乳腺癌筛查和治疗机会不均等。
Disparate access to breast cancer screening and treatment.
机构信息
New York Medical College, Valhalla, NY, 10595, USA.
Department of Surgery, Westchester Medical Center, Valhalla, NY, 10595, USA.
出版信息
BMC Womens Health. 2022 Jun 22;22(1):249. doi: 10.1186/s12905-022-01793-z.
BACKGROUND
Barriers to breast cancer screening remain despite Medicaid expansion for preventive screening tests and implementation of patient navigation programs under the Affordable Care Act. Women from underserved communities experience disproportionately low rates of screening mammography. This study compares barriers to breast cancer screening among women at an inner-city safety-net center (City) and those at a suburban county medical center (County). Inner city and suburban county medical centers' initiatives were studied to compare outcomes of breast cancer screening and factors that influence access to care.
METHODS
Women 40 years of age or older delinquent in breast cancer screening were offered patient navigation services between October 2014 and September 2019. Four different screening time-to-event intervals were investigated: time from patient navigation acceptance to screening mammography, to diagnostic mammography, to biopsy, and overall screening completion time. Barriers to complete breast cancer screening between the two centers were compared.
RESULTS
Women from lowest income quartiles took significantly longer to complete breast cancer screening when compared to women from higher income quartiles when a barrier was present, regardless of barrier type and center. Transportation was a major barrier to screening mammography completion, while fear was the major barrier to abnormal screening work up.
CONCLUSION
Disparity in breast cancer screening and management persists despite implementation of a patient navigation program. In the presence of a barrier, women from the lowest income quartiles have prolonged breast cancer screening completion time regardless of center or barrier type. Women who experience fear have longest screening time completion. Future directions aim to increase resource allocation to ameliorate wait times in overburdened safety-net hospitals as well as advanced training for patient navigators to alleviate women's fears.
背景
尽管《平价医疗法案》扩大了预防性筛查测试的医疗补助范围，并实施了患者导航计划，但乳腺癌筛查仍然存在障碍。服务不足社区的女性接受筛查乳房 X 光检查的比例过低。本研究比较了位于市中心的服务不足社区安全网中心（City）和位于郊区县医疗中心（County）的女性进行乳腺癌筛查的障碍。研究了市中心和郊区县医疗中心的举措，以比较乳腺癌筛查的结果和影响获得护理的因素。
方法
2014 年 10 月至 2019 年 9 月，对逾期未接受乳腺癌筛查的 40 岁及以上女性提供患者导航服务。研究了四种不同的筛查时间事件间隔：从患者接受导航服务到接受乳房 X 光检查、诊断性乳房 X 光检查、活检以及总体筛查完成时间的时间。比较了两个中心之间完成乳腺癌筛查的障碍。
结果
无论障碍类型和中心如何，来自最低收入四分位数的女性在存在障碍的情况下完成乳腺癌筛查的时间明显长于来自较高收入四分位数的女性。交通是完成乳房 X 光筛查的主要障碍，而恐惧是异常筛查工作的主要障碍。
结论
尽管实施了患者导航计划，但乳腺癌筛查和管理的差异仍然存在。在存在障碍的情况下，来自最低收入四分位数的女性完成乳腺癌筛查的时间延长，无论中心或障碍类型如何。经历恐惧的女性完成筛查的时间最长。未来的方向旨在增加资源分配，以缓解负担过重的安全网医院的等待时间，并为患者导航员提供高级培训，以减轻女性的恐惧。
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