If we gave away mammograms, who would get them? A neighborhood evaluation of a no-cost breast cancer screening program.
BACKGROUND
Low- and no-cost mammography programs have become a widespread strategy to increase access to breast cancer screening in low-income populations. However, rigorous evaluations of who remains unscreened in communities with these programs are lacking. We conducted a case-control study of African American older women in East Baltimore, Maryland, comparing attendees at a no-cost program to friends and neighbors not using no-cost venues.


METHODS
We recruited 288 women ages 50 and older, who attended a no-cost program at Johns Hopkins Hospital, to complete a 1(1/2) h home interview, answering semistructured and open-ended questions about cancer and health and a wide range of social and psychological items. For each case, we recruited one friend or neighbor, within 5 years of age, not receiving no-cost screening, to complete a similar control interview. Matched case-control analyses were used to compare program attendees to nonattendees within the target community.


RESULTS
Women using the no-cost program at least once were generally more poorly screened than their neighborhood control prior to the program, but had better recent screening history 3 years after the program began. In multivariate analyses, program attendees were more likely to have <10,000 dollars annual income (OR = 2.34, 95% CI 1.55,3.61), more likely to have had more children (OR = 1.13, 95% CI 1.04,1.24), and less likely to have health insurance (OR = 0.42, 95% CI 0.25,0.68). They were more likely to see a female primary care provider (OR = 1.82, 95% CI 1.24,2.70) and to see multiple providers (OR = 3.38, 95% CI 1.52,8.60).


CONCLUSIONS
Low-cost screening intervention programs reach women who might otherwise not receive screening. However, within target communities, improved partnerships with specific types of primary care providers could reach additional women.
Klassen
Ann C
AC
School of Hygiene and Public Health, The Johns Hopkins University, Baltimore, Maryland 21205, USA. aklassen@jhsph.edu
Smith
Ann L M
AL
Meissner
Helen I
HI
Zabora
James
J
Curbow
Barbara
B
Mandelblatt
Jeanne
J
D001741:Black or African American / Q000523:psychology*; D000368:Aged; D000369:Aged, 80 and over; D015142:Baltimore / Q000453:epidemiology; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D002391:Catchment Area, Health; D005260:Female; D017048:Health Care Costs; D006785:Hospitals, University; D006786:Hospitals, Urban; D006801:Humans; D008327:Mammography / Q000191:economics / Q000523:psychology / Q000706:statistics & numerical data*; D008875:Middle Aged; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012959:Socioeconomic Factors; D017664:Uncompensated Care; D016387:Women's Health