Does utilization of screening mammography explain racial and ethnic differences in breast cancer?
ABSTRACT Reasons for persistent differences in breast cancer mortality rates among various racial and ethnic groups have been difficult to ascertain.
To determine reasons for disparities in breast cancer outcomes across racial and ethnic groups.
The authors pooled data from 7 mammography registries that participate in the National Cancer Institute-funded Breast Cancer Surveillance Consortium. Cancer diagnoses were ascertained through linkage with pathology databases; Surveillance, Epidemiology, and End Results programs; and state tumor registries.
1,010,515 women 40 years of age and older who had at least 1 mammogram between 1996 and 2002; 17,558 of these women had diagnosed breast cancer.
Patterns of mammography and the probability of inadequate mammography screening were examined. The authors evaluated whether overall and advanced cancer rates were similar across racial and ethnic groups and whether these rates were affected by the use of mammography.
African-American, Hispanic, Asian, and Native American women were more likely than white women to have received inadequate mammographic screening (relative risk, 1.2 [95% CI, 1.2 to 1.2], 1.3 [CI, 1.2 to 1.3], 1.4 [CI, 1.3 to 1.4], and 1.2 [CI, 1.1 to 1.2] respectively). African-American women were more likely than white, Asian, and Native American women to have large, advanced-stage, high-grade, and lymph node-positive tumors of the breast. The observed differences in advanced cancer rates between African American and white women were attenuated or eliminated after the cohort was stratified by screening history. Among women who were previously screened at intervals of 4 to 41 months, African-American women were no more likely to have large, advanced-stage tumors or lymph node involvement than white women with the same screening history. African-American women had higher rates of high-grade tumors than white women regardless of screening history. The lower rates of advanced cancer among Asian and Native American women persisted when the cohort was stratified by mammography history.
Results are based on a cohort of women who had received mammographic evaluations.
African-American women are less likely to receive adequate mammographic screening than white women, which may explain the higher prevalence of advanced breast tumors among African-American women. Tumor characteristics may also contribute to differences in cancer outcomes because African-American women have higher-grade tumors than white women regardless of screening. These results suggest that adherence to recommended mammography screening intervals may reduce breast cancer mortality rates.
- SourceAvailable from: Garth H Rauscher
Mammography - Recent Advances, 03/2012; , ISBN: 978-953-51-0285-4
- "For example, in New York City the Black:White breast cancer disparity in 2005 was 37% (Whitman et al, 2011). These data suggest that Black women in Chicago are not benefiting from the technological advancements that have been made in early detection and treatment over the last two decades (Berry et al, 2005; Smith-Bindman et al, 2006; Tehranifar et al, 2009). "
[Show abstract] [Hide abstract]
- "Researchers have ascribed a large portion of this disparity in the late-stage diagnosis and poor survival of breast cancer to racial and ethnic differences in the utilization of mammography screening, which is a critical strategy in early detection and timely treatment of breast cancer (Smith-Bindman et al., 2006). The U.S. Preventive Services Task Force (2002) recommends that women have a mammogram every 1–2 years beginning at age 40 years. "
ABSTRACT: Although many studies have been focused on interventions designed to promote mammography screening among ethnic minority women, few summaries of the effectiveness of the interventions are available. The aim of this study was to determine the effectiveness of the interventions for improving mammography screening among asymptomatic ethnic minority women. A meta-analysis was performed on intervention studies designed to promote mammography use in samples of ethnic minority women. Random-effects estimates were calculated for interventions by measuring differences in intervention and control group screening rates postintervention. The overall mean weighted effect size for the 23 studies was 0.078 (Z = 4.414, p < .001), indicating that the interventions were effective in improving mammography use among ethnic minority women. For mammography intervention types, access-enhancing strategies had the biggest mean weighted effect size of 0.155 (Z = 4.488, p < .001), followed by 0.099 (Z = 6.552, p < .001) for individually directed approaches such as individual counseling or education. Tailored, theory-based interventions resulted in a bigger effect size compared with nontailored interventions (effect sizes = 0.101 vs. 0.076, respectively; p < .05 for all models). Of cultural strategies, ethnically matched intervention deliveries and offering culturally matched intervention materials had effect sizes of 0.067 (Z = 2.516, p = .012) and 0.051 (Z = 2.365, p = .018), respectively. Uniform improvement in mammography screening is a goal to address breast cancer disparities in ethnic minority communities in this country. The results of this meta-analysis suggest a need for increased use of a theory-based, tailored approach with enhancement of access.Nursing research 01/2009; 58(4):246-54. DOI:10.1097/NNR.0b013e3181ac0f7f
- [Show abstract] [Hide abstract]
ABSTRACT: La relation entre la vulnérabilité psychique et le cancer semble moins établie que celle entre la précarité sociale et certains facteurs liés au cancer. La fragilité psychique a été mise en cause dans certaines addictions facteurs de risque du cancer, comme le tabagisme. Les patients qui sont en précarité sociale risquent demoins bénéficier desméthodes de dépistage, d’avoir des traitements moins efficaces et finalement que le contrôle locorégional de leur pathologie et leur taux de survie soient plus faibles que ceux qui sont observés dans la population générale. Les personnes en précarité ne sont cependant pas opposantes, il n’y a pas de rejet systématique du système de santé, et ces personnes sont souvent très au courant des méthodes de dépistage et de leur intérêt. Quelle que soit la classe de précarité dont l’analyse a été faite, la demande de soins de la part des patients est réelle. Les problèmes principaux sont d’ordre organisationnel et de prise en charge. Le suivi des patients n’est pas toujours possible et la notion de « projet de vie » est souvent inexistante, ne permettant pas une organisation des soins. Dans le cadre des dépistages, celui-ci fait pour la population générale n’est pas adapté à une population en marge ou exclue. Des solutions sont possibles, mais elles engagent les structures de politique sociale et de santé mais aussi la conduite de chaque personnel de santé. The link between psychological vulnerability and cancer is not clearly established. However, there does appear to be a link between cancer and social marginality. Psychological fragility has been shown to be associated with tobacco addiction. Socially vulnerable people are at risk of undergoing screening less frequently and being treated less efficiently. These data could explain the deficit in terms of both monitoring of their pathologies and observed survival rates, compared with those relating to the general population. Such people do not refuse treatment or screening and are often well aware of screening methods and their usefulness, and wish to be treated if they are ill. The main problems relate to organisation and careprovision. Monitoring of such patients is not always possible and the notion of a “life-plan” is often nonexistent, thus preventing adequate management of the disease. Screening programs are not adapted for marginal and socially excluded populations. Solutions can be found but they depend on both social and health policies and the behaviour of every individual professional care-provider.Psycho-Oncologie 12/2008; 2(4):250-265. DOI:10.1007/s11839-008-0098-5