Puschel Klaus, Rioseco Andrea, Soto Gabriela, Palominos Mario, León Augusto, Soto Mauricio, Thompson Beti
Department of Family and Community Medicine, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8320000, Chile.
Department of Surgical Oncology, School of Medicine, Pontificia Universidad Católica de Chile, Santiago 8330024, Chile.
Cancers (Basel). 2022 Jul 31;14(15):3734. doi: 10.3390/cancers14153734.
Chile has one of the highest rates of breast cancer in Latin America. Mammography rates among women, especially those of low socioeconomic status (SES), are thought to contribute to high breast cancer morbidity and mortality. A successful randomized controlled trial among women aged 50 to 70 in a low-SES primary care clinic in Chile led to a significant increase in mammography screening rates in a two-year intervention trial. This study assesses the sustainability of the intervention after ten years and identifies factors that might have been associated with a long-term effect using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework. The mammography rates among women aged 50 to 70 in the low-SES intervention clinic were compared to two populations of women aged 50 to 70 from middle-SES clinics and to national data. Qualitative data were used to answer questions of adoption, implementation, and maintenance, while quantitative data assessed the reach and effectiveness. After ten years, low-SES women at the intervention clinic maintained significantly higher mammography screening rates vs. middle-SES women at the comparison clinics (36.2% vs. 30.1% and 19.4% p < 0.0001). Women of a low SES at the intervention clinic also had significantly higher screening rates compared to women of a low SES at a national level (44.2% vs. 34.2% p < 0.0001). RE-AIM factors contributed to understanding the long-term difference in rates. Mailed contact, outreach interventions, and the integration of health promoters as part of the Community Advisory Board were important factors associated with the effects observed. This study provides information on factors that could contribute to reducing the social gap on breast cancer screening.
智利是拉丁美洲乳腺癌发病率最高的国家之一。女性的乳房X光检查率，尤其是社会经济地位较低（SES）的女性，被认为是导致乳腺癌高发病率和高死亡率的原因之一。在智利一家社会经济地位较低的初级保健诊所，针对50至70岁女性进行的一项成功的随机对照试验，在为期两年的干预试验中使乳房X光检查筛查率显著提高。本研究评估了十年后该干预措施的可持续性，并使用RE-AIM（覆盖范围、有效性、采用率、实施情况、维持率）框架确定了可能与长期效果相关的因素。将社会经济地位较低的干预诊所中50至70岁女性的乳房X光检查率，与来自社会经济地位中等的诊所的两组50至70岁女性以及全国数据进行了比较。定性数据用于回答采用率、实施情况和维持率方面的问题，而定性数据则评估了覆盖范围和有效性。十年后，干预诊所中社会经济地位较低的女性的乳房X光检查筛查率显著高于对照诊所中社会经济地位中等的女性（36.2%对30.1%和19.4%，p<0.0001）。与全国社会经济地位较低的女性相比，干预诊所中社会经济地位较低的女性的筛查率也显著更高（44.2%对34.2%，p<0.0001）。RE-AIM因素有助于理解筛查率的长期差异。邮寄联系、外展干预以及将健康促进者纳入社区咨询委员会是与观察到的效果相关的重要因素。本研究提供了有关可能有助于缩小乳腺癌筛查社会差距的因素的信息。
