Women more likely to get regular cancer screening if primary care is well-organized, study finds
Low-income, inner-city women--shown in previous studies to be less likely to get regular screenings for cancer and more likely to die from late-stage disease--tend to more closely follow screening recommendations if their primary health care provider provides comprehensive, well-organized services, according to research conducted at Georgetown University Medical Center. These findings were published in the current issue of the Journal of General Internal Medicine.
This study is the first to examine the impact of specific characteristics of primary care delivery on willingness to have cancer screening tests while also taking into account a variety of attitudinal, socioeconomic and insurance barriers to screening. It involved 1,205 primarily low-income African American women over the age of 40 living in Washington DC. The women, randomly selected from low-income neighborhoods in the District of Columbia, completed a telephone survey lasting about 25 minutes. The researchers focused on whether the women followed screening recommendations for cervical, breast and colorectal cancers, because low-income African American women have been shown in other studies to die from these diseases at a disproportionate rate than women from other ethnic and economic groups, and because regular screening for these diseases has been shown to reduce mortality significantly.
Women were more likely to be screened for cancer if they saw specific primary care clinicians on a regular basis, the study found. "Although progress has been made in narrowing the gap in screening rates between minority and non-minority populations, barriers to screening persist even among the insured," the study reported. "Health care education aimed at patients should stress the importance of identifying a primary care provider and of obtaining screening through that provider."
Ann O'Malley, MD, MPH, assistant professor of oncology at Georgetown's Lombardi Cancer Center, Christopher B. Forrest, MD, PhD, of Johns Hopkins University School of Public Health, and Jeanne Mandelblatt, MD, MPH, professor of oncology at Georgetown, concluded that primary care delivery sites providing coordinated, comprehensive, accessible care that involved a strong patient-clinician relationship were likely to improve the women's adherance to cancer screening recommendations. The study also found that women in private HMOs were more likely to get regular screenings, as opposed to uninsured women or those enrolled in public or private non-HMO insurance programs.
Support for this research was provided by the US Department of the Army and by the National Cancer Institute.
Georgetown University Medical Center includes the nationally ranked School of Medicine, School of Nursing and Health Studies, the Lombardi Cancer Center and a biomedical research enterprise. For more information, visit www.georgetown.edu/gumc.