Results from the randomized trial underway in the Health Insurance Plan of Greater New York to determine the efficacy of periodic screening with mammography and palpation of the breast have been examined to determine the effect of screening on racial differences in breast cancer survival rates. Consistent with experience in general populations, the control group showed a lower five-year survival rate among non-White women with breast cancer than among White women. In the study group, 65 per centIn this paper, information from the randomized control trial to test the efficacy of screening for breast cancer* being conducted by the Health Insurance Plan of Greater New York (HIP) is utilized to examine differentials in survival rates among non-White women compared with White following diagnosis of breast cancer.Briefly, the situation in the general population is that Black women with breast cancer have a markedly poorer fiveyear relative survival rate** from breast cancer than White women as exemplified in Several explanations might be advanced for the relatively poor survival rates from breast cancer among Black women: e.g., differentials in diagnostic delay because of variations in recognition of signs and symptoms and care seeking behavior; quality of care; or the underlying biological course of breast cancer due to genetic or other host factors. Results from the HIP study discussed below suggest that secondary prevention programs may be an effective approach to changing the poor survival rate of Blacks.
The HIP StudyThe HIP study's design, methodology, and findings for all races combined have been reported extensively in the literature.4 The investigation was initiated toward the end of 1%3 to determine whether periodic screening with clinical examination and mammography results in reduced breast cancer mortality among women aged 40-64 years at time of entry. Women in this age group who were members of the Plan, a comprehensive prepaid group practice with a wide spectrum of socioeconomic groups of enrollees, were allocated through a stratified random procedure to study and control groups, each consisting of 31,000 individuals. Study women were offered screening examinations; the 65 per cent who appeared for the initial examination were offered three additional examinations at annual intervals unless earlier follow-up or biopsy was indicated; all but a small proportion (12 per cent) had at least one additional annual examination. Control women received their usual medical care which during the 1960s did not emphasize other early detection methods, e.g., breast self-examination.Screening ended in 1970 and follow-up of the tested cohorts of the study and control women, including those who are no longer enrolled in HIP, has continued to date to
Preliminary findings in a mass screening program for breast cancer give hope that repetitive breast examinations by physicians, together with mammography, will result in a lowered mortality from this disease. A random sample of 31,000 “study” women, aged 40–64, and a similarly constituted “control” group have been under observation. Among the women screened, it has been found that clinical and radiologic examinations contribute independently to case detection, that the clinical examination is effective at all ages, and that mammography's effectiveness is greatest in women aged 50 and over. A substantially lower 3½‐year case fatality rate has occurred in the study group as contrasted with the control group. To date, the effect on mortality is most noticeable for women aged 50–59 at diagnosis, follow‐up must continue for as much as 10 years to determine whether this reduction in deaths will be maintained.
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