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Background: The Avon Breast Health Outreach Program (BHOP) supports community- based organizations and safety-net providers in conducting outreach and education to recruit underserved, low-income and uninsured women for breast cancer screening mammography. Funded organizations report mammography outcomes as part of routine program monitoring. NCI Breast Cancer Consortium data for 2009 reported a cancer detection rate of 3.92 per 1,000 for screening mammograms and 33.21 per 1,000 for diagnostic mammograms. In CY2009, CDC's National Breast and Cervical Cancer Early Detection Program (NBCCEDP) reported 14 percent of mammograms had abnormal results requiring further investigation, with an overall cancer detection rate of 10.2 per 1,000 mammograms. Objective: To describe reported breast cancer detection rates and rates of abnormal mammography findings among Avon BHOP-funded programs. Methods: We reviewed routinely reported program outcomes data for 98 organizations funded continuously through the Avon BHOP for a three-year period from 2009 to 2011. Data for 17,839 mammograms were available in aggregate by year by grantee agency including the number of mammograms reported, number with a preliminary abnormal finding, and number of confirmed cancer diagnoses. Results: Agencies reported an average of 981 mammogram outcomes per year over 3 years (range 108 to 5,946 by agency). The average agency-specific rate of abnormal findings across 3 years was 13.2% (median 11.2%; range 0.49% to 51.0%). The average agency-specific cancer detection rate was 8.1 per 1,000 (median 6.4 per 1,000; range zero to 31.7 per 1,000). 28 organizations had 3-year average cancer detection rates in excess of 10 per 1,000, and 6 had rates exceeding 20 per 1,000. Large fluctuations in the proportion of mammogram outcomes reported as abnormal by a given agency year-over-year were common. Conclusion: Avon BHOP agencies reported overall abnormal and cancer detection rates similar to those of the NBCCEDP, but higher than the general population. Fluctuations in year-over-year rates were common, and may indicate changes in the way program data were reported over time, changes in screening practices (e.g. new clinical providers or new equipment), and/or differences in breast cancer risk among clients recruited for screening over time. High rates of abnormal screening results could indicate delays in obtaining results from follow-up diagnostic testing, problems with the calibration of equipment, or other quality issues. Discussion: Grantees with unusually high or low rates of abnormal or cancer outcomes or significant year-over-year rate fluctuations would benefit from technical assistance to identify and explain the underlying causes of these trends. Ensuring that all clients recruited for breast cancer screening receive high quality mammography services -- including accurate imaging and reliable interpretation by experienced radiologists -- is critical to minimize client anxiety and to ensure that screening results in improved health outcomes. [ABSTRACT FROM AUTHOR]

Background: Numerous studies have documented the relative advantages that computer assisted self-interview (CASI) technology holds over traditional interviewing methods in collecting research data on stigmatized and/or risky health behaviors. However, few studies have explored the broader implications of using CASI to collect basic client-level data during routine health promotion and disease prevention screenings. Aims: The present study aims to address this gap in research by comparing the quality of client-level data collected via audio-computer assisted self-interview (ACASI) with data collected via face-to-face and self-administered paper-based interviews among a sample of clients served through the Avon Breast Health Outreach Program (Avon BHOP). Methods: A total of 303 clients served through the Avon BHOP were sampled from three U.S. sites between November 2011 and March 2012. Clients were randomly assigned to complete the Avon BHOP client intake form (CIF) via one of three interview modes: face-to-face interview (FFI), self-administered paper-based interview (SAPI), or ACASI. We conducted logistic regression and determined odds ratios with 95% confidence intervals to test our hypothesis that use of ACASI would result in significantly higher rates of CIF completion than either FFI or SAPI. We compared rates of completion of the entire CIF, as well as completion of each of the three CIF sections: Demographics, Breast Health Information, and Correlates of Breast Health. Results: Clients were significantly more likely to complete the entire CIF via ACASI than either FFI or SAPI interview modes. The greatest differences were observed when comparing rates of completion between ACASI and SAPI, as clients were almost five times more likely to complete the CIF via ACASI as opposed to SAPI (OR = 4.7, p < 0.001). Additionally, when comparing rates of completion of the three CIF sections on Demographics, Breast Health Information (e.g. mammogram history), and Correlates of Breast Health (e.g., smoking behavior, alcohol consumption), we found that clients were between 3.2 and 7.2 times more likely to complete the sections via ACASI as opposed to SAPI. Discussion: Overall, we found that use of ACASI resulted in significantly higher rates of overall form completion and lower rates of missing data than use of SAPI or FFI, with the greatest identified disparity in form completion between ACASI and SAPI. This study has important implications for breast health specialists or any health practitioners who regularly rely on self-administered questionnaires and/or face-to-face interviews to collect important health information. We recommend that where feasible, ACASI be utilized as an effective means of collecting high quality client-level data. [ABSTRACT FROM AUTHOR]

Introduction: In 2009, the US Preventive Services Task Force (USPSTF) changed its recommendations on the age and frequency for routine mammography. To this point, responses to this change among ethnically diverse women have been not been well examined. The objective of this qualitative study is to describe women's awareness of the change in mammography screening guidelines by the U.S. Preventive Services Task Force and to describe their attitudes toward this change. Methods: White, Black and Hispanic women ages 40-49 years were recruited from a variety of community settings in the Greater Boston, MA area to participate in focus groups (k = 10; N=73). Groups were segmented by race/ethnicity (Black = 29%; White=29%; Hispanic=15%). Women were asked if they were aware of the change in USPSTF guidelines, and if so, their understanding about reasons for this change and intention to comply. Focus groups were audio-taped and transcribed verbatim. Thematic content analysis was used to cull recurring discussion themes. Results: Most women in this study were not aware of changes in the USPSTF mammography screening guidelines. Those who were aware of the guideline change were highly suspicious that it was motivated by a desire for cost savings on the part of insurance companies and/or providers. Concerns regarding the accuracy of mammography, pain associated with screening, and fear of receiving positive test results were prevalent. Nevertheless, most said that they did not intend to comply with changes in guidelines; many believed that regular (yearly) mammography should start at a young age (40 or before) and continue indefinitely. Conclusion: Most women in this sample were unaware about changes in mammography screening guidelines and lacked understanding regarding underlying reasons for the change. Communication about the rationale for changes in mammography screening guidelines has left many women unconvinced about the potential downsides of screening and has generated a high degree of mistrust of insurance companies and medical providers. [ABSTRACT FROM AUTHOR]