African-American & Hispanic WomenMore Vulnerable in Breast Cancer Outcomes

Mammography Rates Tied to Ethnic Disparities in Breast Cancer Outcomes




NEW YORK (Reuters Health) Apr 17 - Although breast cancer survival overall has increased in recent years, African-American women still tend to have more advanced disease upon diagnosis and higher mortality compared with white women. Results of a large prospective study reported in the April 18th issue of Annals of Internal Medicine suggest that varying mammography-screening intervals may account for some of that difference.

Another study in the Annals supports the use of telephone call reminders and "prevention care managers" to facilitate cancer screening among women.

Dr. Rebecca Smith-Bindman of the University of California in San Francisco, and colleagues examined the role of patterns of mammography use by linking data from the Breast Cancer Surveillance Consortium with tumor registries.

The subjects included more than one million women ages 40 years and more who had undergone mammography at least once between 1996 and 2002. A total of 17,558 women received a first-time diagnosis of breast cancer.

Advanced stage tumors were more frequent in African-American and Hispanic women than whites upon diagnosis, and high-grade tumors were more likely in African-American, Hispanic, and Native American women.

The rate of large tumors increased from 1.8 per 1000 mammograms when performed at 1-year intervals, to 4.8 per 1000 when intervals were 4 years or more. White women were more likely than members of other ethnic groups to be screened every year or two.

When Dr. Smith-Bindman's group stratified the cohorts by screening history, the observed differences in advanced cancer rates between African American and white women were attenuated or eliminated. However, black women were still more likely to present with high-grade tumors. Similar stratification for Asian, Native American, and Hispanic women showed lower overall breast cancer rates and lower rates of advanced cancer compared with whites.

Regardless of ethnicity, "increased adherence to recommended mammography screening intervals... may result in decreased mortality rates," Dr. Smith-Bindman and her colleagues observe.

Dr. Allen J. Dietrich, from Dartmouth Medical School in Hanover, New Hampshire, and colleagues evaluated the effect of a telephone "support intervention" to increase screening among minority and low-income women.

They identified 1413 women, ages 50 to 69 years, who were patients at 11 community and migrant health centers in New York City and whose records showed that they were overdue for breast, cervical or colorectal cancer screening. The subjects were randomized to the intervention or to usual care over an 18-month period.

All women received literature regarding recommended preventive services, and those in the usual care group were called once to answer questions and advise them to have the needed tests performed.

Women in the intervention group received an average of four phone calls or letters (range, 1 to 20). The prevention care manager helped patients to identify and overcome barriers to screening, scheduled appointments, and assisted patients in locating transportation to appointments, as well as provided other motivational support.

In the intervention group, rates increased by 10% for Papanicolaou testing, by 17% for mammography, and by more than 60% for colorectal cancer screening. By the end of the study, the proportion who were up to date for all three forms of screening increased by 105%.

Dr. Dietrich and colleagues conclude that "the intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care."

Ann Intern Med 2006;144:541-553,563-571,614-616.