Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women
Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women
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DOI：
10.1016/s0091-7435(03)00087-2
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发表时间：
2003-08-01
影响因子：
5.1
通讯作者：
Mandelblatt, JS
中科院分区：
文献类型：
--
作者：
Kerner, JF;Yedidia, M;Mandelblatt, JS
背景。异常筛查结果后的延迟或不完全随访可能会影响乳腺癌筛查计划的有效性，特别是在医疗服务不足和少数民族人群中。本研究考察了在纽约市三家诊所接受乳腺癌筛查的黑人妇女中，社会经济地位、乳腺癌危险因素、医疗保健系统障碍和患者认知态度因素在异常乳腺癌筛查检查后诊断解决时间的作用。我们确定了184名有异常乳房x光检查或临床乳房检查需要立即随访的黑人妇女，并对她们进行了访谈，检查了她们的医疗记录。采用双变量和多变量logistic回归分析来评估患者和医疗保健系统因素与异常发现后3个月内诊断解决之间的关系。3个月内，39%的女性没有诊断解决方案，6个月内28%。社会经济地位和系统障碍与及时诊断无关。及时解决与乳房x光检查的严重程度、患者在初始乳房x光检查时询问（OR, 2.73; 95% Cl, 1.25-5.96）或接受下一步信息（OR, 2.6; 95% Cl, 1.08-6.21）相关。既往有乳房异常的女性完成及时诊断的可能性较小（OR, 0.42; 95% Cl, 0.20-0.85），癌症焦虑水平较高的女性也是如此（OR, 0.50; 95% CI, 0.27-0.92）。干预措施解决妇女先前的异常发现经验和改善患者/提供者的沟通可能会改善及时和适当的随访。(C) 2003年美国卫生基金会和爱思唯尔科学（美国）。版权所有。
Background. Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics.Methods. We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding.Results. Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% Cl, 1.25-5.96), or receiving next step information (OR, 2.6; 95% Cl, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% Cl, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92).Conclusions. Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up. (C) 2003 American Health Foundation and Elsevier Science (USA). All rights reserved.