Where do women in the U.S. obtain a clinical breast examination and what factors are associated with where they get screened

A99 The U.S. Preventive Services Task Force, which concluded that there is insufficient evidence to recommend for or against routine clinical breast examination (CBE) alone to screen for breast cancer, recommends screening mammography every 1 to 2 years among women aged 40 and older, with or without CBE. Recent studies have suggested that CBE rates may vary according to patient, provider and health care system characteristics. We examined the locations where U.S. women received a CBE and other general preventive health care (clinic health center, private doctor’s office or HMO, hospital outpatient department (OPD), ER or “other” location, or none) among women aged 40 years and older (n = 11,037) who participated in the 2005 National Health Interview Survey (NHIS). We also examined predictors of location of receipt of general preventive health care (and recent CBE). Recent CBE use was defined as within the past two years. The overall household response rate was 86.5%, with an overall response rate for the sample adult module of 69.0.% Age-specific and crude rates of CBE use were calculated using SAS and SUDAAN. A multivariate analysis of predictors of locations where women likely received a recent CBE use, including locations where women receive care, was carried out using logistic regression techniques and SUDAAN. A majority of the women (79.4%) went to a doctor’s office or HMO for routine health care, followed by a clinic or health center (13.6%). About 1.0% of the women went to a hospital OPD for routine health care. At least 4.5% of the women did not receive preventive health care anywhere. The remainder of the women received preventive care at an ER or “other” location. Among all women, 65% reported a recent CBE. The highest rate was found among women receiving routine care from doctors’ offices and HMOs (68.5%). CBE use was somewhat lower among women receiving routine care from clinics or health centers (62.9%), and substantially lower among women receiving care from “other” locations (28.4%) or not reporting receiving preventive care (25.3%). Women older than 64 years were generally less likely than women aged 50-64 to report a recent CBE, although this was not significant among women cared for at clinics or health centers. Asian (46.0%) and Hispanic (49.9%) women were less likely than white (66.1%) and non-Hispanic (66.5%) women to report recent CBEs. This was true in both clinics and doctors’ offices. Married women were most likely to report an exam. Higher education was also associated with CBE use across settings, as were higher income, being employed, having health insurance or a usual source of care, being from the Midwest compared with the South, being born in the U.S., reporting a recent mammogram, and reporting a recent gynecology visit. In multivariate analysis, women who received routine care in a location other than a clinic or health center, doctors office or HMO, or hospital OPD were less to have received a recent CBE (adjusted OR = 0.5, 95% CI = 0.3, 0.8). After adjusting for patient factors, clinics/health centers and hospital OPDs performed as well as doctors’ offices/HMOs in delivering CBE. However, women receiving care in other locations were less likely to report CBE. “Healthcare providers should be aware ofrecognize the lower rates of CBE particularly among women with decreased access to health care. #