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Genetics and breast cancer screening in a Pennsylvanian managed care organization

D'Annibale, Olivia (2018) Genetics and breast cancer screening in a Pennsylvanian managed care organization. Master Essay, University of Pittsburgh.

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Abstract

Background: Breast cancer is the most common cancer among women in the US: annually > 230,000 women are diagnosed and > 40,000 die. Although breast cancer screening (BCS) is a covered benefit and associated with a reduction in breast cancer, mortality, a large percentage of the population are not screened.
Methods: Women 52-74 years old enrolled continuously in the (Managed Care Organization) MCO between October 1, 2014-December 31, 2016 were included in the analysis: 3,624 were BCS utilizers and 3,298 were non-utilizers. I used the Behavioral Model of Health Care Utilization framework to identify predictors of BCS utilization, including predisposing (e.g., age group), enabling (e.g., area of residence), and need-related (e.g., smoking) factors. Differences between groups were assessed using chi-square and logistic regression analyses.
Results: Overall, mean age of the women was 59 (±4) years, 20% were African American and 12% were Hispanic. Approximately 5% had family history of breast cancer, 23% were from rural areas, 39% had 3-5 chronic health conditions, 10% were obese, 15% were smokers, and 48% were non-BCS utilizers. Results showed utilizers were more likely to be African American (OR: 1.28; 95%CI: 1.12-1.47), Hispanic (OR: 1.88; 95%CI: 1.51-2.35), have a family history (OR: 6.95; 95%CI: 4.94-9.83), smoke (OR: 1.20; 95%CI: 1.04-1.39), and had more PCP visits (OR: 1.02; 95%CI: 1.00-1.03). Women residing in rural areas (OR: 0.77; 95%CI: 0.68-0.88), Southwest PA (OR: 0.73; 95%CI: 0.61-0.87), and with no chronic health conditions (OR: 0.30; 95%CI: 0.21-0.42) were less likely to be utilizers.
Conclusion: Despite evidence that regular screening improves diagnosis and treatment of breast cancer, screening rates were low. I observed reverse health disparities with regards to race and ethnicity. Women with higher numbers of PCP visits and/or family history of breast cancer were more likely to be screened. Geographical disparities were also observed. These results indicate the MCO should target specific interventions to educate and remind women about their annual screening and services. Increasing the rate of breast cancer screening would increase the detection of early stage breast cancer and treatment, which would improve overall public health.


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Details

Item Type: Other Thesis, Dissertation, or Long Paper (Master Essay)
Status: Unpublished
Creators/Authors:
CreatorsEmailPitt UsernameORCID
D'Annibale, Oliviaold13@pitt.eduold130000-0002-6498-2889
Contributors:
ContributionContributors NameEmailPitt UsernameORCID
Committee ChairKammerer, Candacecmk3@pitt.educmk3UNSPECIFIED
Committee MemberBarron, Geraldgbarron@pitt.edugbarronUNSPECIFIED
Date: 20 April 2018
Date Type: Completion
Number of Pages: 77
Institution: University of Pittsburgh
Schools and Programs: Graduate School of Public Health > Public Health Genetics
Degree: MPH - Master of Public Health
Thesis Type: Master Essay
Refereed: Yes
Uncontrolled Keywords: genetics, breast cancer, screening, managed care organization, Medicaid, insurance, health disparities
Date Deposited: 29 May 2019 20:43
Last Modified: 29 May 2019 20:47
URI: http://d-scholarship.pitt.edu/id/eprint/34099

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