemiology, and End Results (SEER)(1) registry to Michigan Medicaid enrollment files and identified 5719 women diagnosed with breast cancer, of whom 593 were insured by Medicaid. We first calculated the unadjusted odds ratios (ORs) associated with race, Medicaid insurance, and poverty for breast cancer stage at diagnosis, breast cancer treatment, and death. We then estimated the ORs of having late-stage breast cancer at diagnosis, breast-conserving surgery, no surgery, and death using logistic regression after controlling for clinical and nonclinical factors. All statistical tests were two-sided. Before controlling for Medicaid enrollment and poverty, African-American women had a higher likelihood than white women of each unfavorable breast cancer outcome. However, after controlling for covariates, African-American women were not statistically significantly different from white women on most outcomes except for surgical choice. African-American women were more likely than white women to have no surgery (adjusted OR = 1.62; 95% confidence interval [CI] = 1.11 to 2.37). Among women who had surgery, African-American women were more likely to have breast-conserving surgery than were white women (adjusted OR = 1.63; 95% CI = 1.33 to 1.98). The linkage of Medicaid and SEER data provides more in-depth information on low-income women than has been available in past studies. In our Metropolitan Detroit study population, race was not statistically significantly associated with unfavorable breast cancer outcomes. However, low socioeconomic status was associated with late-stage breast cancer at diagnosis, type of treatment received, and death.

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Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey.

Nancy Breen, Judith Swan, Belinda Lee … (2003)

Understanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys. Data from the 2000 NHIS and earlier surveys were analyzed to discern patterns and trends in cancer screening practices, including Pap tests, mammography, prostate specific antigen (PSA) screening, and colorectal screening. The data are reported for population subgroups that were defined by a number of demographic and socioeconomic characteristics. Women who were least likely to have had a mammogram within the last 2 years were those with no usual source of health care (61%), women with no health insurance (67%), and women who immigrated to the United States within the last 10 years (61%). Results for Pap tests within the last 3 years were similar. Among both men and women, those least likely to have had a fecal occult blood test or endoscopy within the recommended screening interval had no usual source of care (14% for men and 18% for women), no health insurance (20% for men and 18% for women), or were recent immigrants (20% for men and 18% for women). An analysis of changes in test use since the 1987 survey indicates that the disparities are widening among groups with no usual source of care. No striking improvements have been observed for the groups with greatest need. Although screening use for most groups has increased since 1987, major disparities remain. Some groups, notably individuals with no usual source of care and the uninsured are falling further behind; and, according to the 2000 data, recent immigrants also experience a significant gap in screening utilization. More attention is needed to overcome screening barriers for these groups if the population benefits of cancer screening are to be achieved. Published 2003 by the American Cancer Society.DOI 10.1002/cncr.11208