RACE/ETHNIC DIFFERENCES IN EVALUATION OF ABNORMAL MAMMOGRAPHY

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The evaluation and follow-up of abnormal mammography screening has not bee studied for possible ethnic and income group differences in timeliness and type of diagnostic tests. We propose to conduct a cohort study of 1000 women, 40 to 79 years of age, without previous breast cancer, and from four ethnic groups (white, African American, Latina, Chinese) with abnormal mammography examination defined as an examination interpreted as having a new abnormality by the radiologist and requiring a follow-up examination in less than one year. We plan to conduct baseline telephone interviews to compare demographics, patient perceptions about the process of care, access to health care variables, clinical assessments, expectations from their primary clinician, out-of-pocket expenses, and other predictor variables indicated by our conceptual framework, within three months after the index abnormal screening mammography. The main outcomes to be evaluated include time to first diagnostic test, time to resolution or final disposition, intention to adhere, intention to continue screening, interval mammography screening, anxiety, and functional status. We will then conduct follow-up interviews at 12 and 24 months after the index examination to address whether predictor variables affect timely adherence with evaluation of abnormal mammography, intention to continue screening, interval mammography, satisfaction with care, out- of-pocket costs, anxiety, and functional well-being. The cohort design will permit an evaluation of the effect that changes in health care systems may have on these outcomes in these women. Finally, we will develop and pilot test intervention strategies with 150 women to promote the efficient resolution of abnormalities on screening mammography and to reduce potential adverse effects on functional status of these women.