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J Mandelblatt

Publications and source records attributed to J Mandelblatt.

33 records · Page 2Linked to original sources
PubMed1993

Targeting breast and cervical cancer screening to elderly poor black women: who will participate? The Harlem Study Team.

BACKGROUND: Factors associated with participation in breast and cervix cancer screening among elderly black women of low socioeconomic status were determined. METHODS: Data from a baseline cross-sectional random survey were used together with data on whether screening was subsequently completed or refused. The subjects were a random sample of women attending an urban public hospital primary care clinic for routine medical care with a birth year of 1924 or earlier. RESULTS: Among the 271 women in the study group, 70% completed screening. Stated intent was the strongest predictor of participation; women who intended to have both mammography and Pap testing were 2.7 times more likely to participate than those who intended to have neither test (95% confidence interval 1.4, 4.9; P < 0.01), controlling for age, insurance status, and level of chronic illness. Women who had more than three chronic illnesses were twice as likely to participate than those with three or fewer illnesses (95% confidence interval 1.1, 3.4 P < 0.02), controlling for the remaining variables. Other variables, including age, history of a recent screening examination, attitudes, or knowledge, were not related to participation. Stated intent was the only variable that predicted compliance with both mammography and Pap smear completion in separate regression models for the individual tests. CONCLUSION: A high proportion of elderly, socioeconomically disadvantaged black women will participate in cancer screening when it is offered in a primary care setting. Further research on behavioral intentions should be conducted to refine interventions designed to enhance the use of early cancer detection among vulnerable population groups.

Black or African American↗
PubMed1993

Squamous cell cancer of the cervix, immune senescence and HPV: is cervical cancer an age-related neoplasm?

Relationships between cancer and aging will assume greater scientific importance over the coming decades as the number and proportion of elderly increase. Contrary to popular belief, cervical cancer remains an important disease into old age. This paper will briefly review what is known about immune senescence, cervical cancer and immune function, and the relationship between human papilloma virus and immunity, to support the hypothesis that these factors may contribute to the continued occurrence of invasive cervical cancer in the elderly.

Adolescent↗
PubMed1993

A nurse practitioner intervention to increase breast and cervical cancer screening for poor, elderly black women. The Harlem Study Team.

OBJECTIVE: To compare nurse practitioner (NP) and physician rates of breast and cervical cancer screening among poor, elderly black women. DESIGN: A quasi-experimental design was used to compare pre- and postintervention annual screening rates. Rates were determined by medical record audits. SETTING: Two urban public hospital primary care clinics served as the study sites. PATIENTS: All women aged 65 years or more were eligible to participate. INTERVENTIONS: Women were offered screening by a NP during a routine visit in the intervention site; a physician reminder system was used in the control site. MAIN RESULTS: Baseline annual screening rates were comparable in the two study sites. At the end of the study period, rates were significantly higher in the NP site, compared with the control. In the NP clinic, the annual rate of Pap tests increased to 56.9% from the baseline of 17.8%, and mammographies increased to 40% from 18.3%. In comparison, rates remained low in the control site, increasing only to 18.2% of women receiving Pap tests from a baseline of 11.8%, and remaining at 18% for mammography. CONCLUSIONS: Use of a NP to deliver same-day screening is an effective strategy to target poor, elderly black women for breast and cervical cancer screening. However, even with the substantial increases in rates obtained with the NP intervention, screening in this vulnerable population remains below nationally targeted levels.

Black or African American↗
PubMed1992

Cost effectiveness of cervical cancer screening for the elderly.

OBJECTIVE: To analyze the costs and benefits of alternative cervical cancer screening schedules among elderly women. SETTING: Population-based screening programs. DESIGN: A Markov model predicts the outcomes of periodic screening, diagnosis, and treatment for cervical cancer among women from 65 to 109 years of age. PATIENTS: A hypothetical cohort of one million 65-year-old women; representative of the U.S. population. MEASUREMENTS: The costs and yields of screening. RESULTS: Triennial screening reduced mortality from cervical cancer among the elderly by 74% at a cost of $2254 per year of life saved. Annual screening increased costs to $7345 per year of life saved; less frequent schedules yielded lower costs but decreased savings in life. These results were most sensitive to the quality of the Papanicolaou smear and the characteristics of the women using the benefit. If the sensitivity of the Papanicolaou smear was reduced from a baseline estimate of 75% to 50% and the specificity was decreased to 87% from 95%, the cost effectiveness ratio increased by nearly $7000 per year of life saved. If triennial screening is targeted to women who have not had regular screening, the program will save money as well as years of life; however, screening women who have been screened regularly is considerably less efficient, increasing costs to $33,572 per year of life saved. CONCLUSION: The success of the new Medicare benefit depends substantially on physicians assuring that their elderly patients, particularly women without regular prior screening, obtain high quality Papanicolaou smears. The data also show that after a woman 65 years of age or older has a history of regular negative smears, screening is inefficient and can cease.

