title: Lasting Effects of the Breast and Cervical Cancer Early Detection Program on Breast Cancer Detection and Outcomes, Ohio, 2000-2009.
abstract: BACKGROUND
  The National Breast and Cervical Cancer Early Detection Program (BCCP) in Ohio provides screening and treatment services for uninsured low-income women aged 40 to 64. Because participation in the BCCP might engender greater self-efficacy for cancer screening, we hypothesized that breast cancer and survival outcomes would be better in BCCP participants who become age-eligible to transition to Medicare than in their low-income non-BCCP counterparts.
  
  
  METHODS
  Linking data from the 2000 through 2009 Ohio Cancer Incidence Surveillance System with the BCCP database, Medicare files, Ohio death certificates (through 2010), and the US Census, we identified Medicare beneficiaries who were aged 66 to 74 and diagnosed with incident invasive breast cancer. We compared the following outcomes between BCCP women (n = 93) and low-income non-BCCP women (n = 420): receipt of screening mammography in previous year, advanced-stage disease at diagnosis, timely and standard care, all-cause survival, and cancer survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCP status and each of the outcomes, adjusting for patient covariates.
  
  
  RESULTS
  Women who participated in the BCCP were nearly twice as likely as low-income non-BCCP women to have undergone screening mammography in the previous year (adjusted odds ratio, 1.77; 95% confidence interval, 1.01-3.09). No significant differences were detected in any other outcomes.
  
  
  CONCLUSIONS
  With the exception of screening mammography, the differences in outcomes were not significant, possibly because of the small size of the study population. Future analysis should be directed toward identifying the factors that explain these findings.
authors.affiliation: Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, WG-49, Cleveland, OH 44106-4945. Email: skoroukian@case.edu. Dr Koroukian is also affiliated with Case Comprehensive Cancer Center and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Siran M
authors.initials: SM
authors.lastname: Koroukian
authors.affiliation: School of Medicine, and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Bakaki
authors.affiliation: School of Medicine, and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Xiaozhen
authors.initials: X
authors.lastname: Han
authors.affiliation: School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Mark
authors.initials: M
authors.lastname: Schluchter
authors.affiliation: Case Comprehensive Cancer Center and University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Cynthia
authors.initials: C
authors.lastname: Owusu
authors.affiliation: Case Comprehensive Cancer Center and University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Gregory S
authors.initials: GS
authors.lastname: Cooper
authors.affiliation: School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Susan A
authors.initials: SA
authors.lastname: Flocke
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology; D055088:Early Detection of Cancer / Q000379:methods / Q000639:trends*; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D016247:Information Storage and Retrieval; D016015:Logistic Models; D008327:Mammography / Q000639:trends; D017057:Medically Uninsured / Q000706:statistics & numerical data; D006278:Medicare; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000175:diagnosis; D009820:Ohio / Q000453:epidemiology; D011159:Population Surveillance; D011203:Poverty / Q000706:statistics & numerical data; D015397:Program Evaluation; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000208:ethnology