According to a study led by researchers at Georgetown University's Lombardi Cancer Center in Washington, DC, low-income, inner-city women tend to more closely follow screening recommendations if their primary health care provider offers comprehensive, well-organized services.

Previous studies have shown these women to be less likely to get regular screenings for cancer and more likely to die from late-stage disease.

Writing in the Journal of General Internal Medicine, Drs. Ann O'Malley and Jeanne Mandelblatt of Georgetown, and Dr. Christopher Forrest of the Johns Hopkins School of Public Health in Baltimore, said their study was the first to examine the impact of specific characteristics of primary care delivery on a patient's willingness to have cancer screening tests. Importantly, the study also took into account a variety of attitudinal, socioeconomic and insurance barriers that can influence screening levels.

The study involved 1,205 primarily low-income African-American women over the age of 40 living in Washington, DC. The women, randomly selected from low-income neighborhoods, completed a telephone survey lasting about 25 minutes.

The researchers focused on whether the women followed screening recommendations for cervical, breast and colorectal cancers, because low-income African-American women have been shown in other studies to die from these diseases at a disproportionate rate than women from other ethnic and economic groups, and because regular screening for these diseases has been shown to significantly reduce mortality.

The researchers found that women were more likely to be screened for cancer if they saw specific primary care clinicians on a regular basis. "Although progress has been made in narrowing the gap in screening rates between minority and non-minority populations, barriers to screening persist even among the insured," the study reported. "Health care education aimed at patients should stress the importance of identifying a primary care provider and of obtaining screening through that provider."

The researchers concluded that primary care offices that provided comprehensive, accessible care and a strong patient-clinician relationship were likely to improve the women's adherence to cancer screening recommendations.

The study also found that women in private HMOs were more likely to get regular screenings, as opposed to uninsured women or those enrolled in public or private non-HMO insurance programs.

SOURCES:
Journal of General Internal Medicine, February 2002
Georgetown University Medical Center, Lombardi Cancer Center (http://www.lombardi.georgetown.edu)