Irene Prabhu Das | National Institutes of Health (original) (raw)
Papers by Irene Prabhu Das
Journal of oncology practice / American Society of Clinical Oncology, Jan 13, 2015
The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We inv... more The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We investigated the impact of MDC on the processes of care at cancer centers within the National Cancer Institute Community Cancer Centers Program (NCCCP). The study used data from patients diagnosed with stage IIB to III rectal cancer, stage III colon cancer, and stage III non-small-cell lung cancer at 14 NCCCP cancer centers from 2007 to 2012. We used an MDC development assessment tool-with levels ranging from evolving MDC (low) to achieving excellence (high)-to measure the level of MDC implementation in seven MDC areas, such as case planning and physician engagement. Descriptive statistics and cluster-adjusted regression models quantified the association between MDC implementation and processes of care, including time from diagnosis to treatment receipt. A total of 1,079 patients were examined. Compared with patients with colon cancer treated at cancer centers reporting low MDC scores, time...
Journal of oncology practice / American Society of Clinical Oncology, Jan 21, 2014
The National Cancer Institute Community Cancer Centers Program (NCCCP) began in 2007 with a goal ... more The National Cancer Institute Community Cancer Centers Program (NCCCP) began in 2007 with a goal of expanding cancer research and delivering quality care in communities. The NCCCP Quality of Care (QoC) Subcommittee was charged with developing and improving the quality of multidisciplinary care. An assessment tool with nine key elements relevant to MDC structure and operations was developed. Fourteen NCCCP sites reported multidisciplinary care assessments for lung, breast, and colorectal cancer in June 2010, June 2011, and June 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no multidisciplinary care, level 5 = highly integrated multidisciplinary care) in nine elements integral to multidisciplinary care. Thematic analysis of open-ended qualitative responses was also conducted. The proportion of sites that reported level 3 or greater on the assessment tool was tabulated at each time point. For all tumor types, sites that reached this level i...
JNCI Monographs, 2010
Quality cancer care is complex and depends upon careful coordination between multiple treatments ... more Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians [PCPs], and support services) (1). Earlier in this supplement, Taplin and others have pointed out the challenges of transferring information and responsibility among providers and institutions; a problem at the interfaces of care. Advances in surgical procedures, chemotherapy, computer technology, and targeted molecular and radiation therapies have all led to an increase in multimodality therapy, which increases the number of interfaces among cancer specialists and other clinicians in the treatment of any single patient. Contemporary cancer care thus presents a paradox: The potential for unparalleled quality and sophisticated treatment is high, yet the number of potential "failure" events in the continuum of cancer treatment (2) has multiplied significantly. Each failure in communication between various physicians and care providers and every transition and interface miscue can result in delayed treatment planning and implementation, unnecessary duplication of tests, incomplete follow-up, increased patient anxiety, decreased patient satisfaction, and declines in quality of life.
Journal of the National Cancer Institute. Monographs, 1993
In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a... more In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a randomized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service (CIS). This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography; this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief (6-minute) proactive telephone-counseling protocol. The screening-mammography counseling intervention was tested in two regional CIS offices using a randomized two-group design. Callers were randomly assigned to the intervention or control group based on the week of their call to the CIS (n = 1831 eligible female callers). Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months' follow-up (87% response rate). Among ...
Preventive Medicine, 1994
Preventive Medicine, 1999
Breast cancer is the most common neoplasm among degree relatives of breast cancer cases are at in... more Breast cancer is the most common neoplasm among degree relatives of breast cancer cases are at increased women in the United States and the second leading risk of developing the disease themselves, they may be underutilizing screening mammography. Therefore, cause of cancer deaths. There were 178,700 new breast interventions to increase the use of mammography in cancer cases and 43,900 breast cancer deaths estimated this group are urgently needed.
