Barriers to mammography completion and physician referral patterns among urban inner-city women in primary care practice
Walker, Renee Stephanie
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Background. Regular mammography screening has been shown to be the most effective means of detecting breast cancer and reducing mortality. Yet, screening rates for African-American women have consistently been lower than their white counterparts. The purpose of this study is to determine physician patterns for mammogram referral after using a reminder system, to assess the number of women who received a mammogram after receiving a referral, and to identify the barriers to mammography after receiving a referral among predominately African-American women seen in an urban primary care setting. Methods. A consecutive sample of women presenting to two Family Medicine Health Centers for scheduled appointments were evaluated for eligibility for breast cancer screening referral after a review of their medical charts. A provider prompt to recommend mammography was placed on the front cover of the medical record of all women 40 and over who did not have a documented mammogram in the past year and met eligibility criteria. A baseline survey was administered to all eligible patients who consented. Participants who received a mammogram referral were later contacted via telephone 3 months post enrollment to ascertain participant self-report of mammography completion and to identify barriers to completion. Results. Of the 176 enrolled, 83 women received a mammogram referral from their providers during their doctor's visit. The most common reason for non-referral was "not a preventive visit". The predictors of mammography referral was not having a history of respiratory illnesses (OR: 0.34, CI: 0.12-0.97), having a total household annual income between $10,000 and $20,000 (OR: 4.28, CI: 1.41-12.99), and a total household annual income of $30,000 or more, (OR: 5.61, CI: 1.47-21.44). Of those referred, 21.7% completed their mammogram. Women who were widows, unemployed, age fifty and older, whose highest grade completed was high school, whose total household income was between $20,000 and $30,000, and who presented to their provider due to a chronic disease were more likely to have completed a mammogram by the three month follow-up period. The major reason for incomplete mammograms was due to having other priorities. Conclusion. Several studies have evaluated mammography utilization among urban, inner-city women and interventions to alleviate barriers, but few have done this with participants who are already in a health care setting, which allows for targeted interventions. An overwhelming number of studies have shown physician recommendation as a major predictor of breast cancer screening. Clearly, physicians have a substantial impact on their patient's decision to complete breast cancer screening. It would behoove physicians to capitalize on this knowledge for the benefit of their patients' health in the long and short term.