




































 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e1                                              Cancer Health Disparities 

RESEARCH 

Mammography Utilization Trends at a 

Safety-Net Center 
Bridget A. Oppong1,2,3, Chiranjeev Dash1,3, Kepher H. Makambi4, Xiaoyang Ma4, Holly S. Greenwald5, Lucile 

Adams-Campbell*,1,3 

1. Georgetown University Lombardi Comprehensive Cancer Center, Washington D.C. 20057, USA 
2. Department of Surgery, Reston Hospital Center, Reston, VA (current mailing address), 20190, USA 
3. Capital Breast Care Center, Georgetown Lombardi Comprehensive Cancer Center, Washington D.C., 

20003, USA 
4. Department of Biostatistics, Georgetown Lombardi Comprehensive Cancer Center, Washington D.C., 

20003, USA 
5. UC San Diego, Dept. of Internal Medicine, San Diego, CA, 92093, USA 

*Corresponding author email:  lla9@georgetown.edu 

ABSTRACT 
Among uninsured and resource-poor populations, community safety net clinics are important providers 

of breast cancer screening services however there is little data on screening utilization patterns. Using 

data from a safety net screening center in Washington DC, we assessed trends in mammography 

utilization by selected sociodemographic factors. Prospectively collected demographic data were 

abstracted from the electronic medical records of the Capital Breast Care Center (CBCC) during 2010 – 

2015. Time trends of mammography utilization over the 6 years were calculated and statistical 

significance of the differences between trends by the selected sociodemographic factors were analyzed 

using the Cochran-Armitage test. 8448 Black/ African-American and Hispanic women were screened at 

CBCC with 106 diagnoses of breast cancer. The proportion of women <50 years of age declined over 

the 6- year study period, decreased from 42% in 2010 to 35% in 2015 (P-value <0.0001). Trends in the 

racial/ethnic composition of the women screened shifted, with African-American women decreasing, 

while the proportion of Latina patients increased from 42% in 2010 to 51% in 2015 (P-value <0.0001). 

Our data suggest a declining trend in screening among women less than 50 years of age, which may 

reflect a change in referring providers following guideline concordant screening recommendations. 

Future studies are warranted to monitor and evaluate the changing effects of population and 

demographics and screening guidelines. 

KEYWORDS: Mammography screening, safety-net, Blacks, Latinas, trends  

Citation: Oppong BA et al (2019) Mammography utilization trends at a safety-net center. Cancer Health 

Disparities 2:e1-e9 doi:10.9777/chd.2019.1010. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e2                                              Cancer Health Disparities 

RESEARCH 

INTRODUCTION 

Secondary prevention in the form of mammographic 

screening is recognized as an important strategy for 

reducing mortality from breast cancer (US 

Preventative Service Task Force, January 2016). 

Mammography has been shown to reduce breast 

cancer mortality in women aged 50-69 years by as 

much as 30% (Loberg et al., 2015; Mandelblatt et al., 

2016; Myers et al., 2015; Oeffinger et al., 2015). 

Although controversial, younger women, ages 40-

49, have also been shown to benefit from 

mammography with reduced breast cancer mortality 

(Moss et al., 2006; Nelson et al., 2009). A Healthy 

People 2010 goal set by the U.S. Departments of 

Health and Human Services was at least 70% of 

women 40 and over to have received a 

mammogram within the last two years while the 

2020 goal seeks to increase this rate by a further 10% 

(Plescia and White, 2013; Sabatino et al., 2015). 

Although such goals have been established, many 

reports suggest that Black women undergo 

mammography less often, than White counterparts 

(Brooks et al., 2013; Komenaka et al., 2010; Mishra et 

al., 2012; Swan et al., 2003). A recent systematic 

review and meta-analysis of racial disparities in 

screening mammography shows that disparities in 

utilization of screening mammography are still 

evident in Black and Hispanic populations in the 

U.S.(Ahmed et al., 2017). Factors associated with 

decreased screening rates include low-

socioeconomic status, non-Caucasian ethnicity, low 

education level, and recent immigration status 

(Brooks et al., 2013; Komenaka et al., 2010; Mishra et 

al., 2012; Swan et al., 2003). The diversity in 

prevalence and time trends of mammography 

screening with regards to socioeconomic status, 

education, reproductive history, within these minority 

groups have not been well described. 