JNCI Monographs, 2012
The concept of time introduces important complexities in designing and evaluating programs, measu... more The concept of time introduces important complexities in designing and evaluating programs, measuring and analyzing individual changes, and estimating intervention effects in multilevel interventions (MLIs). For example, investigators may focus on time to address whether interventions are more effective in early stages of implementation or whether their effects attenuate over time. Assessing how time is experienced by individual patients may influence both the design of MLIs and the analysis of the effects of such interventions. For example, assessing how interventions interact with individual growth trajectories to affect outcomes of interest may allow investigators to gain a more nuanced understanding of an intervention's impact on individuals. At the environmental and organizational levels, interventions that change structures or processes often play out over extended time intervals and not always in linear fashion.
JNCI Monographs, 2012
Health care in the United States is notoriously expensive while often failing to deliver the care... more Health care in the United States is notoriously expensive while often failing to deliver the care recommended in published guidelines. There is, therefore, a need to consider our approach to health-care delivery. Cancer care is a good example for consideration because it spans the continuum of health-care issues from primary prevention through long-term survival and end-of-life care. In this monograph, we emphasize that health-care delivery occurs in a multilevel system that includes organizations, teams, and individuals. To achieve health-care delivery consistent with the Institute of Medicine's six quality aims (safety, effectiveness, timeliness, efficiency, patient-centeredness, and equity), we must influence multiple levels of that multilevel system. The notion that multiple levels of contextual influence affect behaviors through interdependent interactions is a wellestablished ecological view. This view has been used to analyze health-care delivery and health disparities. However, experience considering multilevel interventions in health care is much less robust. This monograph includes 13 chapters relevant to expanding the foundation of research for multilevel interventions in health-care delivery. Subjects include clinical cases of multilevel thinking in health-care delivery, the state of knowledge regarding multilevel interventions, study design and measurement considerations, methods for combining interventions, time as a consideration in the evaluation of effects, measurement of effects, simulations, application of multilevel thinking to health-care systems and disparities, and implementation of the Affordable Care Act of 2010. Our goal is to outline an agenda to proceed with multilevel intervention research, not because it guarantees improvement in our current approach to health care, but because ignoring the complexity of the multilevel environment in which care occurs has not achieved the desired improvements in care quality outlined by the Institute of Medicine at the turn of the millennium.
Journal of Oncology Practice, 2013
Patients with cancer treated at community hospitals may experience decreased quality of care comp... more Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression. Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparison-group hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. Both NCCCP and comparison-group hospitals showed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.
American Journal of Preventive Medicine, 2011
Journal of the South Carolina Medical Association (1975), 2009
... aSSoCiatioN Irene Prabhu Das, PhD DeAnne K. Hilfinger Messias, RN, PhD, FAAN Deborah Parra-Me... more ... aSSoCiatioN Irene Prabhu Das, PhD DeAnne K. Hilfinger Messias, RN, PhD, FAAN Deborah Parra-Medina, MPH, PhD Kathryn Luchok, PhD ... They measured quality of care by timeliness of work-up and appropriate-ness of care, which referred to the ... Chenitz WC & Swanson JM. ...
Journal of the South Carolina Medical Association (1975), 2009
1. JSC Med Assoc. 2009 Dec;105(7):297-305. The partnership for cancer prevention: addressing acce... more 1. JSC Med Assoc. 2009 Dec;105(7):297-305. The partnership for cancer prevention: addressing access to cervical cancer screening among Latinas in South Carolina. Parra-Medina D, Messias DK, Fore E, Rachel M, Petry D, Das IP. parramedina@uthscsa.edu. ...
Journal of Women's Health, 2007
Objective: Approximately 4000 women annually will die from preventable and treatable cervical can... more Objective: Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions to decrease morbidity and mortality due to cervical cancer.