Aged↗
PubMed1992

Is human papillomavirus associated with cervical neoplasia in the elderly?

There have been no studies in the United States of human papillomavirus (HPV) in elderly women. This paper presents cross-sectional data on HPV and cervical neoplasia among 232 women age 65 or more. HPV deoxyribonucleic acid (DNA) testing was performed using a modified dot-blot hybridization technique. The prevalence of HPV DNA positivity was 3.5% (95% confidence interval (CI) 0.9%, 6.0%). There were six cases of histologic cervical neoplasia. The crude odds ratio for cervical neoplasia among HPV DNA positives was 18.3 (95% CI 2.8, 120.3). The adjusted odds, controlling for age, prior screening history, current sexual activity, and past contraception use, were 12.2 (95% CI 1.2, 122.9). Ever having had a Papanicolaou smear was protective, and there was a trend for the odds of having neoplasia to increase with age. Additional studies with larger samples of elderly women are needed. If confirmed, the results suggest that, independent of past screening, HPV may increase the risk of having cervical neoplasia for elderly women.

Aged↗
PubMed1992

Mammography and Papanicolaou smear use by elderly poor black women. The Harlem Study Team.

OBJECTIVE: To describe factors related to the use of mammography and Papanicolaou smears in low-income women aged 65 or more years to guide development of future interventions. DESIGN: A cross-sectional survey. SETTING AND PATIENTS: Elderly Black women attending a public hospital medical clinic. MEASUREMENTS: Information obtained in a face-to-face interview of a random sample of patients. RESULTS: Four-hundred and forty-five women (94%) consented to be interviewed; 74% reported a mammogram, and 85% reported a Papanicolaou smear in the past, although these early-detection tests were not obtained with any regularity after age 65. Concordance between self-reported screening use and blind chart review was more than 90%. The major reasons for non-use of both screening tests were that a physician hadn't recommended them or that the women didn't know they needed them. Levels of knowledge about breast and cervix cancer were low; 68% believed bumping or bruising the breast caused cancer, and only 25% knew that cancer risk increased with advancing age. In logistic regression models, health status, provider type, perceived benefit, life satisfaction, and knowledge of test intervals were each significantly associated with mammogram use. Age, health status, education, perceived susceptibility and benefit, life satisfaction, and knowledge of test intervals were independently related to Pap use (P < .05). CONCLUSION: This study illustrates that elderly, poor, minority women who are regular health-care users do use mammography and Pap smear screening services. Incorporating screening into routine primary care and physician and patient education could enhance the use of early cancer detection procedures in this age group.

Black or African American↗
PubMed1992

Risk factors for cervical cancer in a black elderly population: preliminary findings.

Limited information is available on cervical cancer among black or elderly women. This paper presents preliminary cross-sectional data on risk factors for prevalent cervical neoplasia among 278 predominantly black, elderly women attending an inner-city, public hospital cancer-screening program. Interviews were administered to obtain information on exposure variables; human papillomavirus DNA hybridization was performed on 83.5% of the participants. Six cases of cervical neoplasia were detected. The crude prevalence OR among women with human papillomavirus infection was 18.3 (95% CI: 1.94, 121.0). Women who reported ever having used birth control also had a significantly increased crude and adjusted risk of cervical cancer, although this variable likely was a proxy measure for sexual behavior. In the logistic regression model, the adjusted prevalence ORs of disease among human papillomavirus-positive women and among women reporting any postmenopausal bleeding were significantly increased. Confidence intervals for adjusted results, however, were wide because of the small number of cases and the low prevalence of some exposures. More studies with larger samples are needed to determine whether accepted risk factors for whites are also associated with cervical neoplasia among black, elderly women.

Black or African American↗
PubMed1991

Clinical implications of screening for cervical cancer under Medicare. The natural history of cervical cancer in the elderly: what do we know? What do we need to know?

Despite the recent passage of coverage for Papanicolaou test screening under Medicare, several aspects of the natural history of cervical cancer in the elderly remain uncertain. This article reviews what we know about cervical cancer in elderly women to provide clinicians with the background necessary for assessments of screening recommendations, integration of new data into practice, and development of consensus approaches to screening in the elderly. Two central questions that affect a screening program for the elderly are how long the neoplastic process takes from preinvasive disease to the development of invasive cancer, and how likely is it that a given neoplastic state observed in an elderly woman will, in fact, progress to a more severe state. The ultimate success of the new Medicare benefit will also be affected by the use of Papanicolaou testing, the technique of obtaining the smear, and the adequacy of reporting and follow-up. The expansion of Medicare benefits to include early cervical cancer detection has the potential to improve the quality and the duration of older women's lives.

