Influences on Mammography Screening Levels
A pair of researchers from Eastern Washington University has identified a number of key factors that appear to strongly influence whether women undergo routine mammography screening for breast cancer.
Writing in the journal Preventive Medicine, Drs. Roe Roberts and Nancy Birch found that average income, type of insurance (or lack thereof), provider type, long waiting times, and poor communication between doctors and their patients were all significant factors that affected mammography screening levels. They based their conclusions on a review of preventive breast cancer screening rates among 1,400 women in the greater Spokane area.
Of these factors, they determined that the relationship between the healthcare provider and the patient herself was both the most important factor as well as the easiest to improve. They strongly urged doctors implement patient education programs about the importance of breast cancer screening. They also suggested that physicians simply take a little more time to personally discuss these issues.
A similar study was published in the Journal of the American Board of Family Practice. Researchers led by Dr. Jeanne Ferrante of the University of South Florida and the H. Lee Moffitt Cancer Center in Tampa assessed the relationship between the local supply of physicians and the early detection of breast cancer for women in the surrounding area.
Using data from the Florida cancer registry in 1994, the researchers specifically focused on the balance between medical specialists and primary care physicians, and how this ratio would impact the earlier detection of breast cancer through mammography screening.
After examining 11,740 Florida breast cancer patient records and comparing them to the distribution of physicians throughout the state, they found no relation between the total supply of physicians and earlier detection.
However, they did notice a significant relationship between the number of primary care physicians and earlier detection. "As the supply of primary care physicians increased, the odds of early-stage diagnosis increased," they wrote.
Another study, published in the American Journal of Public Health, focused on the dramatically lower levels of mammography screening rates for African-American women in eastern North Carolina. One reason: fewer doctor referrals for minority patients.
Dr. Michael O'Malley of the University of North Carolina, Chapel Hill and colleagues compared approximately 2,000 African-American and white women aged 52 and older living in 10 rural North Carolina counties between 1993 and 1994. Their finding: The African-American women were only half as likely to have undergone mammography screening as their white counterparts.
Disturbingly, O'Malley's team also found that doctors were less likely to recommend screening mammography to their African-American patients as compared to their white patients. Fifty-five percent of the white women in the study said that a physician had recommended mammography to them within the past year, compared to only 45 percent of African-American women.
However, they noted that a significant hurdle must still be overcome concerning doctors themselves. "Previous research has shown that when a doctor recommends a mammogram, the chance that a woman will actually get screened increases dramatically," they wrote. "This study underscores the need for healthcare providers to be aware of their influence. They need to recommend mammograms to all women, even those they perceive as of limited means."
SOURCES:
Preventive Medicine, April 2001; 32:348-358
Journal of the American Board of Family Practice, 2000; 13(6): 408-414
American Journal of Public Health, January 2001; 91(1):00-00
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