Targeting cancer control: the state cancer control map and data program.

The State Cancer Control Map and Data Program (National Technical Information Service, Springfield, Va) allows state and county mortality maps and data tables to be tailored according to the user's choice of cancer site, age, gender, race, county, and time period between 1953 and 1987. Counties and subpopulations within these maps and data tables that are identified as having exceptionally high rates of specific cancers can then be targeted for early detection or primary prevention. These maps and data tables provide a means for focusing state, local, and individual efforts to reduce cancer mortality in appropriate populations in areas with high mortality rates.

Factors affecting physician adherence to breast cancer screening guidelines.

A one-group, meta-analytic design was used to assess survey results published between the years of 1985 and 1990 that measured adherence to the breast cancer screening guidelines by U.S. primary care physicians. The purpose of this analysis was twofold: 1) to systematically synthesize current literature to determine why primary care physicians do not adhere to the prescribed breast cancer screening guidelines; and 2) to determine what strategies and interventions would be most effective in increasing adherence to the guidelines. Factors associated with nonadherence to guidelines included cost concerns, patient worry and refusal, radiation risk, and lack of confidence in performing a clinical breast examination. Five factors were associated with increased adherence to guidelines. Effective interventions must address the specific concerns of physicians by specialty to mitigate barriers to adherence. Generic interventions with a single focus are not likely to achieve their intended effects.

Cancer screening behaviors among U.S. women: breast cancer, 1987-1989, and cervical cancer, 1988-1989.

Data from the Behavioral Risk Factor Surveillance System (BRFSS) were used to examine trends in breast and cervical cancer screening behaviors among U.S. women in selected states. Data reported are from the 1987, 1988, and 1989 BRFSS for breast cancer screening (mammography) and from the 1988 and 1989 BRFSS for cervical cancer screening (Papanicolaou [Pap] smear). Results are presented as either state-specific or state-aggregate data for the years noted above. State-specific analyses indicated that self-reported mammography utilization increased between 1987 and 1989. Although whites and blacks reported similar mammography utilization rates both for screening and for a current or previous breast problem, disparities were evident among women of different ages and incomes. The proportion of women who reported ever having had a Pap smear and having heard of a Pap smear were extremely high and remained fairly consistent across the 2 survey years. State-aggregate analyses, however, showed that the percentage of women who had had a Pap smear within the previous year was negatively associated with age and positively associated with income. A higher proportion of blacks than whites obtained Pap smears. These results indicate that certain segments of the population are not taking full advantage of available breast and cervical cancer screening technologies. Public health strategies, such as those outlined in the Breast and Cervical Cancer Mortality Prevention Act of 1990 (Public Law 101-354), should enhance screening opportunities for these women.

Breast and cervical cancer screening in minority populations: a model for using lay health educators.

Although mammography and the Pap smear have significantly reduced US deaths related to breast and cervical cancers, screening prevalence and survival rates for both diseases are disproportionately lower among minority women. This model program outlines techniques for recruiting and training minority women to serve as lay health educators who can effectively deliver preventive health care information to their peers. Lay health educators have three primary functions: to serve as mediators between minority women and health agencies, to establish a social network, and to offer social support. When properly recruited and trained, these educators can bridge the gap between health professionals and the community as well as help health professionals to better understand community and individual concerns about cancer. The goal is to increase the detection, prevention, and treatment of breast and cervical cancers in minority communities and thus decrease related deaths. An ongoing intervention by the Arizona Disease Prevention Center, targeting Yaqui Indian and Mexican-American women aged 35 and older, illustrates specific elements of the model.