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Background: A randomized trial was conducted to evaluate the impact of a community-based intervention on mammography use among low-income women living in public housing., Methods: All 41 public housing high-rise buildings were randomized to treatment and delayed treatment (control) conditions. After a cross-sectional baseline survey, an intervention called Friend to Friend was conducted in the treatment buildings by American Cancer Society and building resident volunteers. The intervention consisted of a health professional talk, small group discussions, and an opportunity to request assistance in obtaining a mammogram or mammogram reminder. A second cross-sectional survey was conducted to measure differences in screening rates between the study groups., Results: Participation in the intervention averaged 27%. The study groups were equivalent at baseline. At follow-up, the proportion of women age 50-79 years who reported mammography screening in the previous 15 months was significantly higher in the treatment group (64%) than in the control group (52%). Breast cancer knowledge, attitudes, and beliefs did not differ between groups., Conclusions: These findings suggest that a multidimensional intervention which reaches women within their social environment and uses community volunteers can increase mammography utilization among women in public housing.

Background: Cancer screening history can often be obtained only by self-report, particularly for disadvantaged populations. We examined the accuracy of self-report of mammography and Pap smear for an urban, low-income population., Methods: Women attending non-primary care clinics (mostly surgery and orthopedics) at a large public teaching hospital in Minneapolis between July 1992 and May 1993 were queried about their screening history (n = 477). The women were interviewed by a trained peer-recruiter and asked whether they had ever heard of a Pap smear or mammogram, whether they had ever had one, where it was done, and when the last one was. We verified self-report by checking medical records where the test was performed., Results: The positive and negative predictive value of recall of mammography in the previous year was 72.4% and 90.6%, respectively. The figures for Pap smear recall were somewhat lower, 65.5% and 85.9%, respectively. We found a record of a mammogram in 88% of women able to recall the year. Of these, slightly over two-thirds recalled their mammogram in the same year as their record indicated. Inaccurate recalls were more commonly of the "telescoping" type, i.e., tests were recalled as having occurred more recently than was the case. Recall was substantially better for recent tests. Results for Pap smear recalls were broadly similar., Conclusions: The accuracy of self-report of mammography and Pap smear is relatively poor for medical practice but is acceptable in population surveys with appropriate correction for overreporting.

Objective: Women are more likely to receive breast and cervical cancer screening if they see female physicians. We studied whether this is due to differences between male and female physicians, or to differences in their patients., Setting: Large midwestern, independent practice association style of health plan., Design: We surveyed male and female primary care physicians matched for age and specialty and a stratified random sample of three of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices regarding prevention, and their comfort and skill with various examinations. Patients reported on their sociodemographic characteristics, their attitudes and practices regarding prevention, and their preferences for physician gender. Claims data were used to calculate mammography and Pap smear screening rates for the physicians., Participants: We studied 154 female and 190 male internists and family physicians and 794 of their patients., Measurements and Main Results: We compared the responses of male and female physicians and their patients and used multivariable analysis to identify the patient and physician factors that accounted for the differences in screening rates between male and female physicians. Female physicians were more likely to ask new patients about components of prevention, to believe in the effectiveness of mammography, to feel more personal responsibility for ensuring that their patients received screening, and to report more comfort in performing Pap smears and breast examinations. Patients of female physicians were more educated and less likely to be married, but did not differ in other sociodemographic characteristics. They had similar attitudes and practices regarding prevention, except that patients of male physicians were more likely to smoke. Significantly more patients of female physicians preferred a female for some component of care. In multivariable analyses, practice organization, patient preference for a female physician, and prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male physicians for Pap smears, and 33% for mammography., Conclusions: Differences in beliefs of male and female physicians and patient preference for a female provider contribute independently to the higher rate of breast and cervical cancer screening by female physicians.

Failure to attend scheduled appointments for mammography results in missed opportunities for breast cancer screening. We tested interventions to decrease mammography appointment failure among women attending the medicine clinic at a public teaching hospital. Consecutive women with mammography orders from October 1992 to November 1993 (970 women undergoing 1,072 mammograms) were assigned to one of three comparison groups: usual care, mailed reminder, and mailed reminder plus nurse counseling. The appointment failure rates were 25.5% in the usual care group, 20.3% in the mailed reminder group, and 19.7% in the special intervention group (p = .13). We conclude that mailed reminders modestly improve mammography appointment keeping by about 5%, and that nurse counseling has little additional effect.

Objective: To identify patient, institutional, and physician characteristics that predict failure to attend scheduled mammography appointments., Design: Retrospective chart review., Setting: Medicine clinic at an urban public teaching hospital., Patients: All 907 women aged 40 years and more scheduled for mammography from March 1990 to June 1991., Measurements and Main Results: The main outcome measure was whether a woman kept her scheduled mammography appointment. Potential predictor variables included patient age, race, marital status, and insurance status; waiting interval to obtain a mammography appointment; and physician gender, level of training, country of training, and native language. The rate of failed mammography appointments was 23%. Univariate analysis showed that appointment failure was associated with age (p = 0.03), with the lowest failure rates (19%) among women aged 60 years and more. Appointment keeping varied significantly by race (p = 0.01), largely because of the higher failure rate among Native American women (36%). Insured women had a failure rate of 22% vs 33% for uninsured women (p = 0.01). The rate of failed appointments varied significantly by waiting interval (p = 0.05), with a peak failure rate of 27% for appointments scheduled 14-27 days in advance. None of the physician variables was associated with appointment failure. Multivariate analysis confirmed these results., Conclusions: Interventions to improve completion of breast cancer screening should include additional efforts targeted at groups with high rates of appointment failure, such as women under the age of 60, the uninsured, and Native Americans. Long waiting intervals to obtain mammography appointments may decrease compliance.

