Both HIV-infected women and minority women have historically lower rates of screening mammography. The objective of this study was to identify factors related to adherence to routine screening mammography in a diverse inner-city cohort of HIV-infected women, to inform future work on targeted interventions to address disparities.
Materials and Methods:
This retrospective cohort study reviewed the electronic medical record of HIV-infected women aged 40 and older engaged in care between October 1, 2003 and March 31, 2008 at a large urban safety-net HIV clinic. Analyses included chi square testing and multivariate logistic regression to assess for patient-specific factors associated with adherence to breast cancer screening, defined as obtaining a screening mammogram within 2 years of engaging in care.
Results:
The 292 women were a racially diverse group, with 70% black, 11% Hispanic, and 42% foreign born. There was suboptimal HIV control, with only 33% having an undetectable viral load (VL). One hundred forty-six (50%) were adherent to screening mammography. In multivariate analysis, women who were foreign born (OR 2.65 [CI 1.52–4.64]) had not completed high school (OR 1.77 [CI 1.06–2.95]) or had an undetectable VL (OR 2.51 [CI 1.44–4.40]) had increased odds of obtaining a mammogram.
Conclusions:
Among a racially diverse urban population of HIV-infected women engaged in care, only half had a mammogram. Foreign-born women had higher odds of undergoing mammography, suggesting that nativity status and social determinants of health are under-recognized drivers of adherence in this population. Future programs targeting screening must be mindful of the multiple predictors of adherence.
Get full access to this article
View all access options for this article.
References
1.
Center for Disease Control. CDC—HIV/AIDS—Living with HIV. Available at: www.cdc.gov/hiv/living/ Accessed October9, 2014.
2.
LatifN, RanaF, GuthrieT. Breast cancer and HIV in the era of highly active antiretroviral therapy: Two case reports and review of the literature. Breast J, 2011; 17:87–92.
3.
GoedertJJ, et al.Risk of breast, ovary, and uterine corpus cancers among 85 268 women with AIDS. Br J Cancer, 2006; 95:642–648.
4.
ShielsMS, PfeifferRM, EngelsEA. Age at cancer diagnosis among persons with AIDS in the United States. Ann Intern Med, 2010; 153:452–460.
5.
SigelK, et al.Cancer screening in patients infected with HIV. Curr HIV/AIDS Rep, 2011; 8:142–152.
6.
El-RayesBF, BerenjiK, SchumanP, PhilipPA, BarenjiK. Breast cancer in women with human immunodeficiency virus infection: Implications for diagnosis and therapy. Breast Cancer Res Treat, 2002; 76:111–116.
7.
ShielsMS, et al.Cancer stage at diagnosis in patients infected with the human immunodeficiency virus and transplant recipients. Cancer, 2015; 121:2063–2071.
8.
CoghillAE, ShielsMS, SunejaG. Engels EA. Elevated cancer-specific mortality among HIV-infected patients in the United States. J Clin Oncol, 2015; 33:2376–2383.
9.
ParameswaranL, TaurY, ShahMK, TrainaTA, SeoSK. Tolerability of chemotherapy in HIV-infected women with breast cancer: Are there prognostic implications?. AIDS Patient Care STDs, 2014; 28:358–364.
10.
GomezA, MonteroAJ, HurleyJ. Clinical outcomes in breast cancer patients with HIV/AIDS: A retrospective study. Breast Cancer Res Treat, 2015; 149:781–788.
11.
Center for Disease Control. Products—Health United States—Women's health. Health, United States, 2014: Women's Health. Available at: www.cdc.gov/nchs/hus/women.htm#access Accessed October1, 2014.
12.
SolomonL, et al.Health services use by urban women with or at risk for HIV-1 infection: The HIV Epidemiology Research Study (HERS). J Acquir Immune Defic Syndr Hum Retrovirol, 1998; 17:253–261.
13.
ShethAN, MooreRD, GeboKA. Provision of general and HIV-specific health maintenance in middle aged and older patients in an urban HIV clinic. AIDS Patient Care STDs, 2006; 20:318–325.
14.
Hoffman-GoetzL, BreenNL, MeissnerH. The impact of social class on the use of cancer screening within three racial/ethnic groups in the United States. Ethn Dis, 1998; 8:43–51.
15.
HershmanD, et al.Racial disparities in treatment and survival among women with early-stage breast cancer. J Clin Oncol, 2005; 23:6639–6646.
16.
Smith-BindmanR, et al.Does utilization of screening mammography explain racial and ethnic differences in breast cancer?. Ann Intern Med, 2006; 144:541–553.
17.
BattagliaTA, et al.Boston patient navigation research program: The impact of navigation on time to diagnostic resolution after abnormal cancer screening. Cancer Epidemiol Biomarkers Prev, 2012; 21:1645–1654.
18.
PhillipsCE, et al.Patient navigation to increase mammography screening among inner city women. J Gen Intern Med, 2011; 26:123–129.