Gynecologic Oncology, 2007
To address socio-demographic factors associated with adherence to follow-up recommendations in a ... more To address socio-demographic factors associated with adherence to follow-up recommendations in a high-risk population of women referred for follow-up care after an abnormal Pap test. 486 women aged 46-64 served by BCCEDP in two southeastern states between 1999-2002 and referred for follow-up care after an abnormal Pap test were the sampling frame for this cross-sectional study; 204 women completed a phone-based interview in 2004. Cox proportional hazards modeling was used to determine the association of various risk factors with time to adherence. Among those completing the phone interview (interview rate=61.4%) the mean age was 53.3 years, 64.7% were African-American women, 81.9% had low-grade cervical lesions, and all were either uninsured or under insured. Over 95% received follow-up care for an abnormal Pap test within 365 days of referral. When the BCCEDP criteria of follow-up within 60 days were applied, 52.9% were adherent. Rates of self-reported and program documented adherence differed significantly by state. After adjusting for state of residence, women who reported having symptoms of a chronic disease were more likely to be adherent within 365 days (aHR=1.42; 95% CI=1.00, 2.04). Neither age, race, lesion severity, education, number of dependent adults or children, self-perceived physical health, nor smoking status was associated with time to adherence. Findings suggest that institutional factors may be more important than individual factors in predicting time to adherence for an abnormal Pap test.
Cancer Epidemiology Biomarkers & Prevention, 2008
Breast cancer affects thousands each year in the United States, and disproportionately affects ce... more Breast cancer affects thousands each year in the United States, and disproportionately affects certain subgroups. For example, the incidence of breast cancer in South Carolina is lower in African American compared with European American women by ~12% to 15%, but their mortality rate is twice as high as in European American women. The purpose of the study was to assess factors associated with breast cancer mortality between African American and European American women. Participants (n = 314) in South Carolina's Breast and Cervical Cancer Early Detection Program (SCBCCEDP), which provides breast cancer screening and treatment services, during the years 1996-2004 were included in the study. Data, including tumor characteristics, delay intervals, and race, were examined using the χ 2 test and the Wilcoxon rank-sum test. Cox regression modeling was used to assess the relationship between delay intervals and other factors. No racial differences were found in age at diagnosis, tumor characteristics, or delay intervals. Time delay intervals did not explain differences and mortality rates by race. Survival, however, was affected by prognostic factors as well as by a significant interaction between hormone-receptor status and race. Despite the excellent record of the SCBCCEDP in screening and diagnostic or treatment referrals, the racial disparities in breast cancer mortality continue to exist in South Carolina. These findings highlight the need for future research into the etiology of racial differences, and their impact on breast cancer survival.
Cancer, 2009
Background-In the United States and particularly South Carolina, African-American women suffer di... more Background-In the United States and particularly South Carolina, African-American women suffer disproportionately higher mortality rates than do European-American women. The timeliness of patient adherence to the follow-up of mammographic abnormalities may influence prognosis and survival. Consequently, the purpose of the present investigation was to examine racial differences in the completion and completion time of a diagnostic work-up following a finding of a suspicious breast abnormality.
Journal of oncology practice / American Society of Clinical Oncology, Jan 13, 2015
The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We inv... more The role of multidisciplinary care (MDC) on cancer care processes is not fully understood. We investigated the impact of MDC on the processes of care at cancer centers within the National Cancer Institute Community Cancer Centers Program (NCCCP). The study used data from patients diagnosed with stage IIB to III rectal cancer, stage III colon cancer, and stage III non-small-cell lung cancer at 14 NCCCP cancer centers from 2007 to 2012. We used an MDC development assessment tool-with levels ranging from evolving MDC (low) to achieving excellence (high)-to measure the level of MDC implementation in seven MDC areas, such as case planning and physician engagement. Descriptive statistics and cluster-adjusted regression models quantified the association between MDC implementation and processes of care, including time from diagnosis to treatment receipt. A total of 1,079 patients were examined. Compared with patients with colon cancer treated at cancer centers reporting low MDC scores, time...
