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Bean-Mayberry BA, Yano EM, Mor MK, Wang M, Fine MJ. Does race affect cancer screening among women in VA care? Poster session presented at: VA HSR&D National Meeting; 2008 Feb 14; Baltimore, MD.
Objectives: While the VA Healthcare System serves many vulnerable patient populations, minimal research has focused on preventive care for women in VA and whether cancer screening measures vary by race. Our aim was to assess overall gender-specific cancer screening rates among women veterans and to assess if performance differences exist by race. Methods: We performed a secondary analysis using a national sample from VA External Peer Review Program (fiscal years 2001-2003) linked to administrative data. We used multiple logistic regression analyses for 2 age-appropriate, gender-specific cancer screening measures, screening mammograms and Pap smears, adjusting for patient demographics, health care utilization, body mass index, geographical region and site. For each measure, we defined age-appropriate subgroups eligible to receive each test using VA and national guidelines. Results: In a cohort of 14,851 women, 71% were white, 17% black, 2% other race, and 10% unknown race. The overall frequency of screening mammography in women aged 52-69 years was high (82%), with no significant differences among racial groups (white 82%, black 81%, other 82%, and unknown 82%; p = .92). In logistic regression analyses, race was not an independent predictor of screening mammography (OR for blacks = 0.98; 95% CI 0.78-1.22; OR other race = 0.98; 95% CI 0.51-1.89; OR unknown race = 0.88; 95% CI 0.66-1.17). The overall frequency of screening for cervical cancer for non-hysterectomized women, aged 18-64 years was also high (90%), with no significant differences among racial groups (white 90%, black 90%, other 85%, and unknown 91%; p = .07). In logistic regression analyses, neither black nor unknown race was an independent predictor of cervical cancer screening (OR for blacks = 1.13; 95% CI 0.92-1.38; other race = OR 0.62; 95% CI 0.42-0.92; and unknown race = OR 1.11; 95% CI 0.90-1.37). Implications: Screening rates for cervical and breast cancer are high for women veterans and do not vary by race. Impacts: Since gender-specific cancer screening for women veterans does not vary by race, VA has accomplished a form of equity in healthcare that many non-VA systems still strive for. Our next step will evaluate specific features of VA care models that facilitate high or low performance measures among women veterans.