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A population health assessment of screening mammography on breast cancer mortality in North Carolina

  • Epidemiology
  • Published:
Breast Cancer Research and Treatment Aims and scope Submit manuscript

Abstract

Purpose

To identify predictors of screening mammography use and the effect of screening mammography on breast cancer mortality in North Carolina.

Methods

This cross-sectional study integrated publicly available data from government and private data repositories to model predictors of screening mammography and breast cancer mortality in North Carolina.

Results

In North Carolina during 2008—2010, on average, 68.1% of women aged 40–74 years underwent a screening mammogram in the previous two years (range: 38.7%–82.1). The ordinary least squares (OLS) regression demonstrated counties experiencing persistent poverty have mammography screening rates that are 4.3% less, on average, than counties without persistent poverty (estimate (SE) = − 4.283 (2.105), p = 0.045). As the percentage of women with a college education increases, the mammography screening rates increase by approximately 0.3% (estimate (SE) = 0.319 (0.078), P < .001) and as the health literacy score increases, the mammography screening rate decreases by 0.3% (estimate (SE) = − 0.318 (0.104), p = 0.003). These variables explain 7.0% of the variability in mammographic screening rates. The OLS regression analysis demonstrated that age-adjusted breast cancer incidence (Estimate (SE) = 0.074 (0.024), p = 0.003) and health literacy score (estimate (SE) = − 0.175 (0.083), p = 0.039) are significantly related to breast cancer mortality.

Conclusions

Demographic, socioeconomic, and environmental variables explain only a small percentage of the variability in the rates of screening mammography and breast cancer mortality in North Carolina. Advances in the available treatments are likely the major contributor to improving breast cancer mortality.

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Data availability

The datasets generated during and/or analyzed during the current study are publicly available as follows. Bureau UC. United States Decennial Census. Accessed May 12, 2022. https://data.census.gov/cedsci/table?q=United%20States&tid=DECENNIALPL2020.P1

NCCPCB. Reducing the burden of cancer in North Carolina: A data and resource guide for communities to fight cancer. Accessed April 23, 2019. https://publichealth.nc.gov/chronicdiseaseandinjury/cancerpreventionandcontrol/docs/ReducingtheBurdenofCancerResourceGuide.pdf. Bureau USC. Annual Estimates of the Resident Population for Selected Age Groups by Sex: April 1, 2010 to July 1, 2019. Accessed January 24, 2022. https://www.census.gov/data/tables/time-series/demo/popest/2010s-state-detail.html. County Health Rankings & Roadmaps. Building a Culture of Health, County by County. Robert Woods Johnson Foundation Program. Accessed June 11, 2020. https://www.countyhealthrankings.org/reports/state-reports/2020-north-carolina-report. HRSA. Area Health Resource File. Accessed March 4, 2022. https://data.hrsa.gov/topics/health-workforce/ahrf. FDA U. FDA Certified Mammography Facilities. Accessed March 4, 2022. https://www.fda.gov/radiation-emitting-products/consumer-information-mqsa/search-certified-facility. National Health Literacy Mapping to Inform Health Care Policy. Health Literacy Data Map. University of North Carolina at Chapel Hill. Accessed April 18, 2022. http://healthliteracymap.unc.edu/#. NCI, CDC. State Cancer Profiles: Screening and Risk Factors Table. Accessed March 4, 2022. https://www.statecancerprofiles.cancer.gov/risk/index.php

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

Author information

Authors and Affiliations

  1. Department of Cardiology, East Carolina University, Greenville, NC, USA

    Ashley E. Burch

  2. Department of Health Services and Information Management, East Carolina University, Greenville, NC, USA

    Ashley E. Burch

  3. Division of Surgical Research, Department of Surgery, Brody School of Medicine at East, Carolina University, 600 Moye Blvd, Greenville, NC, 27834, USA

    William D. Irish & Jan H. Wong

  4. Department of Public Health, East Carolina University, Greenville, NC, USA

    William D. Irish

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Contributions

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by Ashley E. Burch, William D. Irish, and Jan H. Wong. The first draft of the manuscript was written by [full name] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Jan H. Wong.

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Ethics approval

All these data utilized in this report are publicly available and based on guidance from the Office of Human Research Protection, this study was determined not to require institutional review board review under 45 CFR 46.

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Supplementary file1 (DOCX 13 KB) Appendix 1. Variables in multivariable ordinary least squares regression mode.

10549_2022_6773_MOESM2_ESM.docx

Supplementary file2 (DOCX 16 KB) Appendix 2. Non-parametric correlation of the percent screening mammography rates with demographic, socioeconomic, and access to care domains.

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Burch, A.E., Irish, W.D. & Wong, J.H. A population health assessment of screening mammography on breast cancer mortality in North Carolina. Breast Cancer Res Treat 196, 647–656 (2022). https://doi.org/10.1007/s10549-022-06773-3

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