Journal of oncology practice / American Society of Clinical Oncology, Jan 21, 2014
The National Cancer Institute Community Cancer Centers Program (NCCCP) began in 2007 with a goal ... more The National Cancer Institute Community Cancer Centers Program (NCCCP) began in 2007 with a goal of expanding cancer research and delivering quality care in communities. The NCCCP Quality of Care (QoC) Subcommittee was charged with developing and improving the quality of multidisciplinary care. An assessment tool with nine key elements relevant to MDC structure and operations was developed. Fourteen NCCCP sites reported multidisciplinary care assessments for lung, breast, and colorectal cancer in June 2010, June 2011, and June 2012 using an online reporting tool. Each site evaluated their level of maturity (level 1 = no multidisciplinary care, level 5 = highly integrated multidisciplinary care) in nine elements integral to multidisciplinary care. Thematic analysis of open-ended qualitative responses was also conducted. The proportion of sites that reported level 3 or greater on the assessment tool was tabulated at each time point. For all tumor types, sites that reached this level i...
JNCI Monographs, 2010
Quality cancer care is complex and depends upon careful coordination between multiple treatments ... more Quality cancer care is complex and depends upon careful coordination between multiple treatments and providers and upon technical information exchange and regular communication flow between all those involved in treatment (including patients, specialist physicians, other specialty disciplines, primary care physicians [PCPs], and support services) (1). Earlier in this supplement, Taplin and others have pointed out the challenges of transferring information and responsibility among providers and institutions; a problem at the interfaces of care. Advances in surgical procedures, chemotherapy, computer technology, and targeted molecular and radiation therapies have all led to an increase in multimodality therapy, which increases the number of interfaces among cancer specialists and other clinicians in the treatment of any single patient. Contemporary cancer care thus presents a paradox: The potential for unparalleled quality and sophisticated treatment is high, yet the number of potential "failure" events in the continuum of cancer treatment (2) has multiplied significantly. Each failure in communication between various physicians and care providers and every transition and interface miscue can result in delayed treatment planning and implementation, unnecessary duplication of tests, incomplete follow-up, increased patient anxiety, decreased patient satisfaction, and declines in quality of life.
Journal of the National Cancer Institute. Monographs, 1993
In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a... more In 1987, the Division of Cancer Prevention and Control, National Cancer Institute (NCI), funded a randomized trial of a proactive counseling protocol to promote screening mammography among age-eligible female callers to the Cancer Information Service (CIS). This protocol included interactive counseling by CIS counselors to help callers overcome barriers to screening mammography; this counseling was an extension of usual service and was combined with a 2-week follow-up mailout to reinforce the brief (6-minute) proactive telephone-counseling protocol. The screening-mammography counseling intervention was tested in two regional CIS offices using a randomized two-group design. Callers were randomly assigned to the intervention or control group based on the week of their call to the CIS (n = 1831 eligible female callers). Self-reported adherence to NCI screening-mammography guidelines was assessed from telephone interviews conducted at 12 months' follow-up (87% response rate). Among ...
Preventive Medicine, 1994
Preventive Medicine, 1999
Breast cancer is the most common neoplasm among degree relatives of breast cancer cases are at in... more Breast cancer is the most common neoplasm among degree relatives of breast cancer cases are at increased women in the United States and the second leading risk of developing the disease themselves, they may be underutilizing screening mammography. Therefore, cause of cancer deaths. There were 178,700 new breast interventions to increase the use of mammography in cancer cases and 43,900 breast cancer deaths estimated this group are urgently needed.
JNCI Monographs, 2012
The concept of time introduces important complexities in designing and evaluating programs, measu... more The concept of time introduces important complexities in designing and evaluating programs, measuring and analyzing individual changes, and estimating intervention effects in multilevel interventions (MLIs). For example, investigators may focus on time to address whether interventions are more effective in early stages of implementation or whether their effects attenuate over time. Assessing how time is experienced by individual patients may influence both the design of MLIs and the analysis of the effects of such interventions. For example, assessing how interventions interact with individual growth trajectories to affect outcomes of interest may allow investigators to gain a more nuanced understanding of an intervention's impact on individuals. At the environmental and organizational levels, interventions that change structures or processes often play out over extended time intervals and not always in linear fashion.
