Evaluating a Tailored Intervention
The 2002 Annual Report to the Nation on the Status of Cancer states that overall cancer incidence rates stabilized, while overall cancer mortality rates decreased for both men and women between 1973 and 1999. The report utilized the Surveillance, Epidemiology and End Results (SEER) Program and other databases to calculate the trends. The report noted that the breast cancer incidence rate increased in women aged 50-64 years, while the mortality rate decreased in each age group. Despite the continuing dilemma regarding the benefits of screening mammography, early diagnosis resulting from breast self-examinations, clinical breast examinations and mammograms continues to be the most effective means of fighting breast cancer mortality.
Blackman et al. reported that 84.8% of women aged >40 had at least one mammogram in their lifetime in 1997. The American Cancer Society reported that in 1998, 68% of whites, 66% of blacks, 61% of Asians/Pacific Islanders, 61% of Hispanics and 45% of American Indians/Alaska Natives had a mammogram within the past two years. A 1997-1998 random-digit-dialing telephone survey of women >40 years old living in south Los Angeles found that 81.1% reported having at least one mammogram in their lifetime but that only 67.8% of them had a mammogram within the two years preceding the survey. These findings suggest that until more women comply with regular screening as recommended by the American Cancer Society, the goals of public health cannot be achieved. Further, these findings suggest the need to develop interventions that will inform all segments of the population of the benefits of screening mammograms.
Salzmann and colleagues and Mandelblatt and colleagues weighed in on the controversy of extending screening mammography guideline to include women 40-49 years of age. Historically, African-American women have experienced higher incidences of breast cancer than white women below age <50 years. These two studies reached quite different conclusions. In 1998, Salzmann et al. concluded that the cost-effectiveness of screening mammography in women 40-49 years of age is almost five times that in older women. When breast cancer screening policies are being set, the incremental cost-effectiveness of extending mammographic screening to younger women should be considered. In 2004, Mandelblatt et al. concluded that except in pockets of unscreened or high-risk women, further investment in interventions to increase screening are unlikely to be an efficient use of resources. Ensuring that African-American women receive intense treatment seems to be the most cost-effective approach to decreasing the disproportionate mortality experienced by this population.
A 2002 national telephone survey sought to determine if women between the ages of 40 and 69 were confused about the guidelines for getting mammograms. This survey of 733 women found that a majority of women were not confused, but minority women and women with lower education levels were more likely to report being unclear about the guidelines. The authors concluded that the results of this study suggests that the controversy surrounding the effectiveness and cost-effectiveness of screening mammograms and the age at which women should begin have them has no affect on their adherence to screening mammography guidelines. However, they did state that some women lack the information needed to make informed decisions about mammography.
Table 1. Demographic characteristics of study participants (n=430)
40-49 years old
Missing Mean=51.9 SD=11.5
|Study Sample n %
243 56.5 116 27.0 67 15.6 4 0.9
|Race /Ethnicity African-American Hispanic Other||164 193 73||38.1 44.9 17.0|
High-school grad or less Post-high school
|262 168||60.9 39.1|
|Income $0-$ 19,999 $20,000-329,000 Not stated||201 140 89||46.7 32.6 20.7|
|277 153||64.4 35.6|
Married or living as married Not Married
|223 207||51.9 48.1|
This study was designed to accomplish two specific objectives. The first objective was to determine the prevalence of screening mammography among all women >40 years old living in an economically disadvantaged, medically underserved, inner-city community of Los Angeles. The second objective was to assess the effectiveness of a culturally and ethnically tailored telephone intervention designed to increase the rate of screening mammography in African-American and Latina women in this population. The results of the first objective involving 505 survey respondents were reported earlier. This manuscript reports the results of the second objective involving 430 study participants (Table 1). generic propecia