Access to mammography for low-resource 

communities is being addressed by community-

based initiatives, including mobile mammogram 

vehicles and screening facilities participating in the 

National Breast and Cervical Cancer Early 

Detection Program (NBCCEDP)(Stanley et al., 

2013). To meet this need in our nation’s capital, 

which has some of the most disparate breast 

cancer outcomes in the country (Centers for 

Disease Control and Prevention (CDC), 2012; 

DeSantis et al., 2011), the Georgetown Lombardi 

Comprehensive Cancer Center established the 

Breast Care Center (CBCC) in 2004. CBCC serves 

as a critical safety net breast cancer screening 

facility for minority and medically under-insured 

women hailing from DC, Maryland and Virginia. 

CBCC traditionally serves a population that is 

majority Black and Hispanic, and on the younger 

spectrum of the recommended screening age 

(Oppong et al., 2016; Wallington et al., 2016). 

Utilizing data from CBCC, we evaluated 

mammography screening patterns and time 

trends by sociodemographic characteristics in a 

population of primarily Black and Hispanic women 

who received breast cancer screening between 

2010 and 2015. 

MATERIALS AND METHODS 

The study population is derived from CBCC, which 

serves as a safety net for under and un-insured, 

and medically underserved women residing in DC, 

Maryland and Virginia. 

The data were abstracted from January 2010 to 

December 2015 with approval from the 

Institutional Review Board at Georgetown 

University. 

Women presenting to the CBCC within screening 

age (40 or older) proceed to mammography. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e3                                              Cancer Health Disparities 

RESEARCH 

Women who require additional workup are 

assigned a patient navigator, who facilitates the 

diagnostic evaluation with further imaging or 

biopsies. All women presenting for screening have 

their information prospectively collected and 

entered into the Electronic Medical Record system 

(EMR). The results of the screening test are 

entered into the EMR. Variables collected include 

demographic data (including, race, ethnicity, 

highest education attainment level and ward of 

residence), insurance status, family history of 

breast cancer, and menopausal status. The 

imaging results were recorded with standard 

Breast Imaging Reporting and Data System (BI-

RADS) category values (Markossian et al., 2012). 

Out of a total of 20,959 screening and diagnostic 

exams, data on women undergoing screening 

mammograms were abstracted from January 2010 

to December 2015 with approval from the 

Institutional Review Board at Georgetown 

University. Women who present to CBCC but did 

not receive a screening mammogram (i.e. they 

had an abnormal physical exam and required a 

diagnostic mammogram) were not included in the 

study. 

Electronic Medical Record Data Abstraction (EMR) 

We abstracted the density description recorded at 

the first screening mammogram for each woman. 

Statistical Methods 

Patient characteristics were presented as 

frequencies and corresponding proportions for 

variables including age (<50 years, >50 years), 

race (Black/African American, Hispanic), insurance 

(commercial, BCCP/Medicaid Program/Medicare), 

residence state (DC, MD/VA), education (did not 

complete HS, completed HS and above), family 

history of breast cancer (no/yes), menopausal 

status (no/yes). Cochran-Armitage test was used 

to examine the significance of trends in the 

proportions of screening across years (between 

2010 and 2015) by categories of several 

characteristics including age, race, insurance, 

residence state, education, and family history of 

breast cancer. All tests were two-sided and 

significance was assessed at 0.05 level. 

RESULTS 

A total of 8,448 women underwent mammographic 

screening at CBCC from January 2010 to December 

2015. The characteristics of the population are 

shown in Table 1. There were significant trends for 

age, race, and residence. The trend in screening 

mammography increased for older (58% to 65%) 

compared to younger women who decreased 

from 42% in 2010 to 35% in 2015 (P-value 

<0.0001). There was also a trend in the 

racial/ethnic composition of women screened with 

the proportion of Latinas increasing and African 

Americans decreasing (p-value <0.0001). The 

number of D.C. residents also decreased as more 

patients traveled from Maryland and Virginia to 

obtain breast cancer screening (p-value <0.0001). 