19.
ClarkCR, et al.Addressing social determinants of health to improve access to early breast cancer detection: Results of the Boston REACH 2010 Breast and Cervical Cancer Coalition Women's Health Demonstration Project. J Womens Health, 2009; 18:677–690.
20.
LeglerJ, et al.The effectiveness of interventions to promote mammography among women with historically lower rates of screening. Cancer Epidemiol Biomarkers Prev, 2002; 11:59–71.
21.
Center for Disease Control. CDC—Breast cancer rates by race and ethnicity. Available at: www.cdc.gov/cancer/breast/statistics/race.htm Accessed October9, 2014.
22.
RahangdaleL, SarnquistC, YavariA, BlumenthalP, IsraelskiD. Frequency of cervical cancer and breast cancer screening in HIV–Infected women in a county-based HIV clinic in the western United States. J Womens Health, 2010; 19:709–712.
23.
Preston-MartinS, et al.Use of mammographic screening by HIV-infected women in the Women's Interagency HIV Study (WIHS). Prev Med, 2002; 34:386–392.
24.
Commitment to Our Community—Health Needs Assessment. Boston Medical Center. Available at: www.bmc.org/about/commitment-to-community.htm Accessed October10, 2014.
25.
BaranoskiAS, HorsburghCR, CupplesLA, AschengrauA, StierEA. Risk factors for nonadherence with Pap testing in HIV-infected women. J Womens Health, 2011; 20:1635–1643.
26.
Committee on Review Data Systems for Monitoring HIV Care & Institute of Medicine. Monitoring HIV care in the United States: Indicators and data systems. National Academies Press (US), 2012. Available at: www.ncbi.nlm.nih.gov/books/NBK201371/ Accessed May29, 2015.
27.
BaranoskiAS, StierEA. Factors associated with time to colposcopy after abnormal Pap testing in HIV-infected women. J Womens Health, 2012; 21:418–424.
28.
FiscellaK, FremontAM. Use of geocoding and surname analysis to estimate race and ethnicity. Health Serv Res, 2006; 41:1482–1500.
29.
US Preventive Services Task Force. Recommendation summary—Breast cancer screening. Breast cancer: Screening (2009). Available at: www.uspreventiveservicestaskforce.org/Page/Topic/recommendation-summary/breast-cancer-screening Accessed October10, 2014.
30.
DalloFJ, KindrattTB. Disparities in vaccinations and cancer screening among U.S.- and foreign-born Arab and European American non-Hispanic white women. Womens Health Issues, 2015; 25:56–62.
31.
FromentM-A, GomezSL, RouxA, DeRouenMC, KiddEA. Impact of socioeconomic status and ethnic enclave on cervical cancer incidence among Hispanics and Asians in California. Gynecol Oncol, 2014; 133:409–415.
32.
KeeganTHM, et al.Breast cancer incidence patterns among California Hispanic women: Differences by nativity and residence in an enclave. Cancer Epidemiol Biomarkers Prev, 2010; 19:1208–1218.
33.
BillmeierTM, DalloFJ. Nativity status and mammography use: Results from the 2005 National Health Interview Survey. J Immigr Minor Health, 2011; 13:883–890.
34.
BlackwellDL, MartinezME, GentlemanJF. Women's compliance with public health guidelines for mammograms and Pap tests in Canada and the United States: An analysis of data from the Joint Canada/United States Survey of Health. Womens Health Issues, 2008; 18:85–99.
35.
LoftersAK, MoineddinR, HwangSW, GlazierRH. Predictors of low cervical cancer screening among immigrant women in Ontario, Canada. BMC Womens Health, 2011; 11:20.
36.
FernandezME, Tortolero-LunaG, GoldRS. Mammography and Pap test screening among low-income foreign-born Hispanic women in the USA. Cad Saúde Pública, 1998; 14:S133–S147.
37.
KimKE, ChandrasekarE, LamHY. Socio-demographic factors and cancer screening among foreign-born Chinese, Cambodian and Vietnamese women. Race Soc Probl, 2014; 6:4–14.
38.
Kagawa-SingerM, DadiaAV, YuMC, SurboneA. Cancer, culture, and health disparities: Time to chart a new course?. CA Cancer J Clin, 2010; 60:12–39.
39.
OsterAM, SullivanPS, BlairJM. Prevalence of cervical cancer screening of HIV-infected women in the United States. J Acquir Immune Defic Syndr, 2009; 51:430–436.
40.
TyermanZ, AboulafiaDM. Review of screening guidelines for non-AIDS-defining malignancies: Evolving issues in the era of highly active antiretroviral therapy. AIDS Rev, 2012; 14:3–16.
41.
McPheetersML, et al.Closing the quality gap: Revisiting the state of the science (vol. 3: quality improvement interventions to address health disparities). Evid Rep Technol Assess, 2012; 208:1–475.
