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      Meeting the mammography screening needs of underserved women: the performance of the National Breast and Cervical Cancer Early Detection Program in 2002–2003 (United States)

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          Abstract

          Objective

          To examine the extent to which the National Breast and Cervical Cancer Early Detection Program (Program) has helped to meet the mammography screening needs of underserved women.

          Methods

          Low-income, uninsured women aged 40–64 are eligible for free mammography screening through the Program. We used data from the U.S. Census Bureau to estimate the number of women eligible for services. We obtained the number of women receiving Program-funded mammograms from the Program. We then calculated the percentage of eligible women who received mammograms through the Program.

          Results

          In 2002–2003, of all U.S. women aged 40–64, approximately 4 million (8.5%) had no health insurance and had a family income below 250% of the federal poverty level, meeting Program eligibility criteria. Of these women, 528,622 (13.2%) received a Program-funded mammogram. Rates varied substantially by race and ethnicity. The percentage of eligible women screened in each state ranged from about 2% to approximately 79%.

          Conclusions

          Although the Program provided screening services to over a half-million low-income, uninsured women for mammography, it served a small percentage of those eligible. Given that in 2003 more than 2.3 million uninsured, low-income, women aged 40–64 did not receive recommended mammograms from either the Program or other sources, there remains a substantial need for services for this historically underserved population.

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          Most cited references12

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          Progress in cancer screening practices in the United States: results from the 2000 National Health Interview Survey.

          Understanding differences in cancer screening among population groups in 2000 and successes or failures in reducing disparities over time among groups is important for planning a public health strategy to reduce or eliminate health disparities, a major goal of Healthy People 2010 national cancer screening objectives. In 2000, the new cancer control module added to the National Health Interview Survey (NHIS) collected more detailed information on cancer screening compared with previous surveys. Data from the 2000 NHIS and earlier surveys were analyzed to discern patterns and trends in cancer screening practices, including Pap tests, mammography, prostate specific antigen (PSA) screening, and colorectal screening. The data are reported for population subgroups that were defined by a number of demographic and socioeconomic characteristics. Women who were least likely to have had a mammogram within the last 2 years were those with no usual source of health care (61%), women with no health insurance (67%), and women who immigrated to the United States within the last 10 years (61%). Results for Pap tests within the last 3 years were similar. Among both men and women, those least likely to have had a fecal occult blood test or endoscopy within the recommended screening interval had no usual source of care (14% for men and 18% for women), no health insurance (20% for men and 18% for women), or were recent immigrants (20% for men and 18% for women). An analysis of changes in test use since the 1987 survey indicates that the disparities are widening among groups with no usual source of care. No striking improvements have been observed for the groups with greatest need. Although screening use for most groups has increased since 1987, major disparities remain. Some groups, notably individuals with no usual source of care and the uninsured are falling further behind; and, according to the 2000 data, recent immigrants also experience a significant gap in screening utilization. More attention is needed to overcome screening barriers for these groups if the population benefits of cancer screening are to be achieved. Published 2003 by the American Cancer Society.DOI 10.1002/cncr.11208
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            Healthy People 2010

            D. Satcher (2000)
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              Breast cancer screening practices among women in the United States, 2000.

              Results from recent studies indicate that many women in the US undergo routine screening for breast cancer, but some groups of women are under-screened. In this study, we examined the breast cancer screening practices of white and black women in the United States, according to Hispanic ethnicity and other factors, using data from the 2000 National Health Interview Survey. Among women aged > or =40 years, 71.2% (95% confidence interval, CI: 70.0-72.4%) of the 8201 white women and 67.6% (95% CI: 64.5-70.6%) of the 1474 black women in this sample reported having a mammogram in the past two years. About 60.3% (95% CI: 56.7-70.3%) of 970 Hispanic women (including those who reported they were white or black) and 71.5% (95% CI: 70.3-72.7%) of 8705 non-Hispanic women reported having a mammogram in the past two years. About 74.8% (95% CI: 73.8-76.8%) of 8176 white women and 73.8% (95% CI: 71.1-76.6%) of 1471 black women aged > or =40 years had received a clinical breast examination in the past two years. About 60.1% (95% CI: 56.1-64.0%) of 969 Hispanic women (including those who reported they were white or black) and 75.6% (95% CI: 74.6-76.6%) of 8678 non-Hispanic women had received a clinical breast examination in the past two years. Women with lower incomes, those with less education, and recent immigrants were less likely to be screened. Women who had a usual source of health care and those with health insurance coverage were more likely to have been screened. These results underscore the need for continued efforts to ensure that uninsured women and those who are medically underserved have access to cancer screening services.
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                Author and article information

                Contributors
                fbt9@cdc.gov
                Journal
                Cancer Causes Control
                Cancer Causes & Control
                Kluwer Academic Publishers (Dordrecht )
                0957-5243
                1573-7225
                November 2006
                : 17
                : 9
                : 1145-1154
                Affiliations
                [1 ]Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA USA
                [2 ]Office of Strategy and Innovation, Centers for Disease Control and Prevention, Atlanta, GA USA
                [3 ]Housing and Household Economic Statistics Division, U.S. Census Bureau, Washington, DC USA
                [4 ]Centers for Disease Control and Prevention, DCPC, 4770 Buford Highway, NE, Mailstop K-55, Atlanta, GA 30341-3717 USA
                Article
                58
                10.1007/s10552-006-0058-y
                1764594
                17006720
                2a92690e-063c-4fc0-a796-b481c8e349a4
                © Springer Science+Business media B.V. 2006
                History
                : 23 February 2006
                : 26 June 2006
                Categories
                Original Paper
                Custom metadata
                © Springer Science+Business Media B.V. 2006

                Oncology & Radiotherapy
                mammography screening,screening rates,breast cancer,medically underserved

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