Repeat mammography screening among unmarried women with and without a disability.
OBJECTIVE
Unmarried women with disabilities may be a particularly vulnerable group for underutilization of repeat mammography screening. Our goal was to compare the breast cancer screening experiences of unmarried women with disabilities (WWD) versus women with no disabilities (WND), and determine whether these experiences are associated with adherence to repeat screening.


METHODS
We conducted a matched cohort study of 93 WWD and 93 WND to compare mammography experiences by disability status, examine rates of repeat mammography by disability status, and identify factors that are associated with repeat mammography.


RESULTS
WWD were less likely to be on-schedule than WND in univariable (54.8% vs. 71.0%; relative risk, 0.77; 95% confidence limits, 0.61, 0.97), but not multivariable, analyses. In multivariable analyses, there was a significant interaction between disability status and positive experiences as the reasons for returning to the same mammography facility. Among WND, repeat screening ranged from 59% to 86%, depending on the number of positive experiences endorsed (range, 1-5). In contrast, among WWD, screening rates were only 37% among those who did not report any positive experiences and increased to a maximum of 60% regardless of whether women endorsed one to four or all five positive experiences. Severity and type of disability were not associated with repeat screening.


CONCLUSIONS
WWD may be less likely than WND to remain on-schedule for mammography. WWD who do not report any positive experiences as reasons for returning to a mammography facility may be at particularly high risk of underutilization of screening.
Departmentsof Community Health, Brown University Warren Alpert School of Medicine and Program in Public Health, Providence, Rhode Island 02912, USA. Melissa_Clark@brown.edu
Melissa A
MA
Clark
Michelle L
ML
Rogers
Xiaozhong
X
Wen
Victoria
V
Wilcox
Kate
K
McCarthy-Barnett
Jeanne
J
Panarace
Carol
C
Manning
Susan
S
Allen
William
W
Rakowski
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology; D015331:Cohort Studies; D006233:Persons with Disabilities / Q000523:psychology* / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D017533:Marital Status / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D016555:Matched-Pair Analysis; D008875:Middle Aged; D010349:Patient Compliance; D010817:Physician-Patient Relations; D012307:Risk Factors; D012959:Socioeconomic Factors