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Adherence to screening mammography among American Indian women of the northern plains

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Abstract

Breast cancer is a burden for American Indian (AI) women who have younger age at diagnosis and higher stage of disease. Rural areas also have had less access to screening mammography. An Indian Health Service Mobile Women’s Health Unit (MWHU) was implemented to improve mammogram screening of AI women in the Northern Plains. Our purpose was to determine the past adherence to screening mammography at a woman’s first presentation to the MWHU for mammogram screening. Date of the most recent prior non-MWHU mammogram was obtained from mammography records. Adherence to screening guidelines was defined as the prior mammogram occurring 1–2 years before the first MWHU visit among women >41 years, and was the main outcome, whereas, age and clinic site were predictors. Adherence was compared with national data of the Breast Cancer Surveillance Consortium (BCSC). Among 1,771 women >41 years, adherence to screening mammography guidelines was 48.01 % among >65 years, 42.05 % among 50–64 years, 33.43 % among 41–49 years, and varied with clinic site (25.23–65.93 %). Age (p < 0.0001) and clinic site (p < 0.0001) were associated with adherence. Overall, adherence to screening mammography guidelines was found in 39.86 % (706/1771) of MWHU women versus 74.34 % (747,095/1,004,943) of BCSC women. The majority (60.14 %) of women at first presentation to the MWHU had not had mammograms in the previous 2 years, lower screening adherence than nationally (25.66 %). Adherence was lowest among women ages 41–49, and varied with clinic site. Findings suggest disparities in mammography screening among these women.

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Fig. 1

Abbreviations

AAIHS:

Aberdeen Area Indian Health Service

AI:

American Indian

AI/AN:

American Indian/Alaska Native

AOR:

Adjusted odds ratio

BCSC:

Breast Cancer Surveillance Consortium

BI-RADS:

American College of Radiology Breast Imaging-Reporting and Data System®

BRFSS:

Behavior Risk Factor Surveillance System

GPRA:

Government Performance and Review Act

HIPAA:

Health Insurance Portability and Accountability Act

IHS:

Indian Health Service

MWHU:

Indian Health Service Mobile Women’s Health Unit

NHW:

Non-Hispanic White

USPSTF:

U.S. Preventive Services Task Force

UMHS:

University of Michigan Health System

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Acknowledgments

R25CA112383 from the National Cancer Institute. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute of the National Institutes of Health. Data collection and sharing was supported by the National Cancer Institute-funded Breast Cancer Surveillance Consortium (U01CA63740, U01CA86076, U01CA8602, U01CA63736, U01CA70013, U01CA69976, U01CA70040, HHSN261201100031C). A list of the BCSC investigators and procedures for requesting BCSC data for research purposes are provided at: http://breastscreening.cancer.gov/. Spirit of Eagles U54-CA153605-01.

Conflict of interest

Drs. Roubidoux and Joe were part of nine radiologist group at the University of Michigan Health System (UMHS) who interpreted the mammograms for the Mobile Women’s Health Unit, under a contract for mammography services between the UMHS and the Aberdeen Area Indian Health Service (AAIHS). Tina R. Russell was employed by AAIHS. Manuscript was approved by the AAIHS Internal Review Board on Jan 18, 2013.

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Authors and Affiliations

  1. University of Michigan School of Public Health, 1415 Washington Heights, Ann Arbor, MI, 48109-2029, USA

    Emily L. Roen

  2. Division of Breast Imaging, Department of Radiology, University of Michigan Medical School, 2910H Taubman Center, SPC 5326, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA

    Marilyn A. Roubidoux & Annette I. Joe

  3. Midwest Division, Community Partnerships of South Dakota, American Cancer Society, Inc., Sioux Falls, SD, USA

    Tina R. Russell

  4. Department of Epidemiology, University of Nebraska Medical Center, Omaha, NE, USA

    Amr S. Soliman

Authors
  1. Emily L. Roen
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  2. Marilyn A. Roubidoux
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  3. Annette I. Joe
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  4. Tina R. Russell
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  5. Amr S. Soliman
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Correspondence to Marilyn A. Roubidoux.

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Roen, E.L., Roubidoux, M.A., Joe, A.I. et al. Adherence to screening mammography among American Indian women of the northern plains. Breast Cancer Res Treat 139, 897–905 (2013). https://doi.org/10.1007/s10549-013-2580-4

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