Breast Cancer Population Screening Program Results in Early Detection and Reduced Treatment and Health Care Costs for Medicaid.

CONTEXT: The National Breast and Cervical Cancer Early Detection Program has increased access to screening services for low-income females since 1991; however, evaluation information from states implementing the program is sparse. This study evaluates the impact of the Missouri program, Show Me Healthy Women (SMHW), on early detection and treatment cost. OBJECTIVE: To estimate breast cancer treatment and health care services costs by stage at diagnosis among Missouri's Medicaid beneficiaries and assess the SMHW program impact. DESIGN: Analyzed Missouri Medicaid claims linked with Missouri Cancer Registry data for cases diagnosed 2008-2012 (N = 1388) to obtain unadjusted and incremental costs of female breast cancer treatment and follow-up care at 6, 12, and 24 months following diagnosis. Noncancer controls (N = 3840) were matched on age, race, and disability to determine usual health care cost. Regression analyses estimated the impact of stage at diagnosis on expenditures and incremental cost. Show Me Healthy Women participants were compared with other breast cancer patients on stage at diagnosis. A comparison of SMHW participants to themselves had they not been enrolled in the program was analyzed to determine cost savings. RESULTS: Expenditures increased by stage at diagnosis from in situ to distant with unadjusted cost at 24 months ranging from $50 245 for in situ cancers to $152 431 for distant cancers. Incremental costs increased by stage at diagnosis from 6 months at $7346, $11 859, $21 501, and $20 235 for in situ, localized, regional, and distant breast cancers, respectively, to $9728, $17 056, $38 840, and $44 409 at 24 months. A significantly higher proportion of SMHW participants were diagnosed at an early stage resulting in lower unadjusted expenditures and cost savings. CONCLUSIONS: Although breast cancer treatment costs increased by stage at diagnosis, the population screening program's significant impact on early diagnosis resulted in important cost savings over time for Medicaid.

Risk Factors, Preventive Practices, and Health Care Among Breast Cancer Survivors, United States, 2010.

INTRODUCTION: We compared behavioral risk factors and preventive measures among female breast cancer survivors, female survivors of other types of cancers, and women without a history of cancer. Survivorship health care indicators for the 2 groups of cancer survivors were compared. METHODS: Using data from the 2010 Behavioral Risk Factor Surveillance System, we calculated the proportion of women with risk factors and their engagement in preventive practices, stratified by cancer status (cancer survivors or women with no history of cancer), and compared the proportions after adjusting for sociodemographic characteristics. RESULTS: A significantly higher proportion of breast cancer survivors had mammography in the previous year (79.5%; 95% confidence interval [CI], 76.0%-83.0%) than did other cancer survivors (68.1%; 95% CI, 65.6%-70.7%) or women with no history of cancer (66.4%; 95% CI, 65.5%-67.3%). Breast cancer survivors were also more likely to have had a Papanicolaou (Pap) test within the previous 3 years than women with no history of cancer (89.4%; 95% CI, 85.9%-93.0 vs 85.1%; 95% CI, 84.4%-85.8%) and a colonoscopy within the previous 10 years (75.4%; 95% CI, 71.7%-79.0%) than women with no history of cancer (60.0%; 95% CI, 59.0%-61.0%). Current smoking was significantly lower among survivors of breast cancer (10.3%; 95% CI, 7.4%-13.2%) than other cancer survivors (20.8%; 95% CI, 18.4%-23.3%) and women with no history of cancer (18.3%; 95% CI, 17.5%-19.1%). After adjusting for sociodemographic characteristics, we found that breast cancer survivors were significantly more likely to have had mammography, a Pap test, and colonoscopy, and less likely to be current smokers. CONCLUSION: Breast cancer survivors are more likely to engage in cancer screening and less likely to be current smokers than female survivors of other types of cancer or women with no history of cancer.

The effect of the Missouri WISEWOMAN program on control of hypertension, hypercholesterolemia, and elevated blood glucose among low-income women.

INTRODUCTION: The Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) public health program is designed to reduce the risk of heart disease and stroke among low-income, underinsured or uninsured women through clinical screenings, risk factor assessment, and lifestyle interventions. We assessed the effect of the Missouri WISEWOMAN program on the control of high blood pressure, total cholesterol, and blood glucose levels. METHODS: We calculated the proportion of participants (N = 1,130) with abnormal blood pressure, total cholesterol, or blood glucose levels at an initial screening visit who gained control at a follow-up visit 11 to 18 months later during a 7-year period from June 30, 2005, to June 29, 2012. We used logistic regression to identify sociodemographic characteristics and other factors associated with achieving control. RESULTS: Many WISEWOMAN participants gained control of their blood pressure (41.2%), total cholesterol (24.7%), or blood glucose levels (50.0%). After controlling for sociodemographic factors, smoking status, weight status, medication use, and number of lifestyle interventions, nondiabetic women with stage II hypertension (adjusted odds ratio [AOR] = 0.36, 95% confidence interval [CI] = 0.21-0.60) and diabetic women with stage I (AOR = 0.54, 95% CI = 0.32-0.92) and stage II (AOR = 0.23, 95% CI = 0.07-0.77) hypertension were less likely to achieve control of their blood pressure than nondiabetic women with stage I hypertension. Women aged 45 to 64, women with less than a high school education, women who were obese in the initial visit, women who gained 7% or more of their weight, and women who did not participate in any lifestyle intervention sessions were significantly less likely to achieve total cholesterol control than their counterparts. CONCLUSION: The Missouri WISEWOMAN program helps many participants achieve control of blood pressure, total cholesterol, and blood glucose levels; the lifestyle intervention is likely to help participants control total cholesterol. More efforts are needed for women with diabetes and stage II hypertension to achieve blood pressure control.

