Interventions to Enhance Breast Cancer Screening, Diagnosis, and Treatment among Racial and Ethnic Minority Women

Abstract

The authors conduct a systematic review of the literature to identify interventions designed to enhance breast cancer screening, diagnosis, and treatment among minority women. Most trials in this area have focused on breast cancer screening, while relatively few have addressed diagnostic testing or breast cancer treatment. Among patient-targeted screening interventions, those that are culturally tailored or addressed financial or logistical barriers are generally more effective than reminder-based interventions, especially among women with fewer financial resources and those without previous mammography. Chart-based reminders increase physician adherence to mammography guidelines but are less effective at increasing clinical breast examination. Several trials demonstrate that case management is an effective strategy for expediting diagnostic testing after screening abnormalities have been found. Additional support for these and other proven health care organization-based interventions appears justified and may be necessary to eliminate racial and ethnic breast cancer disparities. Keywords breast cancer; screening; diagnosis; treatment; race; ethnicity; interventionBreast cancer is the most common noncutaneous malignancy and the second most common cause of cancer death among U.S. women (Ries et al. 2005). With over 200,000 cases diagnosed each year, the lifetime risk of breast cancer among U.S. women is 1 in 8 (American Cancer Society 2005). Although breast cancer mortality declined by 2.3% per year between 1990 and 2002, racial and ethnic disparities increased during that time, primarily due to a greater decline in breast cancer mortality among white women compared to minority women (Jemal et al. 2004;Ries et al. 2005). Five-year female breast cancer survival is currently 87.5% among whites, 75.0% among blacks, 83.0% among Hispanics/Latinos, 89.4% among Asians/Pacific Islanders, and 79.6% among American Indians/Alaska Natives (Jemal et al. 2004).Disparities in breast cancer survival may be related to racial and ethnic differences at each stage of detection and management, including screening, timeliness of diagnostic testing after abnormal screening, quality of care during breast cancer treatment, and follow-up upon completion of breast cancer therapy (Aziz and Rowland 2002;McWhorter and Mayer 1987). No single element of care explains all of the mortality disparities. For example, breast cancer mortality remains higher among black women compared to white women despite evidence that screening mammography rates have been similar in these two groups since about 1993 ( Figure 1). In addition, compared to white women, Hispanic/Latino women have lower mammography rates and lower 5-year breast cancer survival, while Asian/Pacific Islander women have lower mammography rates and higher 5-year breast cancer survival (National Center for Health Statistics 2005;Jemal et al. 2004 (McPhee et al. 2002), these results suggest that screening mammography is only one of several factors important to racial/ethnic differen...

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