Objective: To determine if women would have higher breast and cervical cancer screening rates if lay health advisers recommended screening and offered a convenient screening opportunity.Design: Controlled trial.Setting: Urban county teaching hospital.Participants: Women aged 40 years and over attending appointments in several non-primary-care outpatient clinics.Interventions: Lay health advisers assessed the participants' breast and cervical cancer screening status and offered women in the intervention group who were due for screening an appointment with a female nurse practitioner.Measurements and Main Results: Screening rates at baseline and at follow-up 1 year after the intervention were determined. At follow-up, the mammography rate was 69% in the intervention group versus 63% in the usual care group (p = .009), and the Pap smear rate was 70% in the intervention group versus 63% in the usual care group (p = .02). In women who were due for screening at baseline, the mammography rate was 60% in the intervention group versus 50% in the usual care group (p = .006), and the Pap smear rate was 63% in the intervention group versus 50% in the usual care group (p = .002). The intervention was effective across age and insurance payer strata, and was particularly effective in Native American women.Conclusions: Breast and cervical cancer screening rates were improved in women attending non-primary-care outpatient clinics by using lay health advisers and a nurse practitioner to perform screening. The effect was strongest in women in greatest need of screening. [ABSTRACT FROM AUTHOR]

Objective: Women are more likely to receive breast and cervical cancer screening if they see female physicians. We studied whether this is due to differences between male and female physicians, or to differences in their patients.Setting: Large midwestern, independent practice association style of health plan.Design: We surveyed male and female primary care physicians matched for age and specialty and a stratified random sample of three of each physician's women patients. Physicians reported on their practice setting, their attitudes and practices regarding prevention, and their comfort and skill with various examinations. Patients reported on their sociodemographic characteristics, their attitudes and practices regarding prevention, and their preferences for physician gender. Claims data were used to calculate mammography and Pap smear screening rates for the physicians.Participants: We studied 154 female and 190 male internists and family physicians and 794 of their patients.Measurements and Main Results: We compared the responses of male and female physicians and their patients and used multivariable analysis to identify the patient and physician factors that accounted for the differences in screening rates between male and female physicians. Female physicians were more likely to ask new patients about components of prevention, to believe in the effectiveness of mammography, to feel more personal responsibility for ensuring that their patients received screening, and to report more comfort in performing Pap smears and breast examinations. Patients of female physicians were more educated and less likely to be married, but did not differ in other sociodemographic characteristics. They had similar attitudes and practices regarding prevention, except that patients of male physicians were more likely to smoke. Significantly more patients of female physicians preferred a female for some component of care. In multivariable analyses, practice organization, patient preference for a female physician, and prevention orientation of female physicians accounted for up to 40% of screening rate differences between female and male physicians for Pap smears, and 33% for mammography.Conclusions: Differences in beliefs of male and female physicians and patient preference for a female provider contribute independently to the higher rate of breast and cervical cancer screening by female physicians. [ABSTRACT FROM AUTHOR]

Objective: To identify patient, institutional, and physician characteristics that predict failure to attend scheduled mammography appointments.Design: Retrospective chart review.Setting: Medicine clinic at an urban public teaching hospital.Patients: All 907 women aged 40 years and more scheduled for mammography from March 1990 to June 1991.Measurements and Main Results: The main outcome measure was whether a woman kept her scheduled mammography appointment. Potential predictor variables included patient age, race, marital status, and insurance status; waiting interval to obtain a mammography appointment; and physician gender, level of training, country of training, and native language. The rate of failed mammography appointments was 23%. Univariate analysis showed that appointment failure was associated with age (p = 0.03), with the lowest failure rates (19%) among women aged 60 years and more. Appointment keeping varied significantly by race (p = 0.01), largely because of the higher failure rate among Native American women (36%). Insured women had a failure rate of 22% vs 33% for uninsured women (p = 0.01). The rate of failed appointments varied significantly by waiting interval (p = 0.05), with a peak failure rate of 27% for appointments scheduled 14-27 days in advance. None of the physician variables was associated with appointment failure. Multivariate analysis confirmed these results.Conclusions: Interventions to improve completion of breast cancer screening should include additional efforts targeted at groups with high rates of appointment failure, such as women under the age of 60, the uninsured, and Native Americans. Long waiting intervals to obtain mammography appointments may decrease compliance. [ABSTRACT FROM AUTHOR]

Failure to attend scheduled appointments for mammography results in missed opportunities for breast cancer screening. We tested interventions to decrease mammography appointment failure among women attending the medicine clinic at a public teaching hospital. Consecutive women with mammography orders from October 1992 to November 1993 (970 women undergoing 1,072 mammograms) were assigned to one of three comparison groups: usual care, mailed reminder, and mailed reminder plus nurse counseling. The appointment failure rates were 25.5% in the usual care group, 20.3% in the mailed reminder group, and 19.7% in the special intervention group (p = .13). We conclude that mailed reminders modestly improve mammography appointment keeping by about 5%, and that nurse counseling has little additional effect. [ABSTRACT FROM AUTHOR]