Abstract B81: Access to care barriers and history of mammography screening in Hispanic/Latino women living in the Northeast, United States
Authors: Jones Beth A. , Genao Inginia , Nunez-Smith Marcella , Soler-Vilà Hosanna , Claus Elizabeth B. , Doyle Margaret , Nappi Susan , Miranda Alejandra , Fernandez Elizabeth , Quintero Juliana 
Published: May 2015

Abstract
Background: Hispanic/Latinas (H/Ls) are more likely to be diagnosed with later staged breast cancer and to have poorer survival compared with White (W) women. Nationally, mammography screening rates in H/Ls are lower than reported for Whites or African Americans. However, little is known about cancer screening in H/Ls living in the Northeast, US. Given the rapidly changing socio-demographic profile of this area of the country, the goal of this prospective study is to identify predictors of adherence to mammography screening guidelines and associated outcomes over a 2-3 year period. Here, we report the role of access to care on history of adherence to mammography guidelines as reported in the baseline interview. Methods: 1600 community-based Hispanic/Latinas, ages 40-75, seeking care at primary care clinics in 4 cities with the largest Hispanic populations in Connecticut, and with no prior history of breast cancer or biopsy, were enrolled in this study between October, 2009 and March, 2011( 75% participation rate). Study participants provided extensive information on socio-demographic, medical care, psychosocial, health beliefs and acculturation factors in a one hour telephone interview, generally conducted in Spanish (85%). Access to care variables included: insurance (none, some public/private), usual care provider (no/yes), recent (index) primary care appointment conducted in English language only (yes/no), some or all of mammogram paid out of pocket (yes/no), as well as special arrangements (e.g., child care) needed to receive mammogram (yes/no) and lost pay associated with mammography appointments (yes, no). Bivariate analyses and multivariate stepwise logistic regression were performed. Odds ratios (OR) and 95% confidence intervals (CI) are reported.
Results: Adjusting for selected socio-demographic (age, education, marital status), acculturation (foreign or Puerto-Rico born), self-assessed English language skill, self-rated health, as well as other access to care variables, participants who reported that their recent primary care appointment was conducted completely in English language were less likely to have received a screening mammogram in the previous year (OR= 1.31, 95% CI 0.96-1.78, marginally significant). Women lacking a usual place for health care (OR= 1.53, 95% CI 1.12-2.08) and women who had to pay for some or all of their mammograms (OR 1.55, 95% CI 1.07-2.25) were significantly less likely to report a screening mammogram in the previous year. Conclusions: Notwithstanding that all participants were recruited from hospital-based or federally funded primary care clinics that serve large H/L populations, access to care barriers were still associated with history of mammography screening in women at increased risk of poor outcomes associated with breast cancer diagnosis. Findings from this investigation will be critical in informing cancer prevention strategies for this under-resourced population.
Citation Format: Beth A. Jones, Inginia Genao, Marcella Nunez-Smith, Hosanna Soler-Vilà, Elizabeth B. Claus, Margaret Doyle, Susan Nappi, Alejandra Miranda, Elizabeth Fernandez, Juliana Quintero. Access to care barriers and history of mammography screening in Hispanic/Latino women living in the Northeast, United States. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B81. doi:10.1158/1538-7755.DISP13-B81