Despite their proven benefit, mammographic screening rates continue to be low among women of lower socioeconomic status and who are ethnic minorities. Efforts to increase early detection in these groups of women have been largely unsuccessful. This study explored the receptivity to inpatient breast cancer screening as a novel approach to increasing mammographic screening among hospitalized women, of whom a substantial proportion are of lower socioeconomic status and from minority groups.
A cross‐sectional study was conducted among 210 hospitalized women, aged 50–75 years, admitted to the medicine services at Johns Hopkins Bayview Medical Center in early 2012. Unpaired t tests and chi‐square tests were used to compare demographic, socioeconomic, and lifestyle characteristics, barriers to screening mammography, and receptivity to inpatient mammography among women who were adherent with the screening guideline (mammography performed within last 2 years) and those who were nonadherent (overdue for their screening or who had never had the test).
In our study population, 64% were white and 32% were African American female patients. The mean age of the study population was 60 years, and 60% reported an annual household income < $20,000. Thirty‐nine percent of the hospitalized women studied met our definition of being nonadherent–overdue for screening. Among these women, 28% were at high risk for breast cancer (Gail score ≥ 1.7%), and 13% have never had a mammogram. The reported barriers to having outpatient mammograms were failure to remember appointments, deficient in counseling by primary care physicians, fear of the unknown and of discovering a problem, and lack of transportation. Most patients (91%) believed that it is important for hospital‐based health care providers to discuss breast cancer screening with women while they are in the hospital. Sixty‐eight percent of nonadherent women would agree to have an inpatient screening mammogram if it was due and offered, including 27% who had never had a mammogram.
Many hospitalized women are not only overdue for mammograms, but they are at high risk for the development of breast cancer. Because a majority of these women would agree to screening while they are in the hospital, the failure to order this test in this scenario because it is not related to the patient's acute illness represents an unresponsiveness to medicine's public trust. This may change with health care reform and the new commitment to patient‐centered systems.