Effects of Screening Mammography on the Comparative Survival Rates of African American, White, and Hispanic Beneficiaries of a Comprehensive Health Care System

Abstract

This study reviewed mammographic screening related to breast carcinoma diagnosis and treatment between 1987 and 1997 at Brooke Army Medical Center, San Antonio, TX. Epidemiologic data from the Department of Defense Automated Central Tumor Registry were merged with data from patients' medical records and responses of the patients or their families to a mailed survey. The cases of 907 women grouped by race-white, African American, and Hispanic-were analyzed. Breast carcinoma diagnosed by mammographic screening showed a reversed ratio of early to late stage of cancer occurring for all three groups. That ratio was 1.45 for African Americans, 2.67 for Hispanics, and 3.08 for whites. For those women diagnosed with screening mammography, no statistically significant difference in 5-year survival was found between the races: 86% for whites, 83% for Hispanics, and 80% for African Americans. Mammographic screening as a diagnostic tool appears to equalize survival among whites, Hispanics, and African Americans, in spite of differences in age, stage of diagnosis, and military rank used as a proxy for socioeconomic status. When not controlling for mammographic diagnosis, Kaplan-Meier analysis revealed significant differences in survival patterns between whites, Hispanics, and African Americans. Five-year survival rates were 71% for whites, 74% for Hispanics, and 53% for African Americans. Screening mammography reduced 5-year mortality by almost 59% in African Americans, 52% in whites, and 36% in Hispanics. Whites were diagnosed with breast carcinoma, on average, at 57 years of age-11 years later than African Americans (average age 46 years) and 7 years later than Hispanic women (average age 50 years). As a diagnostic tool, screening mammography was used to discover breast cancer in 36% of white women, 33% of Hispanics, and 22% of African Americans. Further research is recommended to examine the use of mammography among various racial/ethnic groups.

Elevated PCNA+ tumor-associated macrophages in breast cancer are associated with early recurrence and non-Caucasian ethnicity

“…While we were unable to assess mammography usage in this population, results from prior studies suggest that it would be unlikely to significantly change the results [70,71]. Early detection may not be as useful for high grade, rapidly growing tumors, of which there are an excess in African American and Hispanic women due to the association between young age and high-risk tumors.…”

Racial disparities in treatment and survival of women with stage I–III breast cancer at a large academic medical center in metropolitan Detroit

“…Survival trends for women with breast cancer have slowly improved over the past several decades [1], although disparities by race remain, with the majority of reports showing better survival for Caucasian compared with AA women [2][3][4][5][6][7][8][9][10][11][12][13]. An important question regarding racial differences in breast cancer survival pertains to the degree in which these differences are due to inherent biologic and/or genetic differences, social economic factors, and/or factors related to the quality of medical care received.…”

“…Numerous population-based studies using data from the Surveillance, Epidemiology and End Results (SEER) program [2][3][4][5][6][7][8][9][10] and other data bases [11][12][13], have been published showing worse prognostic features and lower survival rates for AA and other ethnic minority women with breast cancer compared with Caucasian women. A number of studies have also reported on racial differences in the patterns of care for women with breast cancer [8][9][10][11][12]14]. Unequal access to state-of-the-art cancer-directed treatment might, in part, explain racial differences in survival among women with breast cancer in this country.…”

Influence of birthplace on breast cancer diagnosis and treatment for Hispanic women

“…These disparities are mediated by many factors that promote and create barriers to screening and treatment, including socioeconomic characteristics, cultural beliefs, and health insurance status [12][13][14][15][16][17][18][19]. However, even in comprehensive, equal-access health care systems where access to screening and care is the same, Hispanic women are more likely to present with more advanced stage disease, at younger ages and with larger tumors than Caucasian women [20][21][22].Receipt of optimal breast cancer treatment has also been shown to differ between Hispanic and non-Hispanic white women. Even though the recommended care for most women with stage I or II breast cancer is breast-conserving surgery (BCS) with radiation or mastectomy [23], Hispanic women in the US have lower rates of BCS with radiation…”