Insurance type and diagnostic resolution disparities in breast cancer screening

乳腺癌筛查的保险类型和诊断分辨率差异

• 批准号: 8793684
• 负责人: Danielle Durham
• 金额: $ 3.38万
• 依托单位: UNIV OF NORTH CAROLINA CHAPEL HILL
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8793684
• 关键词: Address; Affect; African American; Aftercare; Age; Award; Behavior; Benign; Biometry; Breast; Breast Cancer Detection; Centers for Disease Control and Prevention (U.S.); Characteristics; Data; Diagnosis; Diagnostic; Diagnostic Procedure; Dimensions; Disease; Early Diagnosis; Epidemiologist; Family history of; Film; Fright; Goals; Guidelines; Health Services Accessibility; Health Services Research; Healthcare; Imaging Techniques; Income; Individual; Insurance; Insurance Coverage; Interdisciplinary Study; Intervention; Knowledge; Lead; Life; Light; Low income; Malignant Neoplasms; Mammography; Medicaid; Mentors; Minority; Modality; Outcome; Pathologic; Pathology; Pathway interactions; Patient Care; Patient risk; Patients; Population; Population Heterogeneity; Prevention Guidelines; Procedures; Race; Recommendation; Reporting; Research; Resolution; Risk Factors; Rural; Rural Population; Sample Size; Screening Result; Screening for cancer; Socioeconomic Status; Staging; Stratification; Subgroup; Test Result; Testing; Time; Training; Underinsured; Uninsured; Variant; Woman; Work; advanced disease; breast density; cancer care; cancer epidemiology; career development; didactic education; digital; disorder prevention; experience; follow-up; high risk; imaging modality; innovation; low socioeconomic status; malignant breast neoplasm; mammography registry; mortality; neoplasm registry; population based; prospective; public health relevance; radiologist; residence; rural area; screening; skills training

DESCRIPTION (provided by applicant): Routine screening mammography has been associated with a 15-20% reduction in breast cancer mortality among women ages 40-74 years. An important, but less studied dimension of screening behavior that impacts disease mortality is appropriate follow-up care after a positive screening mammogram result. Low-income and minority women are less likely to undergo screening mammography and are more likely to experience increased wait time for diagnostic resolution of a positive screening exam compared with other women. Because underserved women are typically diagnosed with more advanced disease and have higher breast cancer mortality rates, there is an urgent need to understand the increased wait times among this high risk group. The long term goal of this research is to identify patient factors that can be used to better understand disparities in breast cancer screening. Using standardized data from the Carolina Mammography Registry (CMR), a prospective population-based mammography registry, the proposed research will address the following 3 specific aims: 1) Assess the relationship between insurance type and diagnostic resolution after a positive screening mammogram in large, racially diverse population; 2) Evaluate the extent to which race, rural/urban residence, imaging modality (digital/film), family history of breast cancer, and breast density modify the relationship between insurance type and diagnostic resolution; 3) Determine how a false positive result impacts the relationship between insurance type and diagnostic resolution after a positive screening mammogram result. We believe the proposed research is innovative because of several unique strengths of the CMR data: specifically, the inclusion of a substantial minority and rural population with which to accurately assess disparities, patient level data on family history of breast cancer and breast density, the radiologists' assessment of the screening mammogram, and the linkage of CMR to pathology data and state cancer registry data for determining cancer outcomes. The proposed research will provide us with data on the extent to which variations among patient subgroups exist for diagnostic work-up and resolution after a positive screening mammogram. The applicant aspires to become an independent and productive cancer epidemiologist with a focus on disparities and health services research. The proposed training plan is tailored to engage the applicant in multidisciplinary research and includes formal didactic education, mentor-supervised study, applied skills training, and career development activities. Throughout this award, the applicant will be mentored by an interdisciplinary team with expertise in cancer epidemiology, breast cancer screening, health services research, and biostatistics.

描述（由申请人提供）：常规筛查乳房 X 光检查与 40-74 岁女性乳腺癌死亡率降低 15-20% 相关。影响疾病死亡率的筛查行为的一个重要但较少研究的方面是在乳房 X 光检查结果呈阳性后进行适当的后续护理。与其他女性相比，低收入和少数族裔女性接受乳房 X 光检查的可能性较小，并且更有可能经历更长的等待时间来获得阳性筛查检查的诊断结果。由于服务不足的女性通常被诊断出患有更晚期的疾病并且乳腺癌死亡率更高，因此迫切需要了解这一高风险群体的等待时间增加。这项研究的长期目标是确定可用于更好地了解乳腺癌筛查差异的患者因素。使用卡罗莱纳州乳房X线照相登记处（CMR）（一个基于人群的前瞻性乳房X线照相登记处）的标准化数据，拟议的研究将解决以下3个具体目标：1）在大型、种族多样化的人群中进行阳性筛查乳房X光检查后，评估保险类型与诊断分辨率之间的关系； 2) 评估种族、农村/城市居住地、成像方式（数字/胶片）、乳腺癌家族史和乳腺密度对保险类型和诊断分辨率之间关系的影响程度； 3) 在筛查乳房 X 光检查结果呈阳性后，确定假阳性结果如何影响保险类型与诊断分辨率之间的关系。我们认为，拟议的研究具有创新性，因为 CMR 数据具有几个独特的优势：具体来说，包括大量少数民族和农村人口，可以准确评估差异、乳腺癌家族史和乳腺密度的患者水平数据、放射科医生对筛查乳房 X 光检查的评估，以及 CMR 与病理学数据和州癌症登记数据的联系，以确定癌症结果。拟议的研究将为我们提供有关患者亚组之间存在多大程度的差异的数据，以便在乳房X光检查呈阳性后进行诊断检查和解决。申请人渴望成为一名独立且富有成效的癌症流行病学家，重点关注差异和卫生服务研究。拟议的培训计划是为让申请人参与多学科研究而量身定制的，包括正式的教学教育、导师指导的学习、应用技能培训和职业发展活动。在整个奖励过程中，申请人将得到一个跨学科团队的指导，该团队拥有癌症流行病学、乳腺癌筛查、健康服务研究和生物统计学方面的专业知识。