JNCI Monographs, 2012
Health care in the United States is notoriously expensive while often failing to deliver the care... more Health care in the United States is notoriously expensive while often failing to deliver the care recommended in published guidelines. There is, therefore, a need to consider our approach to health-care delivery. Cancer care is a good example for consideration because it spans the continuum of health-care issues from primary prevention through long-term survival and end-of-life care. In this monograph, we emphasize that health-care delivery occurs in a multilevel system that includes organizations, teams, and individuals. To achieve health-care delivery consistent with the Institute of Medicine's six quality aims (safety, effectiveness, timeliness, efficiency, patient-centeredness, and equity), we must influence multiple levels of that multilevel system. The notion that multiple levels of contextual influence affect behaviors through interdependent interactions is a wellestablished ecological view. This view has been used to analyze health-care delivery and health disparities. However, experience considering multilevel interventions in health care is much less robust. This monograph includes 13 chapters relevant to expanding the foundation of research for multilevel interventions in health-care delivery. Subjects include clinical cases of multilevel thinking in health-care delivery, the state of knowledge regarding multilevel interventions, study design and measurement considerations, methods for combining interventions, time as a consideration in the evaluation of effects, measurement of effects, simulations, application of multilevel thinking to health-care systems and disparities, and implementation of the Affordable Care Act of 2010. Our goal is to outline an agenda to proceed with multilevel intervention research, not because it guarantees improvement in our current approach to health care, but because ignoring the complexity of the multilevel environment in which care occurs has not achieved the desired improvements in care quality outlined by the Institute of Medicine at the turn of the millennium.
Journal of Oncology Practice, 2013
Patients with cancer treated at community hospitals may experience decreased quality of care comp... more Patients with cancer treated at community hospitals may experience decreased quality of care compared with patients treated at higher-volume cancer hospitals. The National Cancer Institute Community Cancer Centers Program (NCCCP) pilot is designed to enhance research and improve cancer care at community hospitals. We assessed changes in quality of care among the 16 initial NCCCP sites versus 25 similar hospitals that did not participate in the NCCCP. We compared changes in concordance with five National Quality Forum-approved quality of care measures (three for breast cancer, two for colon cancer) for patients diagnosed from 2006 to 2007 (pre-NCCCP initiation) versus 2008 to 2010 (post-NCCCP initiation) at NCCCP and comparison-group hospitals. Data were collected using the Commission on Cancer Rapid Quality Reporting System. Analyses were performed using multivariate logistic regression. Analyses included 18,608 patients with breast cancer and 7,031 patients with colon cancer. After NCCCP initiation, patient-level concordance rates for all five quality-of-care measures increased significantly among NCCCP and comparison-group hospitals. Increased quality of care among NCCCP sites was significantly greater than that among comparison-group hospitals for radiation therapy after breast-conserving surgery and hormonal therapy for women with hormone receptor-positive breast cancer. In multivariate regressions, increases in hormonal therapy among NCCCP-site patients were significantly greater than those among comparison-group hospitals. Both NCCCP and comparison-group hospitals showed improved quality of care; however, NCCCP sites had significantly greater improvements for a subset of measures. This greater increase may reflect the multidisciplinary focus of the NCCCP. Because many individuals receive cancer treatment at community hospitals, facilitating high-quality care in these environments must be a priority.
American Journal of Preventive Medicine, 2011
Journal of the South Carolina Medical Association (1975), 2009
... aSSoCiatioN Irene Prabhu Das, PhD DeAnne K. Hilfinger Messias, RN, PhD, FAAN Deborah Parra-Me... more ... aSSoCiatioN Irene Prabhu Das, PhD DeAnne K. Hilfinger Messias, RN, PhD, FAAN Deborah Parra-Medina, MPH, PhD Kathryn Luchok, PhD ... They measured quality of care by timeliness of work-up and appropriate-ness of care, which referred to the ... Chenitz WC & Swanson JM. ...
