BACKGROUND: The Boston Racial and Ethnic Approaches to Community Health (REACH) 2010 Breast and Cervical Cancer Coalition developed a case management intervention for women of African descent to identify and reduce medical and social obstacles to breast cancer screening and following up abnormal results. METHODS: We targeted black women at high risk for inadequate cancer screening and follow-up as evidenced by a prior pattern of missed clinic appointments and frequent urgent care use. Case managers provided referrals to address patient-identified social concerns (e.g., transportation, housing, language barriers), as well as navigation to prompt screening and follow-up of abnormal tests. We recruited 437 black women aged 40-75, who received care at participating primary care sites. The study was conducted as a prospective cohort study rather than as a controlled trial and evaluated intervention effects on mammography uptake and longitudinal screening rates via logistic regression and timely follow-up of abnormal tests via Cox proportional hazards models. RESULTS: A significant increase in screening uptake was found (OR 1.53, 95% CI 1.13-2.08). Housing concerns (p < 0.05) and lacking a regular provider (p < 0.01) predicted poor mammography uptake. Years of participation in the intervention increased odds of obtaining recommended screening by 20% (OR 1.20, 95% CI 1.02-1.40), but this effect was attenuated by covariates (p = 0.53). Timely follow-up for abnormal results was achieved by most women (85%) but could not be attributed to the intervention (HR 0.95, 95% CI 0.50-1.80). CONCLUSIONS: Case management was successful at promoting mammography screening uptake, although no change in longitudinal patterns was found. Housing concerns and lacking a regular provider should be addressed to promote mammography uptake. Future research should provide social assessment and address social obstacles in a randomized controlled setting to confirm the efficacy of social determinant approaches to improve mammography use.
BACKGROUND: The Boston Racial and Ethnic Approaches to Community Health (REACH) 2010 Breast and Cervical Cancer Coalition developed a case management intervention for women of African descent to identify and reduce medical and social obstacles to breast cancer screening and following up abnormal results. METHODS: We targeted black women at high risk for inadequate cancer screening and follow-up as evidenced by a prior pattern of missed clinic appointments and frequent urgent care use. Case managers provided referrals to address patient-identified social concerns (e.g., transportation, housing, language barriers), as well as navigation to prompt screening and follow-up of abnormal tests. We recruited 437 black women aged 40-75, who received care at participating primary care sites. The study was conducted as a prospective cohort study rather than as a controlled trial and evaluated intervention effects on mammography uptake and longitudinal screening rates via logistic regression and timely follow-up of abnormal tests via Cox proportional hazards models. RESULTS: A significant increase in screening uptake was found (OR 1.53, 95% CI 1.13-2.08). Housing concerns (p < 0.05) and lacking a regular provider (p < 0.01) predicted poor mammography uptake. Years of participation in the intervention increased odds of obtaining recommended screening by 20% (OR 1.20, 95% CI 1.02-1.40), but this effect was attenuated by covariates (p = 0.53). Timely follow-up for abnormal results was achieved by most women (85%) but could not be attributed to the intervention (HR 0.95, 95% CI 0.50-1.80). CONCLUSIONS: Case management was successful at promoting mammography screening uptake, although no change in longitudinal patterns was found. Housing concerns and lacking a regular provider should be addressed to promote mammography uptake. Future research should provide social assessment and address social obstacles in a randomized controlled setting to confirm the efficacy of social determinant approaches to improve mammography use.
Authors: Tracy A Battaglia; Julie S Darnell; Naomi Ko; Fred Snyder; Electra D Paskett; Kristen J Wells; Elizabeth M Whitley; Jennifer J Griggs; Anand Karnad; Heather Young; Victoria Warren-Mears; Melissa A Simon; Elizabeth Calhoun Journal: Breast Cancer Res Treat Date: 2016-07-18 Impact factor: 4.872
Authors: George Rust; Shun Zhang; Khusdeep Malhotra; Leroy Reese; Luceta McRoy; Peter Baltrus; Lee Caplan; Robert S Levine Journal: Cancer Date: 2015-04-23 Impact factor: 6.860
Authors: Karen M Freund; Tracy A Battaglia; Elizabeth Calhoun; Julie S Darnell; Donald J Dudley; Kevin Fiscella; Martha L Hare; Nancy LaVerda; Ji-Hyun Lee; Paul Levine; David M Murray; Steven R Patierno; Peter C Raich; Richard G Roetzheim; Melissa Simon; Frederick R Snyder; Victoria Warren-Mears; Elizabeth M Whitley; Paul Winters; Gregory S Young; Electra D Paskett Journal: J Natl Cancer Inst Date: 2014-06-17 Impact factor: 13.506
Authors: Scarlett Lin Gomez; Laura Fejerman; Alice Guan; Daphne Lichtensztajn; Debora Oh; Jennifer Jain; Li Tao; Robert A Hiatt Journal: Cancer Epidemiol Biomarkers Prev Date: 2019-09-23 Impact factor: 4.254
Authors: Jessie Kimbrough Marshall; Olive M Mbah; Jean G Ford; Darcy Phelan-Emrick; Saifuddin Ahmed; Lee Bone; Jennifer Wenzel; Gary R Shapiro; Mollie Howerton; Lawrence Johnson; Qiana Brown; Altovise Ewing; Craig Evan Pollack Journal: J Gen Intern Med Date: 2015-08-11 Impact factor: 5.128