Evaluation of the Program Delivery of Every Woman's Life in Virginia
Susan Kenney Landolt
Authors: Susan Kenney Landolt, Derek Chaoman Ph.D., Carol Wells Bazzichi MS
Introduction: Among women, breast cancer is the most prevalent cancer and the second leading cause of cancer death. Technology advances have improved survival rates for breast cancer overall, but improvements have not been universally experienced by all. Known determinants of breast cancer care disparities include socioeconomic status, race, age, and social support. As a part of the Breast and Cervical Cancer Mortality Prevention Act of 1990 and with the help of CDC funding, the VA Department of Health created Every Woman's Life (EWL). EWL provides breast cancer screening to female VA residents between the ages of 18 and 64 who lack health insurance and fall at or below 200% of the Federal Poverty Level.
Objective: The purpose of this study is to determine if delays in the diagnosis and treatment of breast cancer, within EWL, differs based on sociodemographic characteristics and/ or regional location.
Methods: From its inception to July 2008, 705 women received a breast cancer diagnosis through the EWL program. For these 705 cases prevalence and crude odds ratios were calculated for both diagnosis and treatment delays for all of the demographic variables along with 95% confidence intervals. Adjusted odds ratios were calculated for sociodemographic variables against screening to diagnosis delays and diagnosis to treatment disparities along with 95% confidence intervals.
Results: According to the crude odds ratios more women who fall into the other category of race (OR=2.28 [1.11, 4.67]) and women living alone (OR=1.49 [1.10, 3.02]) experienced diagnosis delays. Both Hispanic women (OR=0.21 [0.05, 0.81]) and women of other race (OR=0.29 [0.11, 0.79]) were more likely to receive treatment in a timely manner. Also, women being treated in any other region than northern VA were more likely to experience treatment delays. However, according to the adjusted odds ratios, the only significant timing delay was the one experienced more often by women in the other race category.
Conclusion: The findings of this study indicate that the only significant indicator of disparity within the Every Women's Life program is race. It was the combined groups of Asian, American Indian, and other women that were more likely to experience diagnosis, but not treatment, delays. No other significant indicators were found within EWL which indicates a success.
