PMID- 25910513
OWN - NLM
STAT- MEDLINE
DCOM- 20160215
LR  - 20221207
IS  - 1878-4321 (Electronic)
IS  - 1049-3867 (Linking)
VI  - 25
IP  - 4
DP  - 2015 Jul-Aug
TI  - Screening Mammography in a Public Hospital Serving Predominantly African-American 
      Women: A Stage-Survival-Cost Model.
PG  - 322-30
LID - S1049-3867(15)00023-7 [pii]
LID - 10.1016/j.whi.2015.02.006 [doi]
AB  - BACKGROUND: Ethnic and socioeconomic disparities pervade breast cancer patterns 
      and outcomes. Mammography guidelines reflect the difficulty in optimizing 
      mortality reduction and cost-effectiveness, with controversy still surrounding 
      the 2009 U.S. Preventive Services Task Force (USPSTF) recommendations. This study 
      simulates USPSTF and American Cancer Society (ACS) guidelines' effects on stage, 
      survival, and cost of treatment in an urban public hospital. METHODS: Charts of 
      274 women diagnosed with stage I, II, or III breast cancer (2008-2010) were 
      reviewed. Published tumor doubling times were used to predict size at diagnosis 
      under simulated screening guidelines. Stage distributions under ACS and USPSTF 
      guidelines were compared with those observed. Cohort survival for observed and 
      hypothetical scenarios was estimated using national statistics. Treatment costs 
      by stage, calculated from Georgia Medicaid claims data, were similarly applied. 
      RESULTS: Mean age at diagnosis was 56 years. African Americans predominated 
      (82.5%), with 96% publically insured or uninsured. Simulated stages at diagnosis 
      significantly favored ACS guidelines (43.1% stage 1/38.3% stage 2/9.9% stage 3 
      vs. USPSTF 23.0%/53.3 %/15.0%), as did 5-year survival and cost of treatment 
      relative to both observed and USPSTF-predicted schema (p<.0001). Following USPSTF 
      guidelines predicted lower survival and additional costs. CONCLUSIONS: Following 
      ACS guidelines seems to lead to earlier diagnosis for low-income African-American 
      women and increase 5-year survival with lower overall and breast-specific costs. 
      The data suggest that adjusting screening practices for lower socioeconomic 
      status, ethnic minority women may prove essential in addressing cancer 
      disparities.
CI  - Published by Elsevier Inc.
FAU - Farley, Clara
AU  - Farley C
AD  - Emory University School of Medicine, Atlanta, Georgia. Electronic address: 
      crfarle@emory.edu.
FAU - Friedman, Danielle
AU  - Friedman D
AD  - Emory University School of Medicine, Atlanta, Georgia.
FAU - Habtes, Imnett
AU  - Habtes I
AD  - Winthrop University Medical Center, Rock Hill, South Carolina; Georgia Cancer 
      Center for Excellence/AVON Foundation Comprehensive Breast Center, Grady Memorial 
      Hospital, Atlanta, Georgia.
FAU - Raskind-Hood, Cheryl
AU  - Raskind-Hood C
AD  - Rollins School of Public Health, Emory University, Atlanta, Georgia.
FAU - Adams, E Kathleen
AU  - Adams EK
AD  - Rollins School of Public Health, Emory University, Atlanta, Georgia.
FAU - Becker, Edmund R
AU  - Becker ER
AD  - Rollins School of Public Health, Emory University, Atlanta, Georgia.
FAU - D'Orsi, Carl
AU  - D'Orsi C
AD  - Emory University School of Medicine, Atlanta, Georgia; Georgia Cancer Center for 
      Excellence/AVON Foundation Comprehensive Breast Center, Grady Memorial Hospital, 
      Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
FAU - Gundry, Kathleen
AU  - Gundry K
AD  - Emory University School of Medicine, Atlanta, Georgia; Georgia Cancer Center for 
      Excellence/AVON Foundation Comprehensive Breast Center, Grady Memorial Hospital, 
      Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
FAU - Birdsong, George
AU  - Birdsong G
AD  - Emory University School of Medicine, Atlanta, Georgia; Georgia Cancer Center for 
      Excellence/AVON Foundation Comprehensive Breast Center, Grady Memorial Hospital, 
      Atlanta, Georgia.
FAU - Gabram-Mendola, Sheryl
AU  - Gabram-Mendola S
AD  - Emory University School of Medicine, Atlanta, Georgia; Georgia Cancer Center for 
      Excellence/AVON Foundation Comprehensive Breast Center, Grady Memorial Hospital, 
      Atlanta, Georgia; Winship Cancer Institute, Emory University, Atlanta, Georgia.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20150421
PL  - United States
TA  - Womens Health Issues
JT  - Women's health issues : official publication of the Jacobs Institute of Women's 
      Health
JID - 9101000
SB  - IM
MH  - Adult
MH  - Black or African American/statistics & numerical data
MH  - Aged
MH  - Aged, 80 and over
MH  - Breast Neoplasms/*diagnostic imaging/*economics/ethnology/mortality
MH  - Costs and Cost Analysis
MH  - Cross-Sectional Studies
MH  - Early Detection of Cancer/*economics/statistics & numerical data
MH  - Ethnicity/statistics & numerical data
MH  - Female
MH  - Georgia/epidemiology
MH  - Health Care Costs
MH  - Health Resources/economics/statistics & numerical data
MH  - Healthcare Disparities/statistics & numerical data
MH  - Hospitals, Public/*statistics & numerical data
MH  - Humans
MH  - Mammography/*economics/statistics & numerical data
MH  - Mass Screening/economics
MH  - Middle Aged
MH  - Neoplasm Staging
MH  - *Practice Guidelines as Topic
MH  - Socioeconomic Factors
MH  - Survival Rate
EDAT- 2015/04/26 06:00
MHDA- 2016/02/16 06:00
CRDT- 2015/04/26 06:00
PHST- 2014/04/02 00:00 [received]
PHST- 2015/02/15 00:00 [revised]
PHST- 2015/02/25 00:00 [accepted]
PHST- 2015/04/26 06:00 [entrez]
PHST- 2015/04/26 06:00 [pubmed]
PHST- 2016/02/16 06:00 [medline]
AID - S1049-3867(15)00023-7 [pii]
AID - 10.1016/j.whi.2015.02.006 [doi]
PST - ppublish
SO  - Womens Health Issues. 2015 Jul-Aug;25(4):322-30. doi: 10.1016/j.whi.2015.02.006. 
      Epub 2015 Apr 21.