Mortality outcome among medically underserved women screened through a publicly funded breast cancer program, 1997-2007

Background: The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) gives low-income, uninsured, and underinsured women access to breast and cervical cancer screening. As part of this program, Nebraska started the Every Woman Matters (EWM) program in 1992. Purpose: The purpose of this study is to assess treatment and mortality differences between women diagnosed with breast cancer through EWM, and women diagnosed through other sources. Methods: A retrospective analysis was performed using 10 years of Nebraska Cancer Registry and EWM program data on women aged 40 to 74 years. This study used chi-square test and multivariate logistic regression.Results: From 1997 to 2007, 4,739 women were diagnosed with breast cancer, 435 of whom were diagnosed through EWM. The EWM and non-EWM groups differed significantly in age, race, marital status, location of residence at the time of diagnosis, neighborhood poverty level at the time of diagnosis, tumor stage at diagnosis, and chemotherapy. No significant differences were found between the 2 groups in radiation therapy, surgical resection, and hormone therapy. In both 1-year and 5-year multivariate mortality models, there was no difference between the 2 groups in odds of death. In the 1-year mortality model, residents of urban metropolitan counties (OR: 2.079; 95% CI: 1.663-2.598) were more likely to die than residents of rural counties. In the 5-year mortality model, black women (OR: 2.239; 95% CI: 1.453- 3.450), residents of areas with a high (more than 20%) neighborhood poverty level at the time of diagnosis (OR: 1.589; 95% CI: 1.204-2.097), and unmarried women (OR: 1.334; 95% CI: 1.164-1.528) had higher odds of death. Women diagnosed through EWM received similar treatments as those diagnosed through other sources. Conclusions: The EWM program was successful in targeting low income women in Nebraska. Targeted outreach of vulnerable groups for cancer screening may be a successful method to improve cancer outcomes and reduce disparities. The Patient Protection and Affordable Care Act will provide women with greater access to preventive screening and treatment services including breast cancer. However, significant barriers will remain for women who are uninsured, specifically in the states which are not expanding Medicaid. In the recent years, federal budget cuts to the NBCCEDP screening program combined with the state cuts have limited access and created long waiting lists for the low income, uninsured women for breast cancer screening.