There was no significant change in the uninsured 

population, with 13-19% annually having private 

commercial insurance. This shows an unchanging 

reliance on the National Breast and Cervical 

Cancer Early Detection Program (NBCCEDP) for 

the remainder of women screened who have 

Medicaid and Medicare. Furthermore, over the 6-

year period there were no differences in those 

screened having a family history of breast cancer 

and reported menopausal status. About 45% of 

the patients seen each year over this period were 

new patients who did not have a previously 

reported mammogram at CBCC. There was no 

significant trend in the proportion of new patients 

seen between 2010-2015. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e4                                              Cancer Health Disparities 

RESEARCH 

Table 1. Characteristics of women presenting for screening mammography at CBCC, 2010-2015. 

 2010 2011 2012 2013 2014 2015 
P* 

Total patients 1429 1584 1596 1364 1056 960 

Age (years) 

<50 578(42) 663(43) 641(41) 525(40) 362(36) 306(35) 
<0.0001 

>=50 814(58) 895(57) 915(59) 800(60) 650(64) 580(65) 

Race 

Black/African American 770(58) 765(54) 731(51) 595(48) 488(52) 424(49) 
<0.0001 

Hispanic 548(42) 646(46) 713(49) 640(52) 456(48) 441(51) 

Insurance 

Commercial 203(16) 216(17) 175(13) 185(15) 152(16) 162(19) 

0.23 BCCP/Medicaid 

Program/Medicare 

1058(84) 1080(83) 1178(87) 1064(85) 804(84) 681(81) 

Residence state 

DC 746(54) 768(49) 667(43) 516(39) 450(45) 392(44) 
<0.0001 

MD/VA 643(46) 788(51) 889(57) 809(61) 561(55) 494(56) 

Education 

Did not finish HS 385(30) 447(31) 456(31) 371(29) 296(31) 266(31) 
0.52 

Complete HS and above 919(70) 985(69) 1003(69) 894(71) 645(69) 579(69) 

Family history of breast cancer 

No 1167(84) 1272(84) 1314(85) 1135(84) 865(84) 794(83) 
0.64 

Yes 225(16) 234(16) 234(15) 220(16) 163(16) 159(17) 

Menopausal status 

No 642(46) 722(47) 767(49) 677(50) 487(47) 443(46) 
0.47 

Yes 767(54) 816(53) 793(51) 683(50) 548(53) 512(54) 

*P value from Cochran-Armitage test 

The trends in proportion of women with benign screening mammography, BI-RADS 1 findings are 

presented in Table 2. Although the proportion of women with normal findings decreased from 2010 to 

2015, trends were not statistically different by age, race/ethnicity, state of residence, insurance status, 

family history or menopausal status. 

Table 2. Trends in Proportions of Women with normal (BI-RADS 1) screening mammography findings at CBCC. 

 2010 2011 2012 2013 2014 2015 

Total patients 848 (0.59) 904 (0.57) 931 (0.58) 843 (0.62) 530 (0.50) 478 (0.50) 

Age 

<50 years 0.67 

[0.63,0.71] 

0.64 

[0.6,0.67] 

0.66 

[0.62,0.69] 

0.68[0.64,0.72

] 

0.58 

[0.53,0.63] 

0.57[0.52,0.63

] 

>=50 years 0.54 0.52 0.53 0.58 0.46[0.42,0.5] 0.43 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e5                                              Cancer Health Disparities 

RESEARCH 

[0.51,0.58] [0.49,0.56] [0.5,0.56] [0.54,0.61] [0.39,0.47] 

Race 

Black/African 

American 

0.56 

[0.53,0.6] 

0.55 

[0.52,0.59] 

0.57 

[0.54,0.61] 

0.60 

[0.56,0.64] 

0.47 

[0.42,0.51] 

0.48 

[0.43,0.52] 

Hispanic 0.63 

[0.59,0.67] 

0.58 

[0.54,0.62] 

0.58 

[0.54,0.62] 

0.62 

[0.59,0.66] 

0.53[0.48,0.57

] 

0.50 

[0.45,0.55] 

Insurance 

Commercial 0.67 

[0.61,0.74] 

0.59[0.52,0.65

] 

0.66 

[0.59,0.73] 

0.63 

[0.56,0.7] 

0.50 

[0.42,0.58] 

0.49 

[0.41,0.56] 

BCCP/Medicaid 

Program/Medicare 

0.57 

[0.54,0.6] 

0.57 

[0.54,0.6] 

0.57 

[0.54,0.59] 

0.62 

[0.59,0.65] 

0.51 

[0.47,0.54] 

0.48 

[0.44,0.51] 

Residence state 

DC 0.58 

[0.54,0.62] 

0.54[0.51,0.58

] 

0.58[0.54,0.6

2] 

0.62 

[0.58,0.66] 

0.45 [0.41,0.5] 0.46[0.41,0.51] 

MD/VA 0.61[0.58,0.

