Timely care after an abnormal mammogram among low-income women in a public breast cancer screening program - PubMed (original) (raw)

Timely care after an abnormal mammogram among low-income women in a public breast cancer screening program

Rebecca Lobb et al. Arch Intern Med. 2010.

Abstract

Background: Since 1990, the National Breast and Cervical Cancer Early Detection Program (BCCEDP) has funded breast cancer screening and diagnostic services for low-income, underinsured women. Case management was implemented in 2001 to address barriers to follow-up after an abnormal mammogram, and free treatment was introduced in 2004. However, the effect of these policies on timeliness of care has not been empirically evaluated.

Methods: Among 2252 BCCEDP participants in Massachusetts during 1998 through 2007, we conducted a time-to-event analysis with prepolicy-postpolicy comparisons to examine associations of case management and free treatment with diagnostic and treatment delays (>60 days and >90 days, respectively) after an abnormal mammogram.

Results: The proportion of women experiencing a diagnostic delay decreased from 33% to 23% after the introduction of case management (P < .001), with a significant reduction in the adjusted risk of diagnostic delay (relative risk [RR], 0.65; 95% confidence interval [CI], 0.53-0.79) that did not differ by race and ethnicity. However, case management was not associated with changes in treatment delay (RR, 0.93; 95% CI, 0.80-1.10). Free treatment was not associated with changes in the adjusted risk of diagnostic delay (RR, 0.61; 95% CI, 0.33-1.14) or treatment delay (RR, 0.77; 95% CI, 0.43-1.38) beyond improvements associated with case management.

Conclusions: Case management to assist women in overcoming logistic and psychosocial barriers to care may improve time to diagnosis among low-income women who receive free breast cancer screening and diagnostic services. Programs that provide services to coordinate care, in addition to free screening and diagnostic tests, may improve population health.

PubMed Disclaimer

Figures

Figure 1

Figure 1. Outcome Measures of Delay

1. Abnormal index mammograms occurred 7/1/1998-3/31/2007. 2. Follow-up events occurred 7/1/1998-6/30/2007. 3. Based on the Centers for Disease Control and Prevention recommendation for timely follow-up. 4. Based on evidence suggesting treatment delays as short as 3 months may contribute to poorer survival.

Comment in

Similar articles

Cited by

References

    1. American Cancer Society. Breast Cancer Facts & Figures 2009-2010. Atlanta, GA: American Cancer Society, Inc.;
    1. Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med. 1993 Jul 29;329(5):326–331. - PubMed
    1. Ward E, Halpern M, Schrag N, et al. Association of insurance with cancer care utilization and outcomes. CA Cancer J Clin. 2008 Jan-Feb;58(1):9–31. - PubMed
    1. Halpern MT, Ward EM, Pavluck AL, Schrag NM, Bian J, Chen AY. Association of insurance status and ethnicity with cancer stage at diagnosis for 12 cancer sites: a retrospective analysis. Lancet Oncol. 2008 Mar;9(3):222–231. - PubMed
    1. Byers TE, Wolf HJ, Bauer KR, et al. The impact of socioeconomic status on survival after cancer in the United States : findings from the National Program of Cancer Registries Patterns of Care Study. Cancer. 2008 Aug 1;113(3):582–591. - PubMed

Publication types

MeSH terms

Grants and funding

LinkOut - more resources