Journal of the South Carolina Medical Association (1975), 2009
1. JSC Med Assoc. 2009 Dec;105(7):297-305. The partnership for cancer prevention: addressing acce... more 1. JSC Med Assoc. 2009 Dec;105(7):297-305. The partnership for cancer prevention: addressing access to cervical cancer screening among Latinas in South Carolina. Parra-Medina D, Messias DK, Fore E, Rachel M, Petry D, Das IP. parramedina@uthscsa.edu. ...
Journal of Women's Health, 2007
Objective: Approximately 4000 women annually will die from preventable and treatable cervical can... more Objective: Approximately 4000 women annually will die from preventable and treatable cervical cancer. Failure to adhere to follow-up recommendations after an abnormal Pap test can lead to development of cervical cancer. This paper summarizes the body of literature on adherence to follow-up after an abnormal Pap test in order to facilitate development of interventions to decrease morbidity and mortality due to cervical cancer.
Gynecologic Oncology, 2007
To address socio-demographic factors associated with adherence to follow-up recommendations in a ... more To address socio-demographic factors associated with adherence to follow-up recommendations in a high-risk population of women referred for follow-up care after an abnormal Pap test. 486 women aged 46-64 served by BCCEDP in two southeastern states between 1999-2002 and referred for follow-up care after an abnormal Pap test were the sampling frame for this cross-sectional study; 204 women completed a phone-based interview in 2004. Cox proportional hazards modeling was used to determine the association of various risk factors with time to adherence. Among those completing the phone interview (interview rate=61.4%) the mean age was 53.3 years, 64.7% were African-American women, 81.9% had low-grade cervical lesions, and all were either uninsured or under insured. Over 95% received follow-up care for an abnormal Pap test within 365 days of referral. When the BCCEDP criteria of follow-up within 60 days were applied, 52.9% were adherent. Rates of self-reported and program documented adherence differed significantly by state. After adjusting for state of residence, women who reported having symptoms of a chronic disease were more likely to be adherent within 365 days (aHR=1.42; 95% CI=1.00, 2.04). Neither age, race, lesion severity, education, number of dependent adults or children, self-perceived physical health, nor smoking status was associated with time to adherence. Findings suggest that institutional factors may be more important than individual factors in predicting time to adherence for an abnormal Pap test.
Cancer Epidemiology Biomarkers & Prevention, 2008
Breast cancer affects thousands each year in the United States, and disproportionately affects ce... more Breast cancer affects thousands each year in the United States, and disproportionately affects certain subgroups. For example, the incidence of breast cancer in South Carolina is lower in African American compared with European American women by ~12% to 15%, but their mortality rate is twice as high as in European American women. The purpose of the study was to assess factors associated with breast cancer mortality between African American and European American women. Participants (n = 314) in South Carolina's Breast and Cervical Cancer Early Detection Program (SCBCCEDP), which provides breast cancer screening and treatment services, during the years 1996-2004 were included in the study. Data, including tumor characteristics, delay intervals, and race, were examined using the χ 2 test and the Wilcoxon rank-sum test. Cox regression modeling was used to assess the relationship between delay intervals and other factors. No racial differences were found in age at diagnosis, tumor characteristics, or delay intervals. Time delay intervals did not explain differences and mortality rates by race. Survival, however, was affected by prognostic factors as well as by a significant interaction between hormone-receptor status and race. Despite the excellent record of the SCBCCEDP in screening and diagnostic or treatment referrals, the racial disparities in breast cancer mortality continue to exist in South Carolina. These findings highlight the need for future research into the etiology of racial differences, and their impact on breast cancer survival.
Cancer, 2009
Background-In the United States and particularly South Carolina, African-American women suffer di... more Background-In the United States and particularly South Carolina, African-American women suffer disproportionately higher mortality rates than do European-American women. The timeliness of patient adherence to the follow-up of mammographic abnormalities may influence prognosis and survival. Consequently, the purpose of the present investigation was to examine racial differences in the completion and completion time of a diagnostic work-up following a finding of a suspicious breast abnormality.