65] 

0.60[0.56,0.63

] 

0.58 

[0.55,0.61] 

0.62 

[0.58,0.65] 

0.54 

[0.5,0.58] 

0.50 

[0.46,0.55] 

Education 

Did not finish HS 0.59 

[0.54,0.64] 

0.56 [0.51,0.6] 0.56 [0.51,0.6] 0.59 

[0.54,0.64] 

0.49 

[0.44,0.55] 

0.45[0.39,0.51

] 

Complete HS and 

above 

0.60[0.57,0.

63] 

0.57[0.54,0.6] 0.59[0.56,0.62

] 

0.63[0.6,0.66] 0.50[0.46,0.5

4] 

0.51 

[0.47,0.55] 

Family history of breast cancer 

No 0.60[0.57,0.

62] 

0.58[0.55,0.6] 0.58 

[0.55,0.6] 

0.62 

[0.59,0.65] 

0.50 

[0.47,0.53] 

0.51 

[0.47,0.54] 

Yes 0.59 

[0.52,0.65] 

0.55 

[0.48,0.61] 

0.59 

[0.52,0.65] 

0.59[0.53,0.66

] 

0.49 

[0.41,0.57] 

0.46 

[0.38,0.54] 

Menopausal status 

No 0.64[0.61,0.

68] 

0.64[0.6,0.67] 0.63[0.6,0.67] 0.66 

[0.62,0.69] 

0.56 [0.51,0.6] 0.55 

[0.5,0.59] 

Yes 0.55 

[0.51,0.58] 

0.51 

[0.48,0.54] 

0.53 

[0.49,0.56] 

0.58 

[0.54,0.62] 

0.45 

[0.41,0.49] 

0.45 

[0.41,0.49] 

Of the 106 cancers diagnosed over 6 years, there were no statistically significant trends in age, 

race/ethnicity, insurance status, or family history of breast cancer (Table 3). Although a higher proportion 

of the cancer cases were in Black women over 50, there was no statistically significant time trend by age at 

diagnosis. The number of cancer cases diagnosed in women residing in Maryland and Virginia increased 

from 2010-2015, while those in DC residences declined (p-value 0.04) 

 

 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e6                                              Cancer Health Disparities 

RESEARCH 

Table 3. Trends analysis of cancer patients diagnosed 2010-2015. 

 Year of screening 

P*  2010 2011 2012 2013 2014 2015 

Total patients 19 16 10 22 20 19 

Age 

<50 years 8 (42) 6 (38) 3 (30) 8 (36) 8 (40) 7 (37) 
0.86 

>=50 years 11 (58) 10 (63) 7 (70) 14 (64) 12 (60) 12 (63) 

Race 

Black/African 

American 

13 (76) 11 (73) 6 (67) 7 (44) 11 (65) 10 (63) 

0.24 

Hispanic 4 (24) 4 (27) 3 (33) 9 (56) 6 (35) 6 (38) 

Insurance 

Commercial 5 (29) 1 (8) 1 (10) 5 (23) 3 (16) 6 (32) 

0.68 BCCP/Medicaid 

Program/Medicare 

12 (71) 11 (92) 9 (90) 17 (77) 16 (84) 13 (68) 

Residence state 

DC 11 (58) 8 (50) 4 (40) 9 (41) 6 (30) 6 (32) 
0.043 

MD/VA 8 (42) 8 (50) 6 (60) 13 (59) 14 (70) 13 (68) 

Family history of breast cancer 

No 15 (83) 10 (63) 9 (90) 17 (81) 17 (85) 14 (78) 
0.69 

Yes 3 (17) 6 (38) 1 (10) 4 (19) 3 (15) 4 (22) 

