Mammography Follow-up in minority and medically underserved women

Awarding Agency:  American Cancer Society (ACS)
Award No:  MRSGT-07-008-01CPHPS
Principal Investigator: Alecia Malin Fair, DrPH

Grant Summary: The striking increase in the population of minority and medically underserved women receiving screening mammograms over the past decade, would indicate that breast cancer mortality is on the decrease for this population.  Screening mammography is a modality to detest breast cancer early if abnormal or inconclusive results are followed-up with further diagnostic testing.  In our study population, a substantial proportion of women do not receive adequate diagnostic follow-up services, such a repeat mammography, biopsy or fine-needle aspiration for an abnormal or inconclusive finding on their screening mammography.  It is critical to ensure that women who have made the effort to obtain screening mammograms receive the maximum benefit from this test.  We are interested in what factors promote or inhibit women from receiving further tests to confirm a normal or cancerous finding from the screening mammography results.  We believe that several factors, working together can contribute to timely follow-up of abnormal mammography within the recommended time period of three months.

We will conduct a series of studies to examine the relationship between 1) the level of the individual’s motivation to receive further diagnostic testing, 2) the characteristics and communication style of the medical provider who performs further diagnostic testing and 3) id the health services delivery of care is patient centered.  Ultimately, we want to create an intervention where all three spheres of the health care environment (patient, provider, health system) are represented.  Our model states that the patient’s level of activation; which is the patient’s innate knowledge, skills and confidence to self-manager their preventive health needs, and the patient’s feelings of internal locus of control; the belief that their own actions determine the rewards that they obtain, coupled with perceptions of the risks and barriers to diagnostic follow-up will affect the clinician’s behavior and the patient’s behavior during the health care visit.  We further posit that the interaction between the clinician-patient dyad can be partially predicted from patient characteristics such as income, education and health insurance status.  In addition, the health system structure affects follow-up of abnormal mammography factors by affecting clinician behavior and patient behavior.  This model will be used to frame the patient, clinician and health system variables that may contribute to more efficacious follow-up to minority and medically underserved women’s abnormal mammography status.

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