Nebraska Women Benefit From Efforts To Close Gaps In Cancer Screening

A decade-long Nebraska study that showed disparities in breast and cervical cancer screenings could have spurred changes that raised the percentage of women screened in the state.


"Disparities in screening between racial and ethnic groups, even in a homogeneous state such as Nebraska, are a problem and by digging into some of the differences we were able to have an impact on breast and cervical cancer screening," said lead study author Shingairai Feresu, Ph.D., an assistant professor at the University of Nebraska Medical Center in Omaha.


The research team crunched the numbers of low-income, uninsured, and in some cases, less educated women screened by Pap smear, clinical breast exam and mammogram between 1993 and 2004.


Native American women were more likely than white women to have mammograms ordered, while African-American and Native American women were less likely than white women to have a clinical breast exam. African-American women were less likely than white women to have a Pap test, the researchers found.


Their findings appear in the August issue of the Journal of Health Care for the Poor and Underserved.


Melissa Leypoldt, R.N.,is the program director of Every Woman Matters in Nebraska, a health screening and awareness initiative with 67 programs nationwide. She called the study "a snapshot of the women served through the program and the services they received." Consequently, "we have used the data to direct program resources and manpower," she said.


In 2006, the state had its lowest rate of death from breast cancer since 1967, Leypoldt said.


"Programs such as EWM, together with other outreach efforts in the state might have helped to improve or increase preventive services such as screening for breast and cervical cancer to the point where Nebraska ranked 26th in screening for these conditions in 1990 and now ranks 16th nationwide," Feresu said.


Despite some changes in eligibility requirements for this program such as a midstream change in the age of women who could get a mammogram and the requirement that women re-qualify every year the number of women who had not had a Pap test in the state dropped from 20 percent in 1991 to 15 percent in 2002. In 1990, 45 percent of women had not gotten a mammogram; by 2002, that figure was 20 percent, according to Feresu.


For Native Americans, Every Woman Matters has been on the reservations since it began and mobile mammogram units may account for the superior access to mammograms in this group. Nebraska has recently experienced an influx of Hispanic immigrants, and EWM has now incorporated Hispanic women into its efforts.


Direct mailings have proved very effective in reaching women, Leypoldt said: "We look for eligible populations, then see who is not being screened, and target them."


The program is adding cardiovascular and diabetes screening to its services.


Feresu SA, et al. Breast and cervical cancer screening among low-income women in Nebraska: findings from the Every Woman Matters program, 1993-2004. Journal of Health Care for the Poor and Underserved 19(3), 2008.


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