In the last two decades, the death rate from breast cancer has fallen by about seven percent in younger white women. However, in this period African-American women, particularly older African-American women, have experienced a 26 percent increase in mortality, despite having a lower incidence of disease than their white counterparts. For all races of women, mammography screening can potentially reduce mortality by up to 30 percent. Prior cost-effectiveness analyses of breast cancer screening among general population have demonstrated that reduction in mortality can be achieved at a reasonable cost per life year saved. However, there are no data on whether additional expenditures to enhance the cancer control process for African-American women, particularly older African-American women, might affect the overall cost-effectiveness of screening. To address this important gap in our knowledge, we have assembled an experienced multi-disciplinary team of health economists, geriatricians, mathematical modelers, oncologists, health service researchers, decision analysts, and epidemiologists. We will extend prior cost-effectiveness analyses by 1) using existing race-specific data to develop a simulation model of the natural history of disease specific to African-American women ages 50 to 74 years; 2) obtaining primary data on the utilities for breast cancer outcomes among African- Americans to generate quality-adjusted life-years (QALYs) as the outcome of analysis; 3) including non-medical direct (e.g., patient transportation costs, patient time costs); and 4) developing and estimating sub-models which evaluate the incremental costs and effects of programs specifically designed to improve the value of screening in this high-risk population (e.g., programs designed to enhance breast cancer screening use, prompt diagnosis after abnormal screening, and adherence to recommended treatment). We hypothesize that the added costs of targeted cancer control programs for vulnerable African- American women will be offset by the gains in quality-adjusted life years saved as a result of down-staging disease and improving treatment. The results of such analysis will be useful to inform the optimal design of health services delivery programs, and to highlight priority research and service areas to ensure that we reach targeted levels of breast cancer mortality reduction among all women in the US.

Agency
National Institute of Health (NIH)
Institute
National Cancer Institute (NCI)
Type
Research Project (R01)
Project #
3R01CA072908-02S1
Application #
6134899
Study Section
VA Health Services Research and Development Scientific Merit Review Board (HSRD)
Project Start
1998-07-01
Project End
2001-06-30
Budget Start
1999-09-30
Budget End
2000-06-30
Support Year
2
Fiscal Year
1999
Total Cost
Indirect Cost
Name
New School University
Department
Administration
Type
Other Domestic Higher Education
DUNS #
071030969
City
New York
State
NY
Country
United States
Zip Code
10011
Mandelblatt, Jeanne S; Schechter, Clyde B; Yabroff, K Robin et al. (2005) Toward optimal screening strategies for older women. Costs, benefits, and harms of breast cancer screening by age, biology, and health status. J Gen Intern Med 20:487-96
Mandelblatt, Jeanne; Armetta, Catherine; Yabroff, K Robin et al. (2004) Descriptive review of the literature on breast cancer outcomes: 1990 through 2000. J Natl Cancer Inst Monogr :8-44
Mandelblatt, Jeanne S; Schechter, Clyde B; Yabroff, K Robin et al. (2004) Benefits and costs of interventions to improve breast cancer outcomes in African American women. J Clin Oncol 22:2554-66
Cantor, Scott B; Fahs, Marianne C; Mandelblatt, Jeanne S et al. (2003) Decision science and cervical cancer. Cancer 98:2003-8
Kerner, Jon F; Yedidia, Michael; Padgett, Deborah et al. (2003) Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women. Prev Med 37:92-101
O'Malley, Ann S; Lawrence, William; Liang, Wenchi et al. (2002) Feasibility of mobile cancer screening and prevention. J Health Care Poor Underserved 13:298-319
Pignone, Michael; Saha, Somnath; Hoerger, Tom et al. (2002) Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med 137:96-104
Mandelblatt, Jeanne S; Kerner, Jon F; Hadley, Jack et al. (2002) Variations in breast carcinoma treatment in older medicare beneficiaries: is it black or white. Cancer 95:1401-14
O'Malley, Ann S; Forrest, Christopher B; Mandelblatt, Jeanne (2002) Adherence of low-income women to cancer screening recommendations. J Gen Intern Med 17:144-54
Yabroff, K R; O'Malley, A; Mangan, P et al. (2001) Inreach and outreach interventions to improve mammography use. J Am Med Womens Assoc 56:166-73, 188

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