Economic effect of smoke-free ordinances on 11 Missouri cities.

INTRODUCTION: The harmful effects of secondhand smoke are convincing more and more communities across the United States and the world to prohibit smoking in public places, especially in eating and drinking establishments. A 1993 Missouri state law allows smoking in designated areas in indoor public places such as restaurants and bars. Consequently, some Missouri communities have adopted local ordinances that prohibit smoking in all indoor workplaces, including restaurants and bars. We used an objective measure of economic activity, the taxable sales revenues of eating and drinking establishments, to empirically examine the economic effect of smoke-free ordinances. METHODS: We studied the economic effect of smoke-free ordinances in 11 Missouri cities using multivariate log-linear regression models with log-transformed taxable sales revenues of eating and drinking establishments as the dependent variable and the smoke-free ordinance as the independent variable, while controlling for seasonality, economic condition and unemployment. We used data from 20 quarters before the smoke-free ordinances and at least 10 quarters after the smoke-free ordinances for all cities. The null hypothesis of no effect of smoke-free ordinance on taxable sales of the eating and drinking establishments was tested. RESULTS: Eight of the 11 cities had increased taxable sales for eating and drinking establishments postordinance. The remaining 3 experienced no change. CONCLUSION: The findings of our study are consistent with findings from most published economic studies that a smoke-free ordinance does not harm a local economy.

A comparison of the health status and behavioral risk factors among English-speaking Hispanics and non-Hispanic Blacks and Whites in Missouri.

OBJECTIVES: The study objectives were to estimate the prevalence of chronic diseases and other health indicators for Hispanics in Missouri, and to compare their prevalence estimates with other racial/ethnic groups. DESIGN / SETTING / PARTICIPANTS: This study, conducted in public health and academic settings, used combined data from the 2002 and 2003 Missouri Behavioral Risk Factor Surveillance System and the 2003 Missouri County-Level Study. Data were post-stratified with Hispanic ethnicity as a separate group. MAIN OUTCOME MEASURES: Twenty health indicators were compared. Logistic regression was used to control for sociodemographic characteristics. RESULTS: Overall, 21.7% (95% confidence interval [CI] 13.4-30.0) of Hispanics, 19.8% (95% CI 14.4-25.2%) of non-Hispanic Blacks, and 12.2% (95% CI 11.2-13.1%) of non-Hispanic Whites had no insurance coverage. Hispanics were significantly less likely to report poor or fair health (12.1%, 95% CI 7.5-16.7%) than non-Hispanic Blacks (21.6%, 95% CI 17.2-26.0%), and less likely to report activity limitation (12.9%, 95% CI 8.0-17.9%) than non-Hispanic Whites (20.2%, 95% CI 19.1-21.2%). Controlling for sociodemographic characteristics, Hispanics had greater physician-diagnosed diabetes (OR = 2.0, 95% CI 1.0-3.3%) and Hispanics aged > or = 50 were less likely to have no sigmoidoscopy or colonoscopy in the past five years (OR = 0.5, 95% CI 0.2-1.0%) compared to non-Hispanic Whites. CONCLUSIONS: Other than lower healthcare coverage and diabetes status, the health indicators for English-speaking Hispanics were similar to, or better than, non-Hispanic Blacks and Whites. However, these data may not represent all Hispanics in Missouri since health status between English-speaking and non-English speaking Hispanics may differ significantly.

Breast Cancer Survivorship Care: Targeting a Colorectal Cancer Education Intervention.

Breast cancer survivors are at risk of developing a second primary cancer. Colorectal cancer (CRC) is one of the leading second primary cancers, and it is often preventable. We developed a multi-component educational tool to inform and encourage women breast cancer survivors to engage in CRC screening. To assess the strengths and weakness of the tool and to improve the relevancy to the target audience, we convened four focus groups of women breast cancer survivors in Missouri. We also assessed the potential impact of the tool on the knowledge, attitudes, and beliefs regarding CRC and collected information on the barriers to CRC screening through pre- and post-focus groups' questionnaires. A total of 43 women breast cancer survivors participated and provided very valuable suggestions on design and content to update the tool. Through the process and comparing pre- and post-focus group assessments, a significantly higher proportion of breast cancer survivors strongly agreed or agreed that CRC is preventable (78.6% vs. 96.9%, p = 0.02) and became aware that they were at a slightly increased risk for CRC (18.6% vs. 51.7%, p = 0.003). The most cited barrier was the complexity of preparation for colonoscopy.

Public health and cooperative group partnership: a colorectal cancer intervention.

OBJECTIVES: To describe the development of a multi-component colorectal cancer educational tool for female breast cancer survivors through a cooperative group and public health partnership. DATA SOURCES: PubMed, World Wide Web, guidelines from professional organizations, surveys and focus groups with breast cancer survivors. CONCLUSION: Collaboration is at the core of cooperative group and public health research. This partnership led to the development of a colorectal cancer educational tool for breast cancer survivors. Focus groups revealed that female breast cancer survivors were receptive to education on colorectal cancer screening. IMPLICATIONS FOR NURSING PRACTICE: Nurses are instrumental in research collaborations between cooperative groups and public health. The colorectal educational intervention for breast cancer survivors serves as an exemplar of partnerships leading to innovative research planning and implementation outcomes.