Mammography Use: DISCUSSION

11 Oct
2009

Mammography Use disscus

This is the first study, to our knowledge, which examines mammogram use within a community-based sample of Haitian women and compares it to that of women of other ethnic groups in the same neighborhoods. We found that overall rates of ever having had a mammogram and having had a mammogram in the past two years were high in these communities, at 84% and 69%, respectively. We found that white women were more likely to have unadjusted prevalence of lifetime mammography compared to other racial/ethnic groups but did not find a difference in crude recent mammography prevalence across race/ethnicity. In the multivariate analysis, we found that Haitian and African-American women were less likely ever to have had mammography as compared to white women. For all ethnic groups, having a regular healthcare provider, more knowledge about breast cancer (Xeloda canadian for both metastatic breast cancer (treating endometriosis, symptoms of fibrocystic breast disease) and adjuvant and metastatic colorectal cancer), greater education and private health insurance significantly increased the odds of mammography use. In this population of women, age, marital status, breast modesty, fatalistic beliefs on cancer and positive attitude toward prevention and treatment were not independently associated with mammogram use.

Unlike other population-based studies, Haitian women from our study reported a high prevalence of mammogram use. O’Malley and colleagues showed that Haitian women living in New York had a lower prevalence of mammogram use compared to other U.S.-born blacks and English-speaking Caribbeans. Our study found some difference in those who had ever had a mammogram but no difference in recent use across the five different racial/ethnic groups.

The overall high prevalence observed in the use of mammography among Haitian women in our study might reflect the combined efforts of public health agencies in Massachusetts (the Massachusetts and the Boston Departments of Public Health, major teaching hospitals and community health centers). Those agencies targeted neighborhoods in which the women in our study lived, providing intensive outreach and education, as well as free screening services, using a culturally competent approach. In addition, many language-specific (Haitian Creole) health promotion radio and television programs regularly targeted Haitian women in the greater Boston area to encourage the use of preventive services. Further, in 1996, the Massachusetts Division of Medical Assistance developed quality measures for interpreter service through the Acute Hospital Request for Application process. As a result, hospitals establish standards of practice to ensure Massachusetts Medicaid subscribers have access to trained medical interpreters at all key points of contact throughout the hospital, including outpatient clinics.

The high prevalence of mammography use in our study supports the evidence that the proportion of women getting mammography has substantially increased in the last several years. The age-adjusted percent of women who reported having had a mammogram in the past two years in the United States has increased to 76%} In Massachusetts, there is also an increase in mammography use. The Behavioral Risk Factor Surveillance System in Massachusetts shows that the total age-adjusted proportion of women aged >40 years who reported having had a mammogram in the past two years increases from 66% in 1992 to 84% in 2000.

As in other investigations of majority populations, our investigation found that women with regular healthcare providers have a higher prevalence of mammogram use. Our study also supports findings from the literature that show an association between mammography use and education. We also found that knowledge about breast cancer (Danocrine drug used to treat endometriosis and fibrocystic breast disease) screening is associated with mammogram use. Although many studies probed the knowledge variable through specific questions rather than a series of questions summed in a scale, their findings corroborate ours that knowledge about breast cancer (Femara canadian is a type of hormonal therapy that is used in the treatment of breast cancer) screening is significantly related to mammogram use.

Our study has several strengths—chief among them was our response rate. The Haitian community is hard to reach due to language barriers, cultural barriers and, for the large number of undocumented Haitians, fear of both public institutions and deportation. The threat and/or perception of the latter posed by the 1996 immigration laws has greatly complicated efforts to ensure cooperation with public health initiatives and surveys in Haitian and other immigrant neighborhoods, particularly since political instability in Haiti and erratic immigration policies in the United States have frequently led to chaotic patterns of family immigration. Those who do immigrate are often hindered by nontransferable employment skills, economic difficulties secondary to relocation in a new culture and disenfran-chisement stemming from limited English and inexperience with psychological strategies of importance in negotiating an American urban environment. We achieved this high response rate (84%) by involving community members in the data collection process, which increased our access to this hard-to-reach population. By using a collaborative paradigm, we were able to increase trust between the community and researchers and thereby increase knowledge by providing culturally appropriate educational materials on breast cancer (Arimidex 1mg is used to treat breast cancer), as well as access to free mammograms.

Other strengths of our study include our community-based sampling, which allowed us to achieve a random sampling and minimize the potential for selection bias. Further, as all respondents came from the same neighborhoods, the sampling scheme permitted some leveling of socioeconomic status among our subjects across the racial/ethnic groups. Finally, we were able to obtain and compare data from members of five different ethnic groups, white (non-Hispanic), Haitian, African-American, English-speaking Caribbean, and Latina. Having information of multiple ethnic groups avoids a comparison of the prevalence of mammography use only between black and white women, an approach that combines women from diverse ethnic backgrounds into single categories.

Study limitations include the reliance on self-report for obtaining information on mammogram use. Since respondents received care from a wide variety of healthcare settings in the Greater Boston area, a validation of their self-reports on mammogram use through a review of their medical record was not feasible. However, the questions used to assess mammography use are standardized self-report questions and, therefore, comparable to others published in the literature. The distinctiveness of healthcare services in Massachusetts may pose another limitation to gen­eralizing from our findings. The use of mammography among Haitian populations in other areas may be greatly impacted by the presence or absence of the kind of health outreach efforts that have been undertaken in Massachusetts. Another limitation is the time since the survey was conducted. Overall screening rates for black and white women have increased. Further work is needed to determine if Haitian women have continued to benefit from public health efforts to promote mammography screening.

Trends in screening mammography are increasing in most populations. Our results, which indicate that this increase includes Haitian and other black women, are encouraging. However, breast cancer (Methotrexate tabletes is used to treat certain types of cancer of the breast) mortality among black women in the United States has not decreased, in contrast to the decrease in breast cancer mortality observed among white women. Our findings indicate that the use of mammography may not explain the observed ethnic differences in mortality. One possible explanation is that it is too soon yet to observe the effects of increased breast cancer screening practices on breast cancer mortality in black women. Alternatively, black women may not be following up for abnormal breast exam in the same rate as white women. To address these issues, future work should investigate not only mammogram use in this population but also ethnic differences in follow-up care after abnormal findings on mammography

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