Repeat Mammography Screening Among Unmarried Women With and Without a Disability
Received 9 March 2009; received in revised form 5 August 2009; accepted 6 August 2009. published online 24 September 2009.
Objectives
Unmarried women with disabilities may be a particularly vulnerable group for underutilization of repeat mammography screening. Our goal was to compare the breast cancer screening experiences of unmarried women with disabilities (WWD) versus women with no disabilities (WND), and determine whether these experiences are associated with adherence to repeat screening.
Methods
We conducted a matched cohort study of 93 WWD and 93 WND to compare mammography experiences by disability status, examine rates of repeat mammography by disability status, and identify factors that are associated with repeat mammography.
Results
WWD were less likely to be on-schedule than WND in univariable (54.8% vs. 71.0%; relative risk, 0.77; 95% confidence limits, 0.61, 0.97), but not multivariable, analyses. In multivariable analyses, there was a significant interaction between disability status and positive experiences as the reasons for returning to the same mammography facility. Among WND, repeat screening ranged from 59% to 86%, depending on the number of positive experiences endorsed (range, 1–5). In contrast, among WWD, screening rates were only 37% among those who did not report any positive experiences and increased to a maximum of 60% regardless of whether women endorsed one to four or all five positive experiences. Severity and type of disability were not associated with repeat screening.
Conclusion
WWD may be less likely than WND to remain on-schedule for mammography. WWD who do not report any positive experiences as reasons for returning to a mammography facility may be at particularly high risk of underutilization of screening.
aDepartments of Community Health and Obstetrics and Gynecology, Brown University Warren Alpert School of Medicine and Program in Public Health, Providence, Rhode Island
bDepartment of Community Health, Brown University Warren Alpert School of Medicine and Program in Public Health, Providence, Rhode Island
cPembroke Center for Teaching and Research on Women, Brown University, Providence, Rhode Island
dRhode Island Breast Cancer Coalition, Coventry Rhode Island
eRhode Island Developmental Disabilities Council, Warwick, Rhode Island
fSenior Action in a Gay Environment (SAGE/RI), Providence, Rhode Island
Correspondence to: Melissa A. Clark, PhD, Brown University Warren Alpert School of Medicine and Program in Public Health, Box G-S121, 6th floor, Providence, RI 02912; Phone: (401) 863-3170; fax: (401) 863-7912.
Supported by the National Cancer Institute, K07-CA87070, and Susan G. Komen for the Cure®, POP0504335, to Melissa A. Clark, PhD.
ABSTRACT