Breast and cervical cancer screening for Puerto Ricans, African Americans, and non-Hispanic whites attending inner-city family practice centers.

OBJECTIVES: Disparities exist for breast and cervical cancer screening among racial/ ethnic groups and low-income women. This study determines racial/ethnic variation in: 1) staging readiness for mammography, Pap smears, and clinical breast exam (CBE); 2) identifying patterns of adherence; and 3) determining sociodemographics associated with compliance with all three exams. DESIGN: Cross-sectional. SETTING: Two urban family medicine clinics. PATIENTS: A consecutive sample of 343 women presenting for care. INTERVENTIONS: Women were staged (maintainers, actors, contemplators, precontemplators, relapse contemplators, and relapse precontemplators) according to self-reported receipt of mammography, CBEs, and Pap smears. MAIN OUTCOME MEASURES: Adherence across exams was assessed. Sociodemographics were compared among racial/ethnic groups for women adherent with all three exams. RESULTS: Sixty-one percent were adherent with mammography, 93% with Pap smears, and 67% with CBEs. Thirty percent were contemplating mammography. Fifty-eight percent of Puerto Rican women were adherent with CBEs compared to 68.6% of African American and 78.5% of non-Hispanic White women. Puerto Rican women were less likely to be maintainers of CBE and more likely to be precontemplators and relapsers than non-Hispanic White women (P=.004). Forty-eight percent were adherent with all three exams. Puerto Rican women compliant with all three screens were younger and less educated than African American and non-Hispanic White CONCLUSIONS: Racial/ethnic differences in screening patterns exist among women attending urban family practice centers. Primary care providers must be culturally sensitive when recommending screening and can use staging as a tool to target women most receptive to intervention.

Self-report and primary care medical record documentation of mammography and Pap smear utilization among low-income women.

PURPOSE: To determine whether self-report of mammography and Pap smear utilization was accurate and to determine whether racial/ethnic differences existed. METHODS: Face-to-face surveys were administered to 314 consecutively selected women over 40 attending two low-income inner-city family practice sites. Medical records were reviewed for documentation of mammography and Pap smear utilization. Level of agreement between self-report and chart review was reported. Sensitivity, specificity, positive predictive value and negative predictive value were calculated. MAIN FINDINGS: Puerto Rican women had lower income levels and were less educated than African-American and non-Latina white women. Self-report of mammograms and Pap smears were higher than medical record documentation. Level of agreement was higher for more recent tests. Negative predictive values for mammography were high (75-95.5%). Lower sensitivity, specificity, positive predictive value and negative predictive value for mammography were seen among Puerto Rican women compared to African-American and non-Latina white women. CONCLUSIONS: High negative predictive values suggest that asking women about mammography use may be an inexpensive, easy intervention in the primary care setting to increase screening among women currently not being screened by increasing conversations between patients and providers to address personal barriers to screening.