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Women's Health

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Breast and cervical cancer screening varies by age among black and Hispanic women

Elderly women constitute most of the new cases and deaths from breast cancer. Also, 25 percent of new cases of cervical cancer and 43 percent of deaths from cervical cancer are in women 65 or older. Elderly minority women bear the largest brunt of these two diseases. Yet, a new study shows that elderly black and Hispanic women are screened less for breast and cervical cancer than their younger counterparts. The study, supported in part by the Agency for Health Care Policy and Research (HS08395), was conducted by researchers at Georgetown University School of Medicine and the Johns Hopkins School of Hygiene and Public Health.

The researchers surveyed by telephone a sample of 1,420 Hispanic and black women from New York City. The Hispanic women were from Colombia, the Dominican Republic, Puerto Rico, and Ecuador, and the black women were from the United States, the Caribbean, and Haiti. The researchers asked the women about their past use of mammography, clinical breast examination (CBE), and Pap smears.

Women 65 years of age and older were 21 percent less likely than younger women to have ever had a Pap smear and 33 percent less apt to have had a Pap smear recently, after controlling for access to care, sociodemographic factors, health, time in the United States, and attitudes towards health care. However, for younger women, being in poor health increased the odds of Pap smear screening, while for elderly women, being in poor health decreased the odds of such screening. Poor health likely leads to greater interaction with the health system and an increased opportunity for screening in younger women, while there may be triaging of older women by health status, note the authors.

Being elderly also tended to be an independent but weaker predictor of CBE use, not having had a recent mammogram, and not ever having had a mammogram. The strongest predictor of breast cancer screening for all ages was having a usual source of care. Women who had a regular source of care were 200 percent more apt to have ever had or recently had both mammography and CBE. Also, women with the most negative attitudes toward cancer (anxiety, hopelessness, denial, superstition) were 40 to 60 percent less likely to have ever been screened or recently screened for breast cancer. The authors conclude that further research is needed to explain the relationships between age, health, and use of screening among minority women.

See "Breast and cervix cancer screening among multiethnic women: Role of age, health, and source of care," by Jeanne S. Mandelblatt, M.D., M.P.H., Karen Gold, Ph.D., Ann S. O'Malley, M.D., M.P.H., and others in Preventive Medicine 28, pp. 418-425, 1999.

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