Background: Disparities in screening mammography use persist among low-income women, even those who are insured, despite the proven mortality benefit. We evaluated the prevalence of breast cancer screening non-adherence among hospitalized women and their receptivity to inpatient screening mammography as a novel approach to increase breast cancer screening rate.
Methods: A cross sectional study was conducted among 250 hospitalized women age 50-75 years, admitted to medicine service at Johns Hopkins Bayview Medical Center in early 2012.
Results: Approximately one-third of women enrolled were African American, and 61% of the study population reported an annual household income of < $20,000. 41% were overdue for screening, of which, 13% never had a mammogram. Thirty-two percent of the women were at high risk for breast cancer (Gail score ≥1.7%). The most commonly reported barriers to screening mammograms were failure to remember appointments, and lack of transportation. We also evaluated the socio-demographic and clinical comorbidities risk factors associated with non-adherence. After adjustment of all these predictors, three variables were found to be independently associated with non-adherence to breast cancer screening: low income (OR=3.81, 95%CI; 1.84–7.89), current or ex-smoker (OR=2.29, 95%CI; 1.12–4.67), and history of stroke (OR=2.83, 95%CI; 1.21–6.60). Although most women believed that it is important for healthcare providers to discuss breast cancer screening while patients are in the hospital, 72% were willing to pay out of pocket a mean of $83.41 (95% CI, $71.51-$95.31) in advance towards inpatient screening mammogram.
Conclusions: A significant number of hospitalized women from lower socioeconomic class are non-adherent and at high risk of developing breast cancer. Because hospitalization creates the scenario wherein patients are in close proximity to healthcare resources, at a time when they may be reflecting upon their health status, strategies could be employed to counsel, educate, and motivate these patients towards health maintenance.