Factors associated with repeat mammography in a New York State public health screening program.

Screening mammography is the most effective method for early detection of breast cancer, but repeat mammography rates are not optimal in most populations. Since 1988, New York State has supported a program of breast cancer screening for underserved, uninsured, or underinsured women. The present study was designed to identify sociodemographic and clinical factors associated with failure to return for repeat mammography screening after a negative initial mammogram. Of women initially screened between 1988 and 1991 (N = 9,485), 27 percent obtained repeat mammograms by 1993. The final logistic regression model contained program site, race and ethnicity, family income, and time since last mammogram.

A comparison of screening mammography results from programs for women of different socioeconomic status.

BACKGROUND: The ability of screening mammography programs serving women of different socioeconomic status (SES) to diagnose early stage breast carcinoma in a comparably effective fashion has been questioned. METHODS: Results of screening 50,653 women of lower SES were compared with those of screening 45,923 more socioeconomically advantaged women during the same period in New York State. Results were compared with those reported for the general population to the New York State cancer registry. RESULTS: Additional workup was required for approximately 12% of the women in each group. Although more women of lower SES underwent biopsy, the positive predictive value of a biopsy recommendation was almost the same for the two populations (27% for women of higher SES vs. 25% for women of lower SES). Among women with breast carcinoma, ductal carcinoma in situ was diagnosed in 27% of more affluent women and 15% of women of lower SES, a considerable improvement from the 10% rate of diagnosis in the general population in New York State. Minimal cancers accounted for 54% of those diagnosed in more affluent women and at least 31% of those diagnosed in women of lower SES. CONCLUSIONS: Screening mammography programs can be effective for women of lower SES and can be conducted as efficiently as they are for more affluent women. Differences in diagnosis of small cancers in the two groups reported in this article may reflect differences in age and patterns of prior screening experience in the two populations.

Development of cancer prevention and control initiatives in a state health agency: the New York experience.

The public health response to cancer in the New York State Department of Health has evolved over many years. A number of organizational units contribute to surveillance and monitoring, quality assurance, policy analysis and advocacy, education, service delivery, and evaluation components. Extensive cooperation with health professionals and consumers outside of state government is also essential.

Community-based breast health partnerships.

Breast Health Partnerships are a unique community-based method for delivering comprehensive breast cancer screening services. They are problem-solving groups that work to bring the resources of individual partners "to the table" to overcome obstacles to the recruitment of underserved women and the delivery of comprehensive breast cancer screening services. Partners include representatives from government agencies as well as the voluntary and private sectors. Developing this "community of solution" increases institutionalization of key components of a comprehensive screening program. Simultaneously, it increases fiscal accountability by ensuring local resources are maximized before public dollars are spent.