Compliance and self-reported barriers to follow-up of abnormal screening mammograms among women utilizing a county mobile mammography van.

Our primary objective was to describe the follow-up patterns for abnormal screening mammograms among women in a large urban county who utilized mobile mammography. We conducted a retrospective cohort analysis using electronic records, medical chart review, and questionnaires. Compliance with diagnostic evaluation was 43% to 60%. Among women who did have follow-up, more than 40% did not do so in a timely fashion. Younger women and those with less suspicious mammograms were more likely to have longer delays. We concluded that programs that utilize mobile mammography should include intensive, multilingual tracking systems in order increase diagnostic follow-up for this vulnerable population.

Mobile mammography: assessment of self-referral in reaching medically underserved women.

BACKGROUND: Mobile mammography can be useful in reaching medically underserved women. However, it is not known whether self-referral for mobile mammography is the best approach for reaching the most vulnerable populations. OBJECTIVES: 1) To describe the community outreach patterns of a county-sponsored mobile mammography unit, 2) To characterize the follow-up patterns for women with abnormal screening mammograms, and 3) to identify reasons why women screened on mobile units seek follow-up care outside of the safety-net system. METHODS: We prospectively followed women aged > or = 40 years who received mobile mammograms using electronic records and medical chart review, and surveyed women who had no evidence of diagnostic follow-up. We also reviewed administrative records to determine outreach patterns of the mobile mammography units. RESULTS: Seventy-five percent of mobile visits were with community-based organizations or community health centers. At least one quarter of women chose to follow-up outside of the safety-net for evaluation of abnormal screening mammograms. Of these, nearly 40% reported having insurance or a private physician as the primary reason for having diagnostic evaluation outside of the public hospital system. CONCLUSIONS: Despite serving primarily community-based facilities, self-referral for mobile mammography may not optimally target medically underserved women most in need of breast cancer screening.

Disparities in screening mammography. Current status, interventions and implications.

OBJECTIVE: This paper describes trends in screening mammography utilization over the past decade and assesses the remaining disparities in mammography use among medically underserved women. We also describe the barriers to mammography and report effective interventions to enhance utilization. DESIGN: We reviewed medline and other databases as well as relevant bibliographies. MAIN RESULTS: The United States has dramatically improved its use of screening mammography over the past decade, with increased rates observed in every demographic group. Disparities in screening mammography are decreasing among medically underserved populations but still persist among racial/ethnic minorities and low-income women. Additionally, uninsured women and those with no usual care have the lowest rates of reported mammogram use. However, despite apparent increases in mammogram utilization, there is growing evidence that limitations in the national survey databases lead to overestimations of mammogram use, particularly among low-income racial and ethnic minorities. CONCLUSIONS: The United States may be farther from its national goals of screening mammography, particularly among underserved women, than current data suggests. We should continue to support those interventions that increase mammography use among the medically underserved by addressing the barriers such as cost, language and acculturation limitations, deficits in knowledge and cultural beliefs, literacy and health system barriers such as insurance and having a source regular of medical care. Addressing disparities in the diagnostic and cancer treatment process should also be a priority in order to affect significant change in health outcomes among the underserved.

Inadequate follow-up for abnormal Pap smears in an urban population.

PURPOSE: To determine the factors associated with inadequate follow-up for abnormal Pap smears among a cohort of Boston women from urban academic clinics. METHODS: Subjects were women > 18 years with abnormal cervical cytology between February 1999 and April 2000. Inadequate follow-up was defined as lack of subsequent cervical cytology or pathology specimen within four months of the initial abnormal specimen for high-grade lesions or within 7 months for low-grade lesions. RESULTS: Of the 423 subjects, the mean age was 33 years. Sixty percent were black, 23% Hispanic, 15% white, 2% Asian. The population was largely uninsured or publically insured. The overall inadequate follow-up rate was 38%. In bivariate analysis, age was a significant risk factor; 46% of women ages 18-29 had inadequate follow-up (p < 0.01). In multivariate analysis, women aged 18-29 years were more likely than women 50 years and older to have inadequate follow-up (OR 2.7, 95% CI 1.1-6.4), as were women with Medicaid insurance compared with private insurance (OR 1.9, 95% CI 1.01-3.5). After 12 months, 26% of women with abnormal Pap smears still had not received follow-up. CONCLUSIONS: In a predominantly urban minority population, the overall rate of inadequate follow-up for abnormal Pap smears was high at 38%. Programs to address follow-up of abnormal cervical cytology should focus on minority populations, especially younger and all low-income women.