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Lasting Effects of the Breast and Cervical Cancer Early Detection Program on Breast Cancer Detection and Outcomes, Ohio, 2000–2009

Lasting Effects of the Breast and Cervical Cancer Early Detection Program on Breast Cancer Detection and Outcomes, Ohio, 2000–2009

ORIGINAL RESEARCH — Volume 12 — July 23, 2015

Siran M. Koroukian, PhD; Paul M. Bakaki, MD, PhD; Xiaozhen Han, MS; Mark Schluchter, PhD; Cynthia Owusu, MD, MS; Gregory S. Cooper, MD, MA; Susan A. Flocke, PhD

Suggested citation for this article: Koroukian SM, Bakaki PM, Han X, Schluchter M, Owusu C, Cooper GS, et al. Lasting Effects of the Breast and Cervical Cancer Early Detection Program on Breast Cancer Detection and Outcomes, Ohio, 2000–2009. Prev Chronic Dis 2015;12:140491. DOI: http://dx.doi.org/10.5888/pcd12.140491.

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On this Page

• Abstract
• Introduction
• Methods
• Results
• Discussion
• Acknowledgments
• Author Information
• References
• Tables

Author Siran Koroukian, PhD, answers questions about her study in the latestPCD podcast.

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Abstract

Introduction

The National Breast and Cervical Cancer Early Detection Program (BCCP) in Ohio provides screening and treatment services for uninsured low-income women aged 40 to 64. Because participation in the BCCP might engender greater self-efficacy for cancer screening, we hypothesized that breast cancer and survival outcomes would be better in BCCP participants who become age-eligible to transition to Medicare than in their low-income non-BCCP counterparts.

Methods

Linking data from the 2000 through 2009 Ohio Cancer Incidence Surveillance System with the BCCP database, Medicare files, Ohio death certificates (through 2010), and the US Census, we identified Medicare beneficiaries who were aged 66 to 74 and diagnosed with incident invasive breast cancer. We compared the following outcomes between BCCP women (n = 93) and low-income non-BCCP women (n = 420): receipt of screening mammography in previous year, advanced-stage disease at diagnosis, timely and standard care, all-cause survival, and cancer survival. We conducted multivariable logistic regression and survival analysis to examine the association between BCCP status and each of the outcomes, adjusting for patient covariates.

Results

Women who participated in the BCCP were nearly twice as likely as low-income non-BCCP women to have undergone screening mammography in the previous year (adjusted odds ratio, 1.77; 95% confidence interval, 1.01–3.09). No significant differences were detected in any other outcomes.

Conclusion

With the exception of screening mammography, the differences in outcomes were not significant, possibly because of the small size of the study population. Future analysis should be directed toward identifying the factors that explain these findings.

Acknowledgments

This study was funded by the American Cancer Society (Research Scholar Grant no. 121913-RSGI-12-093-01-CPHPS, to Dr Koroukian). Dr Koroukian was also supported in part by the Clinical and Translational Science Collaborative of Cleveland, UL1TR000439 from the National Center for Advancing Translational Sciences component of the National Institutes of Health (NIH) and NIH Roadmap for Medical Research. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the NIH. The authors thank Ms Tsui Chan, MA, for her work on geocoding and US Census data, and Phyo T. Htoo, MD, MPH, PhD candidate, for his analysis of the OCISS data. The authors also thank Ms Lynn Giljahn and Ms Tina Bickert of the Ohio Department of Health for their careful review of earlier versions of this manuscript.

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Author Information

Corresponding Author: Siran M. Koroukian, PhD, Associate Professor, Department of Epidemiology and Biostatistics, School of Medicine, Case Western Reserve University, 10900 Euclid Ave, WG-49, Cleveland, OH 44106-4945. Telephone: 216-368-5816. Email: skoroukian@case.edu.

Author Affiliations: Paul M. Bakaki, Xiaozhen Han, School of Medicine, and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio; Mark Schluchter, Susan A. Flocke, School of Medicine and Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, Ohio; Cynthia Owusu, Gregory S. Cooper, Case Comprehensive Cancer Center and University Hospitals of Cleveland, School of Medicine, Case Western Reserve University, Cleveland, Ohio. Dr Koroukian is also affiliated with Case Comprehensive Cancer Center and Population Health and Outcomes Research Core, Clinical and Translational Science Collaborative, Case Western Reserve University, Cleveland, Ohio.

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