Segel Joel E, Chetlen Alison, Ramos Mark, Zaorsky Nicholas G, Chi Guangqing, Luan Patrick
Department of Health Policy and Administration, Penn State University, University Park, PA 16802, USA.
Department of Public Health Sciences, Penn State College of Medicine, Hershey, PA 17033, USA.
Mil Med. 2025 Jun 30;190(7-8):e1465-e1470. doi: 10.1093/milmed/usae525.
Breast and cervical cancer screening is critical to identifying cases at earlier stages in order to begin treatment earlier and improve survival. Screening rates have been shown to vary within the Military Health System (MHS). The goal is to estimate drivers of variation in screening rates within the MHS.
We used 2007-2019 MHS Data Repository Data to examine individual-level and catchment area-level factors associated with 1- and 2-year breast and cervical cancer screening rates. Specifically, we estimated univariate and multivariate association between 1- and 2-year probability of breast and cervical cancer screening rates and age group, marital status, rank, service branch, beneficiary type (service member vs. dependent), race/ethnicity of service members, catchment area fraction of overall care through purchased care and average per capita spending. The project was approved by both the Penn State Institutional Review Board (IRB) and the Defense Health Agency's electronic IRB.
Overall, we observed a 45.6% 1 year and a 65.7% 2-year mammography screening rate and a 30.5% 1 year and a 51.9% 2-year Pap testing rate. For breast cancer screening, we found higher screening rates for older (ages 50-64 years), married, service members, more senior ranked women or those married to more senior ranked members, and non-Hispanic Black women in both unadjusted and multivariate analyses. Conversely, we found higher rates of cervical cancer screening for younger, unmarried, more junior ranked women as well as for non-Hispanic Black women. We also found higher rates for both breast and cervical cancer screening in catchment areas with a greater fraction of care delivered through the private sector.
Our finding of higher screening in catchment areas with higher rates of purchased care warrants additional study to understand what factors may drive this result. The differential findings of the association between individual characteristics and breast and cervical cancer screening suggest important differences in these 2 types of screening with potentially different policies required to encourage and enhance breast vs. cervical cancer screening. Finally, our results showing higher screening among non-Hispanic Black women suggests important features of the MHS, such as universal, low-cost sharing coverage may help to reduce racial and ethnic disparities in breast and cervical cancer screening.
乳腺癌和宫颈癌筛查对于在早期阶段发现病例至关重要，以便尽早开始治疗并提高生存率。研究表明，军事卫生系统（MHS）内的筛查率存在差异。目标是评估MHS内筛查率差异的驱动因素。
我们使用2007 - 2019年MHS数据存储库数据，研究与1年和2年乳腺癌及宫颈癌筛查率相关的个体层面和集水区层面因素。具体而言，我们估计了乳腺癌和宫颈癌筛查率的1年和2年概率与年龄组、婚姻状况、军衔、军种、受益类型（现役军人与家属）、现役军人的种族/族裔、通过购买医疗服务提供的总体医疗服务的集水区比例以及人均平均支出之间的单变量和多变量关联。该项目获得了宾夕法尼亚州立大学机构审查委员会（IRB）和国防卫生局电子IRB的批准。
总体而言，我们观察到1年乳腺钼靶筛查率为45.6%，2年为65.7%；1年巴氏试验率为30.5%，2年为51.9%。对于乳腺癌筛查，在未经调整和多变量分析中，我们发现年龄较大（50 - 64岁）、已婚、现役军人、军衔较高的女性或与军衔较高成员结婚的女性以及非西班牙裔黑人女性的筛查率较高。相反，我们发现年龄较小、未婚、军衔较低的女性以及非西班牙裔黑人女性的宫颈癌筛查率较高。我们还发现在通过私营部门提供的医疗服务比例较高的集水区，乳腺癌和宫颈癌筛查率也较高。
我们发现在购买医疗服务比例较高的集水区筛查率较高，这值得进一步研究以了解哪些因素可能导致这一结果。个体特征与乳腺癌和宫颈癌筛查之间关联的差异结果表明，这两种筛查存在重要差异，可能需要不同的政策来鼓励和加强乳腺癌与宫颈癌筛查。最后，我们的结果显示非西班牙裔黑人女性的筛查率较高，这表明MHS的一些重要特征，如普遍的低成本分担保险范围，可能有助于减少乳腺癌和宫颈癌筛查中的种族和族裔差异。
