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Grant Details

Grant Number: 5R03CA091734-02 Interpret this number
Primary Investigator: Schootman, Mario
Organization: Washington University
Project Title: Gis, Multilevel Modeling and Breast Cancer Screening
Fiscal Year: 2002


Certain segments of the population (e.g., women of low income and those without health insurance) are less likely screened for breast cancer despite its proven effectiveness to reduce the risks heath from this disease. although differences exist between rural and urban populations that are associated with use of screening, rural urban screening differences need further investigation. Most studies that have shown rural women are less likely screened are several years old. these studies have typically asked screening differences at the county level and not used lower levels of geography such as Census tracts. they ave typically used only individual level factors as potential barriers to screening and ignored the influence of ecological factors (e.g., area deprivation and income inequality) using multilevel models. Finally, these studies did not have the added advantage of using newly developed methods, such as geographic information systems (GIS). Other studies have not found rural-urban screening differences. As a result, it is not clear if rural women are less likely screened when taking a more rigorous approach using multilevel modeling in connection with GIS. In the proposed study, we will use a one-stage stratified cluster sampling method and multilevel approach in connection with a GIS to describe rural urban screening differences and identify ecological barriers to early detection. Following the random selection of Census tracts stratified by their rurality, we will use the Mitofsky-Waksberg random digit dating method to identify women aged 50-69. Eligible women will be interviewed by telephone about their breast cancer screening and individual level factors including demographics, access to health care, and psychological barriers. Ecological factors will be obtained from existing data sources and include social disorganization, area deprivation, country mammography rates, physician distribution, and availability of mammography facilities. Multilevel modeling and GIS facilitate new and exciting opportunities that could identify new barriers to screening, which may be used to reduce breast cancer mortality by implementing multilevel interventions. Few studies focusing on breast cancer screening have taken this approach, which we, and others feel is warranted.


Geographic disparity, area poverty, and human papillomavirus vaccination.
Authors: Pruitt S.L. , Schootman M. .
Source: American journal of preventive medicine, 2010 May; 38(5), p. 525-33.
PMID: 20409501
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Racial and geographic differences in mammography screening in St. Louis City: a multilevel study.
Authors: Lian M. , Jeffe D.B. , Schootman M. .
Source: Journal of urban health : bulletin of the New York Academy of Medicine, 2008 Sep; 85(5), p. 677-92.
EPub date: 2008-07-12.
PMID: 18622709
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Breast cancer screening and incidence in communities with a high proportion of uninsured.
Authors: Schootman M. , Walker M.S. , Jeffe D.B. , Rohrer J.E. , Baker E.A. .
Source: American journal of preventive medicine, 2007 Nov; 33(5), p. 379-386.
PMID: 17950403
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The effects of radiotherapy for the treatment of contralateral breast cancer.
Authors: Schootman M. , Jeffe D.B. , Gillanders W.E. , Yan Y. , Aft R. .
Source: Breast cancer research and treatment, 2007 May; 103(1), p. 77-83.
EPub date: 2006-10-11.
PMID: 17033921
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Prognosis of metachronous contralateral breast cancer according to stage at diagnosis: the importance of early detection.
Authors: Schootman M. , Fuortes L. , Aft R. .
Source: Breast cancer research and treatment, 2006 Sep; 99(1), p. 91-5.
EPub date: 2006-03-23.
PMID: 16555124
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Effect of area poverty rate on cancer screening across US communities.
Authors: Schootman M. , Jeffe D.B. , Baker E.A. , Walker M.S. .
Source: Journal of epidemiology and community health, 2006 Mar; 60(3), p. 202-7.
PMID: 16476748
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A Bayesian semi-parametric model for colorectal cancer incidences.
Authors: Zhang S. , Sun D. , He C.Z. , Schootman M. .
Source: Statistics in medicine, 2006-01-30; 25(2), p. 285-309.
PMID: 16381075
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Evaluating the utility and accuracy of a reverse telephone directory to identify the location of survey respondents.
Authors: Schootman M. , Jeffe D. , Kinman E. , Higgs G. , Jackson-Thompson J. .
Source: Annals of epidemiology, 2005 Feb; 15(2), p. 160-6.
PMID: 15652722
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The full potential of breast cancer screening use to reduce mortality has not yet been realized in the United States.
Authors: Schootman M. , Jeffe D. , Reschke A. , Aft R. .
Source: Breast cancer research and treatment, 2004 Jun; 85(3), p. 219-22.
PMID: 15111759
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Small-area incidence trends in breast cancer.
Authors: Schootman M. , Sun D. .
Source: Epidemiology (Cambridge, Mass.), 2004 May; 15(3), p. 300-7.
PMID: 15097010
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