All women should seek cancer screening tests such as mammograms, pap tests and colorectal screenings on a yearly or bi-yearly basis, according to the U.S. Preventive Services task force. But many American women, especially in low income or minority groups, do not receive this essential preventative care.
A research study by Dartmouth Medical School professor Dr. Allen J. Dietrich of the Norris Cotton Cancer Center may have identified an essential factor in getting women the care they need -- the telephone.
Dietrich partnered with Jonathan Tobin of the Clinical Directors Network, Inc., a clinical research network and clinician education organization, to design a clinical study testing this method of increasing the number of minority women in New York City who seek preventative screenings.
"There are clear cut disparities in cancer screening for low income and certain minority groups. For these women their death rates are higher and they are getting treatment later," Dietrich said.
Dietrich's study contacted 1,413 women, all of whom were patients of the migrant health care network in New York City and were overdue for at least one cancer screening test. Of the women contacted, more than 78 percent were enrolled in Medicaid and more than 60 percent spoke Spanish as their first language.
The study divided these women into a control group and an experimental group, with the latter receiving four additional phone calls from "care managers" who were trained to address the women's concerns surrounding their access to cancer screening.
Care managers provided services such as asking women's doctors to send informational letters, providing their own informational letters about the tests in both Spanish and English and addressing issues such as transportation to the clinic and insurance questions.The care managers "became health coaches for the women," teaching "them to bring up the screening themselves with their primary care physician," Dietrich said.
During the 18-month-long study, screening rates for breast, cervical and colorectal cancer went up dramatically for women in the experimental group. Pap tests went up 7 percent, mammograms increased by 10 percent and colorectal cancer screenings went up more than 13 percent. The increase in colorectal screening rates might have also been influenced by Katie Couric's aggressive media campaign that encouraged New Yorkers to get screened, however.
The president-elect of the American Cancer Society, Dr. Richard Wender, who is familiar with Dietrich's prior work, recognized the results of the study as "promising."
"If you depend just on the memory of the physician at the time of the visit to remember to order all the things they're supposed to order, it's less likely to happen," Wender said in a press release from the American Cancer Society.
Local groups such Vital Community in the Upper Valley have even expressed interest in starting similar programs for poor or minority women. The ultimate goal of the study, however, would be to implement it on a national scale.
The best way to cause widespread change would be through Medicaid, Dietrich said.
"This study provides evidence that telephone support can work by applying this methodology to existing infrastructure to reach people who need it," Dietrich said.
Since insurance companies already have detailed reports of which tests each woman has received in the past for reimbursement purposes, Dietrich suggested that the role of the "care manager" could be shifted to companies.
Companies would then call the women overdue for screening tests and urge them to request the tests the next time they visit their physician. Finally, the company would monitor the results of this intervention based upon charges for the required tests that would hopefully come through their office within the next six months, Dietrich said.
The report was published in the April 18 edition of the Annals of Internal Medicine.
