Abstract C71: Validity of self-reported mammography screening in prospective study of Hispanic / Latino women living in the Northeast, US
Authors: Jones Beth A. , Markowski Justin H. , Genao Inginia , Nunez-Smith Marcella , Soler-Vilà Hosanna , Claus Elizabeth , Claye Emma , Nappi Susan , Doyle Margaret , Miranda Alejandra , Walker Charles 
Published: March 2017

Background & Objectives:

Hispanic/Latinas (H/Las) are more likely to be diagnosed with later staged breast cancer when compared with White women. Mammography screening, an important early detection tool, is effective when received at regular intervals. National data suggest that mammography screening rates in H/Las are lower than reported for Whites and African Americans. However, little is known about the predictors of screening adherence in the largely immigrant population of Hispanic/Latinas living in the Northeast, US. From a prospective study that examined the roles of social determinants, health beliefs, knowledge and attitudes, acculturation, and medical factors that are hypothesized to predict adherence to mammography screening guidelines, we report here on multiple outcome measure of adherence to mammography screening guidelines in place at the time of this study (2008-2014). Our goal is to report on the validity of self-reported screening history during the follow-up period using abstracted radiology record data as the gold standard.

Methods:

We enrolled and conducted hour long interviews with 1600 community-living Hispanic/Latino women, ages 40-75, seeking care at primary care clinics in the 4 Connecticut cities with the largest Hispanic populations. Women with no prior history of breast cancer or biopsy were eligible for inclusion in our study. In an extensive baseline interview, we collected detailed information on socio-demographic, access to care, medical, health knowledge and belief variables. Information on screening mammography that occurred during 2-4 years of follow-up was derived from 2 sources: 1) radiology records (n = 1570; 98% consented to record review) and 2) follow-up interviews conducted beginning no earlier than 30 months from enrollment (n = 772, 49.2%). Cohen's Kappa agreement statistics with 95% Confidence Intervals (CI) are reported. Multivariate analyses were used to characterize over-reporters from under-reporters using the radiology record as the gold standard.

Results:

Among the 1570 women who returned signed consent forms allowing medical record review, non-adherence to guidelines calling for annual mammography was 55.4% (n = 870) and 38.9% (n = 610) calling for biennial mammography screening. Compared with self-reported mammography screening available from the sub-cohort of women with follow-up interview information (n = 772), the percent agreement between self-reported and medical record screening history was 59.2% (n = 457) with kappa = 0.18 (95% CI: 0.11, 0.25) for annual screening and 71.4% with kappa = 0.27 (95% CI: 0.20, 0.34) for biennial screening.

Among the 315 (40.8%) women whose self-reports did not agree with the medical record, 192 (61.0%) over-reported and 123 (39.0%) under-reported adherence to annual mammography recommendations. Prospective predictors of over-reporting, derived from multivariate adjusted models included history of mammography screening before enrollment in study and fair/poor self-rated health (p &lt;= .05); there was a suggestion that age less than 50 and annual household income greater than or equal to $10,000 were also more common in this group.

Conclusions:

In this large prospective study of cancer screening in Hispanic/Latinas living in the Northeast, US, adherence to mammography screening guidelines was lower than is reported in retrospective self-reported survey data used by most public health practitioners. Importantly, when self-reported mammography screening was compared with radiology record review, the agreement was lower than ideal at less than 60%, with over-reporting more frequent than under-reporting. These results have implications for cancer prevention and control efforts and discussions regarding mammography screening guidelines, as it may be that actual non-adherence to mammography screening guidelines is higher than indicated by self-report.

Citation Format: Beth A. Jones, Justin H. Markowski, Inginia Genao, Marcella Nunez-Smith, Hosanna Soler-Vilà, Elizabeth Claus, Emma Claye, Susan Nappi, Margaret Doyle, Alejandra Miranda, Charles Walker. Validity of self-reported mammography screening in prospective study of Hispanic / Latino women living in the Northeast, US. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr C71.