An Assessment of the Quality of Mammography Care at Facilities Treating Medically Vulnerable Populations

Bibliographic Data

ID9103447
AuthorsLee Goldman (University of California, San Francisco, corresponding author), L Elizabeth Goldman, Sebastien Haneuse (0000-0003-4963-0655, University of Washington), Sebastien J-P A Haneuse, Diana L Miglioretti (0000-0002-5547-1833, Health Center), Karla Kerlikowske (0000-0001-8793-8779, University of California, San Francisco), Diana S M Buist (0000-0001-5408-2804, Group Health Cooperative), Bonnie Yankaskas, Bonnie C Yankaskas (University of North Carolina at Chapel Hill), Rebecca Smith-Bindman, Rebecca Smith‐Bindman (0000-0003-1972-639X, University of California, San Francisco, corresponding author)
Year2008
Volume46
Issue7
Pages701-708
Publication date2008-07-01
Peer ReviewedYes
Open AccessNo
TypeARTICLE
VenueMedical Care (JOURNAL)
Journal identifiersISSN: 0025-7079 • E-ISSN: 1537-1948
PublisherOvid Technologies (Wolters Kluwer Health) (PUBLISHER)
DOI10.1097/mlr.0b013e3181789329
PMID18580389
PMCIDPMC2674332
OpenAlexW2046061481
LanguageEN
Citations received3
References cited41

BACKGROUND: Women in medically vulnerable populations, including racial and ethnic minorities, socioeconomically disadvantaged, and residents of rural areas, experience higher breast cancer mortality than do others. Whether mammography facilities that treat vulnerable women demonstrate lower quality of care than other facilities is unknown. OBJECTIVES: To assess the quality of mammography women receive at facilities characterized as serving a high proportion of medically vulnerable populations. RESEARCH DESIGN: We prospectively collected self-reported breast cancer risk factor information, mammography interpretations, and cancer outcomes on 1,579,929 screening mammography examinations from 750,857 women, aged 40-80 years, attending any of 151 facilities in the Breast Cancer Surveillance Consortium between 1998 and 2004. To classify facilities as serving medically vulnerable populations, we used 4 criteria: educational attainment, racial/ethnic minority, household income, and rural/urban residence. RESULTS: After adjustment for patient-level factors known to affect mammography accuracy, facilities serving vulnerable populations had significantly higher mammography specificity than did other facilities: ie, those serving a higher proportion of women who were minorities [odds ratio (OR): 1.32; 95% confidence interval (CI): 1.01-1.73], living in rural areas (1.45; 1.15-1.73), and with lower household income (1.33; 1.05-1.68). We observed no statistically significant differences between facilities in mammography sensitivity. CONCLUSIONS: Facilities serving high proportions of vulnerable populations provide screening mammography with equal or better quality (as reflected in higher specificity with no corresponding decrease in sensitivity) than other facilities. Further research is needed to understand the mechanisms underlying these findings

Breast cancer · Cancer · Confidence interval · Disadvantaged · Educational attainment · Environmental health · Ethnic group · Family medicine · Mammography · Odds ratio · Residence · Breast Lesions and Carcinomas · Demography · Digital Radiography and Breast Imaging · Global Cancer Incidence and Screening · Internal Medicine · Medicine · Gerontology

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