Press Releases: National
November 8, 2005
Women Refuse Follow-up Tests for Breast Cancer Despite Access to Care
Kaiser Permanente Research Shows That Refusers Tend to Be Older and Have More Children
OAKLAND, Calif. – In a study of women with breast cancer, Kaiser Permanente researchers and others examined characteristics of women who refused recommended follow-up testing after a positive breast cancer screening test, or a visit to a medical provider for breast cancer symptoms. Those refusing were more likely to be 75 or older and have six or more children. The study appears in the Nov. 8, 2005 issue of the Journal of the National Cancer Institute.
"What is surprising is that these women who declined the recommended follow-up procedures were getting regular medical care and had a number of clinical visits prior to cancer diagnosis," says lead researcher Sheila Weinmann, PhD, with Kaiser Permanente's Center for Health Research in Portland, Ore.
"Results of this study showed that refusal was not associated with socioeconomic status or race," says Joyce Gilbert, MPH, formerly a researcher with Kaiser Permanente's Center for Health Research in Hawaii. Gilbert, now with Kaiser Permanente's Care Management Institute, says that "the nature of refusal is not yet fully understood."
Researchers found the most frequently documented reasons women refused follow-up care included denying there was a problem or having a fatalistic view of their medical prognosis. Others expressed fear of further diagnostic tests and surgery and fear of discomfort from a mammogram. Most refusals occurred at a clinical visit but some also took place during mammography appointments or during follow-up telephone calls. Sixty-one percent of the refusers had breast cancer symptoms noted in their medical chart sometime within the three years before breast cancer diagnosis.
The study looked at medical records of 1,347 women age 50 and older who had been diagnosed with late-stage breast cancer and an equal number of women with early-stage breast cancer. The women, who were diagnosed from 1995 to 1999, were from five Kaiser Permanente sites and two other nonprofit health care systems that are part of the Cancer Research Network, a consortium of research organizations affiliated with nonprofit integrated health care delivery systems and the National Cancer Institute.
Seven percent of the women refused a health provider's advice for a follow-up procedure sometime during the three years before diagnosis. The women refusing breast cancer follow-up services were almost twice as likely as non-refusers to be in the late-stage group.
Researchers were affiliated with the following: Kaiser Permanente's Northwest, Hawaii, Southern California, Colorado and Northern California regions; Group Health Cooperative, Seattle; Henry Ford Health System, Detroit; and Medical University of South Carolina, Charleston.
Kaiser Permanente has research offices in California, Oregon, Hawaii, Georgia, Colorado, Maryland, and Ohio. Results of research conducted by Kaiser Permanente physicians and investigators have been published in the Journal of the American Medical Association, the New England Journal of Medicine, the Permanente Journal, the American Journal of Public Health, Pediatrics, and other clinical journals. Kaiser Permanente is America's leading integrated health plan.
About Kaiser Permanente
Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve 8.6 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
