This Program Project, Cancer Screening, Managed Cared, and the Undeserved addresses the major impediments to achievement of the breast and cervical cancer screening goals for the Year 2000: . screening for women who have never been screened; . establishment of maintenance screening behavior; and .improved follow-up of abnormal tests to diagnosis and treatment. Despite notable gains in these areas, low-income and multi-ethnic populations still suffer disproportionately high rates of late-stage disease and mortality due to these cancers. Moreover, advances to data may be jeopardized by the complexity and rapid changes as the delivery of health services evolves into managed care. The proposed research, collectively referred to as the Pathfinders studies, seeks to unravel the impediments to early detection and develop viable, cost-effective solutions. Our investigators are a multi-disciplinary and multi-ethnic team from San Francisco Bay Area research institutions and are members of the Northern California Cancer Center (NCCC) consortium. The team will build on past experiences in studies of under-served populations to tackle critical behavioral and health services research questions. Three projects linked by the Pathfinders them address these issues: 1) Access and Early Cancer Detection for the Under-served 2) A Strategy to Improve Pap Smear Follow-up in a High-risk Under-served Population 3) Race/ethnic Differences in the Evaluation of Abnormal Mammography The first two of these projects are randomized controlled trials that evaluate the effectiveness and cost-effectiveness of innovative interventions. The third study is an exploration of issues interfering with timely and complete resolution of mammographic abnormalities from the women's perspective and the piloting of a responsive intervention. In our core research we will also record and study the changes taking place in cancer screening as a result of the upheaval in health care delivery and methodologic problems in its evaluation. Core components will also provide cohesive services and methodologic, biostatistical, and cost-effectiveness analysis expertise. The proposed research will make a unique contribution to cancer control research and complement other cancer control activities of the NCCC and its consortium in Northern California.
| Pérez-Stable, Eliseo J; Afable-Munsuz, Aimee; Kaplan, Celia Patricia et al. (2013) Factors influencing time to diagnosis after abnormal mammography in diverse women. J Womens Health (Larchmt) 22:159-66 |
| Stewart, Susan L; Rakowski, William; Pasick, Rena J (2009) Behavioral constructs and mammography in five ethnic groups. Health Educ Behav 36:36S-54S |
| Otero-Sabogal, Regina; Stewart, Susan; Shema, Sarah J et al. (2007) Ethnic differences in decisional balance and stages of mammography adoption. Health Educ Behav 34:278-96 |
| Wagner, Todd H; Engelstad, Linda P; McPhee, Stephen J et al. (2007) The costs of an outreach intervention for low-income women with abnormal Pap smears. Prev Chronic Dis 4:A11 |
| Alderete, Ethel; Juarbe, Teresa C; Kaplan, Celia Patricia et al. (2006) Depressive symptoms among women with an abnormal mammogram. Psychooncology 15:66-78 |
| Juarbe, Teresa C; Kaplan, Celia Patricia; Somkin, Carol P et al. (2005) Are risk factors for breast cancer associated with follow-up procedures in diverse women with abnormal mammography? Cancer Causes Control 16:245-53 |
| Karliner, Leah S; Patricia Kaplan, Celia; Juarbe, Teresa et al. (2005) Poor patient comprehension of abnormal mammography results. J Gen Intern Med 20:432-7 |
| Engelstad, Linda P; Stewart, Susan; Otero-Sabogal, Regina et al. (2005) The effectiveness of a community outreach intervention to improve follow-up among underserved women at highest risk for cervical cancer. Prev Med 41:741-8 |
| Wagner, Todd H; Goldstein, Mary K (2004) Behavioral interventions and cost-effectiveness analysis. Prev Med 39:1208-14 |
| Somkin, Carol P; McPhee, Stephen J; Nguyen, Tung et al. (2004) The effect of access and satisfaction on regular mammogram and Papanicolaou test screening in a multiethnic population. Med Care 42:914-26 |
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