title: Breast and cervical cancer screening patterns among American Indian women at IHS clinics in Montana and Wyoming.
abstract: OBJECTIVE
  We investigated factors associated with primary and secondary breast and cervical cancer screening among American Indian (AI) women receiving care from the Indian Health Service (IHS) in Montana and Wyoming.
  
  
  METHODS
  Rates of primary screening (i.e., screening without evidence of a prior abnormal) and secondary screening during a three-year period (2004-2006) were determined in an age- and clinic-stratified random sample of 1,094 women at six IHS units through medical record review.
  
  
  RESULTS
  Three-year mammography prevalence rates among AI women aged ≥45 years were 37.7% (95% confidence interval [CI] 34.1, 41.3) for primary and 58.7% (95% CI 43.9, 73.5) for secondary screening. Among women aged ≥18 years, three-year Pap test prevalence rates were 37.8% (95% CI 34.9, 40.6) for primary and 53.2% (95% CI 46.0, 60.4) for secondary screening. Primary mammography screening was positively associated with number of visits and receiving care at an IHS hospital (both p<0.001). Primary Pap test screening was inversely associated with age and positively associated with the number of patient visits (both p<0.001). Secondary mammography screening was inversely associated with driving distance to an IHS facility (p=0.035).
  
  
  CONCLUSIONS
  Our results are consistent with other surveys among AI women, which report that Healthy People 2010 goals for breast (90%) and cervical (70%) cancer screening have not been met. Improvements in breast and cervical cancer screening among AI women attending IHS facilities are needed.
authors: Pennsylvania State University College of Medicine, Department of Public Health Sciences, Hershey, PA, USA. rwilson@psu.edu
authors: Robin Taylor
authors: RT
authors: Wilson
authors: Jennifer
authors: J
authors: Giroux
authors: Kathryn Rita
authors: KR
authors: Kasicky
authors: Bethany Hemlock
authors: BH
authors: Fatupaito
authors: Eric C
authors: EC
authors: Wood
authors: Renee
authors: R
authors: Crichlow
authors: Neil A Sun
authors: NA
authors: Rhodes
authors: Jennifer
authors: J
authors: Tingueley
authors: Andrea
authors: A
authors: Walling
authors: Kathryn
authors: K
authors: Langwell
authors: Nathaniel
authors: N
authors: Cobb
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D055088:Early Detection of Cancer / Q000379:methods / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D040361:Healthy People Programs / Q000592:standards; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D009009:Montana; D014481:United States; D016549:United States Indian Health Service / Q000706:statistics & numerical data; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis / Q000517:prevention & control*; D014626:Vaginal Smears / Q000706:statistics & numerical data*; D014959:Wyoming; D055815:Young Adult