The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #63946

Ning Lu, PhD, MPH¹, Kuo-Cherh Huang, DrPH, MBA², and Richard W. Wilson, DHSc, MPH¹. (1) Department of Public Health, Western Kentucky University, 1 Big Red Way, Bowling Green, KY 42101-3576, 270-745-5260, ning.lu@wku.edu, (2) Graduate Institute of Health Care Administration, Taipei Medical University, 250 Wu-Hisng St., Taipei, Taiwan

Utilization of screening programs has been documented as an effective measure for early detection of breast and cervical cancer and thus reducing mortality among women ages 40 and older. The purpose of this study is to examine the trend of using mammogram, Pap smear and clinical breast examination in the past 10 years among Kentucky women ages 40 and over by age, race, education, income, and health insurance coverage. Data for this study came from Kentucky Behavioral Risk Factor Surveillance System, which collected information on using preventive measures, demographics and socioeconomic status from a representative sample of Kentucky's adult population in years 1991, 1995 and 2000. Women ages ³40 were included in data analysis. The main variables of interest for this study are 1) whether a woman has ever had a mammogram, Pap smear and clinical breast examination; 2) whether a woman has received the three cancer screenings within the past two years. For all analyses standard errors were adjusted for the complex survey design. Our data revealed that the use of breast cancer screening has significantly increased for all segments of women. About 88% of women had a mammogram in 2000, up from 65% in 1991 and 81% in 1995, with the greatest increase in women ages ³65 (26 percentage points increase). Majority of women (87%) had a mammogram within the past two years in 2000 up from 83% in 1991. A stable percent of women (86% to 88%) who used clinical breast examination was observed in 1991, 1995 and 2000. However, the use of Pap smear declined slightly from 95% in 1991 to 91% in 2000, with the deepest decline found among women younger than 65 and with no health insurance coverage (6 percentage points decrease). Although the use of mammogram increased significantly among disadvantaged women between 1991 and 2000, disparities in using all three screening programs still exist by income, education and health insurance coverage in the past decade. Women with the least amount of income (<$15,000) and the lowest level of education (< high school graduate) were least likely to be screened. Compared with medically insured, uninsured women were less likely to use a mammogram, (OR=0.46, 95%CI=0.32, 0.65), to have a clinical breast examination (OR=0.34, 95%CI=0.22, 0.52), and to have a Pap smear test (OR=0.39, 95%CI=0.22, 0.69). No significant differences were found in using the screening programs by race when other confounding variables were adjusted.

Learning Objectives:

At the conclusion of the session, the participant in this session will be able to:
• Describe the trend of breast and cervical cancer screening practices in women in the past decade.
• Describe the disparities in breast and cervical cancer screening practices by socioeconomic status and health insurance coverage.
• Realize that although the use of breast and cervical cancer screening has increased appreciably among disadvantaged women, the rates for using screening programs are still significantly lower in women of low levels of income and education, and in women of no health insurance, compared to their counterparts.

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.