Aged↗
PubMed1991

Determinants of late stage diagnosis of breast and cervical cancer: the impact of age, race, social class, and hospital type.

Previous studies of the relationship between cancer stage, age, and race have not controlled for social class and health care setting. Logistic regression analyses, using information from the New York State Tumor Registry and area-level social class indicators, demonstrated that, in New York City, older Black, lower class women in public hospitals were 3.75 and 2.54 times more likely to have late stage breast or cervical cancer, respectively, than were younger White, high social class women in non-public hospitals.

Adult↗
PubMed1989

Cervical cancer screening in primary care: issues and recommendations.

The essential controversy about cervical cancer screening is not whether or not it should be done, but who should be screened, how often they should be screened, and how to obtain the best sample for the screen. This section highlights these issues, emphasizing the role of the primary care provider in cervical cancer control.

Adolescent↗
PubMed1986

Gynecological care of elderly women. Another look at Papanicolaou smear testing.

Mortality from cervical cancer is decreasing in countries where aggressive Papanicolaou smear screening programs are in place. However, elderly women are likely to be lifelong nonusers or underusers of Papanicolaou screening, and mortality has not declined for older women. Many studies have noted that nonparticipants in Papanicolaou screening have a 2.7 to four times greater incidence of cervical cancer when they are screened compared with women who have been screened at least once. Gynecological screening was offered to 1542 elderly women in a primary care setting; 75% of the women had not had regular prior screening and 25% had never been screened. Half of these women chose to participate in our screening program. An overall prevalence rate of 13.5 per 1000 abnormal Papanicolaou smears (95% confidence interval, 5.6 to 21.4) was noted in the group. Age, race, prior screening history, and abnormal gynecological symptoms failed to predict the women who would have abnormal Papanicolaou smears. Our results suggest that cervical cancer screening should continue beyond 65 years of age if women have not received regular prior screening.

Age Factors↗
PubMedDate not supplied

Preventive health practices in a teaching hospital: house staff attitudes and performance of gynecological screening.

Attitudes toward and the performance of Pap smears by the house staff in nongynecological hospital admissions were evaluated as markers of preventive health practices in a tertiary-care hospital. A major discrepancy between house staff attitudes and behaviors was noted. The residents considered it important to offer a Pap smear to all women on admission. However, a random review of 150 medical and surgical charts revealed a lack of documentation of pelvic examinations in 67 percent of the charts and Pap smears in 33 percent of the charts. Overall, Pap smears were actually performed on only eight of 150 patients. A survey of random hospital floors revealed a lack of equipment and facilities for performing Pap smears. Such factors were thought to be the major contributors to the failure by house staff to perform pelvic exams and Pap smears. Steps to increase the performance of these types of preventive health practices should include the use of a checklist admission form and the maintenance of appropriately equipped facilities on all hospital floors. We suggest a greater emphasis on the development of educational strategies to teach preventive health care principles in residency training programs.

Adult↗
PubMedDate not supplied

Breast and cervical cancer screening of poor, elderly, black women: clinical results and implications. Harlem Study Team.

Our objective is to describe the clinical findings from a nurse-practitioner-based breast and cervical cancer screening program for poor, elderly, black women. We designed a cross-sectional descriptive study set at an urban public hospital medical clinic. All women 65 years of age and older were eligible to be screened. We measured these main outcomes: rates of participation, abnormal tests, and neoplasia. Women were offered screening during a routine visit. Of 689 women, 491 (71%) participated. Mammography was completed by 66% of women; one had stage 1 cancer, and 76% were negative. Among the women (24%) with abnormal mammograms, the overwhelming majority were diagnosed with benign lesions. For ten of 450 women completing Papanicolaou (Pap) smears, results were suspicious or positive for malignancy, for a prevalence rate of 22.2/1,000 (95% confidence interval [CI] = 8.6/1,000 to 35.8/1,000). Three were subsequently designated falsely positive; five had confirmed cervical neoplasia; and two had other reproductive malignancies. Two women with negative smears also had neoplasia: one with vulvar cancer and one with human papilloma virus (HPV) infection and cervical neoplasia, for a total of six cervical neoplasias. Interestingly, one-fifth of women with a hysterectomy had an intact cervix, including one with cervical neoplasia. Nearly one-third of women with abnormal Paps or mammograms failed to complete follow-up. Success of screening programs for the elderly will depend on the risk group targeted, careful examination, degree of sensitivity and specificity of the tests, and acceptability of follow-up diagnosis and treatment.

Black or African American↗