*P value from Cochran-Armitage test 

DISCUSSION 

Main finding of this study 

Our results showed a significant trend in the 

decline in the screening of women less than 50 

years of age over the study period. This may 

represent a change in the screening guidelines 

followed by the local referring physicians and 

partnering community organizations, especially 

with the varied recommendations from the US 

Preventative Task Force and other organizations 

such as the American Cancer Society (US 

Preventative Service Task Force, January 2016; 

Loberg et al., 2015; Oeffinger et al., 2015). During 

the study period, CBCC followed the screening 

recommendations consistent with the American 

Cancer Society and the National Breast and 

Cervical Cancer Early Detection Program 

(NBCCEDP) offering annual mammography 

starting at age 40. 

Another demographic shift is an increase in 

Hispanic patients from 42% to 51% from 2010 to 

2015, a trend that is statistically significant. A 

related observation is the increase in Maryland 

and Virginia residents among the women 

screened. In the Washington Metropolitan area, 

the largest immigrant groups are from Latin 

America (U.S. Census Bureau, Dec. 12, 2012), with 

many living outside DC proper. Over the past 

three years, CBCC outreach efforts have increased 

in the Latino community with the hiring of Spanish 

speaking health educators and patient navigators. 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e7                                              Cancer Health Disparities 

RESEARCH 

Extending our community reach is likely 

contributing to our observations. 

In this climate of healthcare change, it is interesting 

that we did not see any trends representing changes 

in the proportion of women having commercial 

insurance coverage. The Affordable Care Act 

(ACA)(Meyer et al., 2017; Silva et al., 2017) was 

implemented in 2014 and this study does not show a 

decline in the uninsured population. Most of the 

CBCC population remains covered by Medicare, 

Medicaid and the NBCCEDP in conjunction with 

other state and local screening programs. Funding 

from these programs are integral in providing 

screening for the under and uninsured. As we collect 

more data under the ACA, shifts in the coverage 

landscape will undoubtedly impact the uninsured 

women. 

What is already known 

Results from our study underscore the importance of 

community based clinics in increasing cancer 

screening uptake among underserved communities. 

To provide access to mammography for low-

resource populations, community-based initiatives 

utilize mobile mammogram vehicles and screening 

facilities that participate in the National Breast and 

Cervical Cancer Early Detection Program (NBCCEDP) 

(Stanley et al., 2013). In order to do this effectively, 

the community that is served has to be evaluated on 

a continuing basis to ensure adequate outreach. As 

minority communities evolve and demographics 

shift, such program evaluations can direct resource 

allocation and outreach targets. 

Limitations 

At the CBCC our database instituted in 2010 has 

enabled data analyses for program evaluation. This 

established EMR, however does have limited 

variables which in turn limits our analyses of trends to 

only the available collected factors [age, race, 

insurance, residence state, education, and family 

history of breast cancer]. To enhance our data, 

variables including, ethnicity or country of origin, 

having a primary care physician, primary spoken 

language, access to transportation or how a woman 

arrived at the facility would be desirable. 

Furthermore, the demographic data is based on 

patient report with accuracy unable to be confirmed. 

An example is, omitted or misrepresented 

information from some undocumented patients who 

may be uncomfortable giving some specific details 

such as place of residence. We also present the 

completed data over a 6-year period and for a 

trends analysis a longer period of time would make 

our observation more robust and increase accuracy. 

What this study adds 
The data reported here exemplify demographic 

changes in a dynamic screening population and 

the ongoing evaluation and assessments needed 

to identify such changes. In addition, our data also 

underscores the importance of changes in 

community outreach and support services within 

the organization to effectively provide cancer 

screening and prevention services to a changing 

population. Over the past few years there has 

been an increase in Hispanic women and 

Maryland and Virginia residents seeking CBCC’s 

services in our catchment area. Monitoring these 

trends has guided our increased outreach efforts 

in the Latina community and in communities in 

Maryland and Virginia which are part of the 

Georgetown Lombardi cancer Center’s catchment 

area. The enhanced outreach in the Latina 

community has been facilitated by increased 

access to Spanish language education materials 

and interpretation services; and new partnerships 

with community-based organizations that provide 

an array of services for Hispanic women. This 

ensures breast cancer screening services are 



 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e8                                              Cancer Health Disparities 

RESEARCH 

available to those in need and that the outreach is 

done in a culturally sensitive manner. 

