Program reveals higher rates of advanced cancer in its participants than in other programs
Low-income women participating in an Oregon breast cancer screening program had a higher incidence of breast cancer than women in other screening programs, according to Oregon Health & Science University researchers. The study suggests women without access to care may use screening programs for evaluation and treatment of breast disease because they have no other avenue to care. Results of the study appear in the August issue of The Archives of Surgery, one of the JAMA/Archives journals.
The Oregon Breast and Cervical Cancer Program was implemented in 1996 as a statewide screening program for medically underserved low-income women. The researchers studied women in the program to determine incidence and stage of breast cancer, the role of the clinical breast exam and patient compliance with treatment.
John Vetto, M.D., associate professor of surgery (surgical oncology) in the OHSU School of Medicine and a member of the OHSU Cancer Institute, and his colleagues evaluated 15,730 women who had a total of 23,149 mammograms and 20,396 clinical breast exams from Jan. 1, 1997, to Dec. 31, 2001.
Two percent of the mammograms were suspicious, representing a rate of 12.3 cancers per 1,000 women. This is significantly higher than results found in other screening programs, which can be as low as six cancers per 1,000 women.
"If you take a sample of truly asymptomatic women in whom you have already excluded women with breast cancer, you wouldn't find such a high breast cancer rate," Vetto said. "Unfortunately, this is the first time we could go into the community targeting women who have difficulty accessing care with a large-scale, funded screening program. And therefore, what we found were a lot of cancers that were already present."
The clinical breast exam component of the program was especially important. Compliance with surgical recommendations was also excellent. The authors attribute their high compliance rate to excellent translation and transportation services provided by the program, as well as the gratis work of community surgeons.
"What this study highlights is the incredible need for screening programs to detect breast cancer," Vetto said. "They virtually save women's lives. This work only accentuates the absolute necessity of quality care for low-income women."