Hiatt R A, Pasick R J, Stewart S, Bloom J, Davis P, Gardiner P, Johnston M, Luce J, Schorr K, Brunner W, Stroud F
Northern California Cancer Center, Union City, California 94587, USA.
Prev Med. 2001 Sep;33(3):190-203. doi: 10.1006/pmed.2001.0871.
Underutilization of breast and cervical cancer screening has been observed in many ethnic groups and underserved populations. Effective community-based interventions are needed to eliminate disparities in screening rates and thus to improve prospects for survival.
The Breast and Cervical Cancer Intervention Study was a controlled trial of three interventions in the San Francisco Bay Area from 1993 to 1996: (1) community-based lay health worker outreach; (2) clinic-based provider training and reminder system; and (3) patient navigator for follow-up of abnormal screening results. Study design and a description of the interventions are reported along with baseline results of a household survey conducted in four languages among 1599 women, aged 40-75.
Seventy-six percent of women ages 40 and over had had at least one mammogram, and most had had a clinical breast examination (88%) and Pap smear (89%). Rates were significantly lower for non-English-speaking Latinas and Chinese women (56 and 32%, respectively, for mammography), and maintenance screening (three mammograms in the past 5 years) varied from 7% (non-English-speaking Chinese) to 53% (Blacks). Pap smear screening in the past 3 years was low among non-English-speaking Latinas (72%) and markedly lower among non-English-speaking Chinese women (24%). The strongest predictors of screening behavior were having private health insurance and frequent use of medical services. Having a regular clinic and speaking English were also important. Race/ethnicity, education, household income, and employment status were, overall, not significant predictors of screening behavior.
These baseline results support the importance of cancer screening interventions targeted to persons of foreign origin, particularly those less acculturated.
在许多种族群体和服务不足的人群中，乳腺癌和宫颈癌筛查的利用率较低。需要有效的社区干预措施来消除筛查率的差异，从而改善生存前景。
乳腺癌和宫颈癌干预研究是1993年至1996年在旧金山湾区进行的一项针对三种干预措施的对照试验：（1）基于社区的非专业健康工作者外展服务；（2）基于诊所的提供者培训和提醒系统；（3）患者导航员，用于跟踪异常筛查结果。报告了研究设计、干预措施描述以及在1599名40至75岁女性中用四种语言进行的家庭调查的基线结果。
40岁及以上的女性中有76%至少进行过一次乳房X光检查，大多数人进行过临床乳房检查（88%）和巴氏涂片检查（89%）。非英语的拉丁裔和华裔女性的检查率明显较低（乳房X光检查分别为56%和32%），维持性筛查（过去5年进行过三次乳房X光检查）从7%（非英语的华裔）到53%（黑人）不等。过去3年中，非英语的拉丁裔女性巴氏涂片检查率较低（72%），非英语的华裔女性则明显更低（24%）。筛查行为的最强预测因素是拥有私人医疗保险和频繁使用医疗服务。有固定的诊所和会说英语也很重要。总体而言，种族/族裔、教育程度、家庭收入和就业状况不是筛查行为的重要预测因素。
这些基线结果支持了针对外国移民，尤其是文化适应程度较低者的癌症筛查干预措施的重要性。