Our data suggest a declining trend in screening 

among women less than 50 years of age, which 

may reflect a change in referring providers 

following guideline concordant screening 

recommendations. Now that there are recent 

changes in mammography screening guidelines, 

we expect these trends to change in coming years. 

Future studies are warranted to monitor and 

evaluate the changing effects of population and 

demographics and screening guidelines. 

Acknowledgements 

Avon Foundation for Women Grant #05-2017-008. 

Conflict of interest 
The authors declare that no competing or conflict of 

interests exists. The funders had no role in study 

design, writing of the manuscript, or decision to 

publish. 

Authors’ contributions 
BAO, CD, HSG and LAC conceived of the 

presented idea. CD, KHM and XM developed the 

theory and performed the computations. CD and 

KHM verified the analytical methods. All authors 

discussed the results and contributed to the final 

manuscript. 

REFERENCES 
Ahmed, A.T., Welch, B.T., Brinjikji, W., Farah, W.H., Henrichsen, 

T.L., Murad, M.H., and Knudsen, J.M. (2017). Racial 

Disparities in Screening Mammography in the United 

States: A Systematic Review and Meta-analysis. J. Am. 

Coll. Radiol. 14, 157-165.e9. 

Brooks, S.E., Hembree, T.M., Shelton, B.J., Beache, S.C., 

Aschbacher, G., Schervish, P.H., and Dignan, M.B. (2013). 

Mobile mammography in underserved populations: 

analysis of outcomes of 3,923 women. J. Community 

Health 38, 900-906. 

Centers for Disease Control and Prevention (CDC). (2012). 

Cancer screening - United States, 2010. MMWR Morb. 

Mortal. Wkly. Rep. 61, 41-45. 

DeSantis, C., Siegel, R., Bandi, P., and Jemal, A. (2011). Breast 

cancer statistics, 2011. CA Cancer. J. Clin. 61, 409-418. 

Howlader N., Noone A.M., Krapcho M., Miller D., Bishop K., 

Kosary C.L., Yu M., Ruhl J., Tatalovich Z., Mariotto A., 

Lewis D.R., Chen H.S., Feuer E.J., Cronin K.A. (eds). (2017). 

SEER Cancer Statistics Review, 1975-2014. Table 1.12. 

National Cancer Institute. Bethesda, MD, 

http://seer.cancer.gov/csr/1975_2014/, 2017. 

Komenaka, I.K., Martinez, M.E., Pennington, R.E.,Jr, Hsu, C.H., 

Clare, S.E., Thompson, P.A., Murphy, C., Zork, N.M., and 

Goulet, R.J.,Jr. (2010). Race and ethnicity and breast 

cancer outcomes in an underinsured population. J. Natl. 

Cancer Inst. 102, 1178-1187. 

Loberg, M., Lousdal, M.L., Bretthauer, M., and Kalager, M. 

(2015). Benefits and harms of mammography screening. 

Breast Cancer Res. 17, 63-015-0525-z. 

Mandelblatt, J.S., Stout, N.K., Schechter, C.B., van den Broek, 

J.J., Miglioretti, D.L., Krapcho, M., Trentham-Dietz, A., 

Munoz, D., Lee, S.J., Berry, D.A., et al. (2016). 

Collaborative Modeling of the Benefits and Harms 

Associated With Different U.S. Breast Cancer Screening 

Strategies. Ann. Intern. Med. 164, 215-225. 

Markossian, T.W., Darnell, J.S., and Calhoun, E.A. (2012). 

Follow-up and timeliness after an abnormal cancer 

screening among underserved, urban women in a 

patient navigation program. Cancer Epidemiol. 

Biomarkers Prev. 21, 1691-1700. 

Meyer, C.P., Krasnova, A., Sammon, J.D., Lipsitz, S.R., 

Weissman, J.S., Sun, M., and Trinh, Q.D. (2017). 

Accountable care organizations and the use of cancer 

screening. Prev. Med. 101, 15-17. 

Mishra, S.I., DeForge, B., Barnet, B., Ntiri, S., and Grant, L. 

