Breast and cervical cancer screening for Puerto Ricans, African Americans, and non-Hispanic Whites attending inner-city family practice centers

Objectives: Disparities exist for breast and cervical cancer screening among racial/ethnic groups and low-income women. This study determines racial/ethnic variation in: 1) staging readiness for mammography, Pap smears, and clinical breast exam (CBE); 2) identifying patterns of adherence; and 3) determining sociodemographics associated with compliance with all three exams. Design: Cross-sectional. Setting: Two urban family medicine clinics. Patients: A consecutive sample of 343 women presenting for care. Interventions: Women were staged (maintainers, actors, contemplators, precontemplators, relapse contemplators, and relapse precontemplators) according to self-reported receipt of mammography, CBEs, and Pap smears. Main Outcome Measures: Adherence across exams was assessed. Sociodemographics were compared among racial/ethnic groups for women adherent with all three exams. Results: Sixty-one percent were adherent with mammography, 93% with Pap smears, and 67% with CBEs. Thirty percent were contemplating mammography. Fifty-eight percent of Puerto Rican women were adherent with CBEs compared to 68.6% of African American and 78.5% of non-Hispanic White women. Puerto Rican women were less likely to be maintainers of CBE and more likely to be precontemplators and relapsers than non-Hispanic White women (P=.004). Forty-eight percent were adherent with all three exams. Puerto Rican women compliant with all three screens were younger and less educated than African American and non-Hispanic White women. Conclusions: Racial/ethnic differences in screening patterns exist among women attending urban family practice centers. Primary care providers must be culturally sensitive when recommending screening and can use staging as a tool to target women most receptive to intervention.