(2012). Social determinants of breast cancer screening in 

urban primary care practices: a community-engaged 

formative study. Womens Health Issues 22, e429-38. 

Moss S.M., Cuckle H., Evans A., Johns L., Waller M., Bobrow L. 

(2006). Effect of mammographic screening from age 40 

years on breast cancer mortality at 10 years’ follow-up: a 

randomised controlled trial. Lancet 368, 2053–60. 

Myers, E.R., Moorman, P., Gierisch, J.M., Havrilesky, L.J., 

Grimm, L.J., Ghate, S., Davidson, B., Mongtomery, R.C., 

Crowley, M.J., McCrory, D.C., Kendrick, A., and Sanders, 

G.D. (2015). Benefits and Harms of Breast Cancer 

Screening: A Systematic Review. Jama 314, 1615-1634. 

Nelson H.D., Tyne K., Naik A., Bougatsos C., Chan B.K., 

Humphrey L. (2009). Screening for breast cancer: an 

update for the U.S. Preventive Services Task Force. Ann 

Intern Med 151, 727–37, W237–W242. 

Oeffinger, K.C., Fontham, E.T., Etzioni, R., Herzig, A., 

Michaelson, J.S., Shih, Y.C., Walter, L.C., Church, T.R., 

Flowers, C.R., LaMonte, S.J., et al. (2015). Breast Cancer 

Screening for Women at Average Risk: 2015 Guideline 

https://www.ncbi.nlm.nih.gov/pubmed/?term=Bougatsos%20C%5BAuthor%5D&cauthor=true&cauthor_uid=19920273
https://www.ncbi.nlm.nih.gov/pubmed/?term=Chan%20BK%5BAuthor%5D&cauthor=true&cauthor_uid=19920273
https://www.ncbi.nlm.nih.gov/pubmed/?term=Humphrey%20L%5BAuthor%5D&cauthor=true&cauthor_uid=19920273


 
 
 
 
 

 

www.companyofscientists.com/index.php/chd                   e9                                              Cancer Health Disparities 

RESEARCH 

Update From the American Cancer Society. Jama 314, 

1599-1614. 

Oppong, B.A., Dash, C., Coleman, T., Torres, T., and Adams-

Campbell, L.L. (2016). Time to Diagnostic Evaluation After 

Mammographic Screening in an Urban Setting. J. 

Womens Health. (Larchmt) 25, 1225-1230. 

Plescia, M., and White, M.C. (2013). The National Prevention 

Strategy and breast cancer screening: scientific evidence 

for public health action. Am. J. Public Health 103, 1545-

1548. 

Sabatino, S.A., White, M.C., Thompson, T.D., Klabunde, C.N., 

and Centers for Disease Control and Prevention (CDC). 

(2015). Cancer screening test use - United States, 2013. 

MMWR Morb. Mortal. Wkly. Rep. 64, 464-468. 

Silva, A., Molina, Y., Hunt, B., Markossian, T., and Saiyed, N. 

(2017). Potential impact of the Affordable Care Act's 

preventive services provision on breast cancer stage: A 

preliminary assessment. Cancer. Epidemiol. 49, 108-111. 

Stanley, S., Arriola, K.J., Smith, S., Hurlbert, M., Ricci, C., and 

Escoffery, C. (2013). Reducing barriers to breast cancer 

care through Avon patient navigation programs. J. Public 

Health Manag. Pract. 19, 461-467. 

Swan, J., Breen, N., Coates, R.J., Rimer, B.K., and Lee, N.C. 

(2003). Progress in cancer screening practices in the 

United States: results from the 2000 National Health 

Interview Survey. Cancer 97, 1528-1540. 

U.S. Census Bureau (Dec. 12, 2012). U.S. Census Bureau 

Projections Show a Slower Growing, Older, More Diverse 

Nation a Half Century from Now. 

US Preventative Service Task Force (January 2016). Final 

Update Summary: Breast Cancer: Screening. 

Wallington, S., Oppong, B., Dash, C., Coleman, T., Greenwald, 

H., Torres, T., Iddirisu, M., and Adams-Campbell, L.L. 

(2016). A Community-Based Outreach Navigator 

Approach to Establishing Partnerships for a Safety Net 

Mammography Screening Center. J. Cancer Educ. 

 

 

 

 

 

 


