Mammography screening in African American women

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Prostate cancer is the most frequently diagnosed cancer in males in the United States, accounting for an estimated 186,320 new cases in 2008. There are striking racial or ethnic differences in prostate cancer incidence and mortality rates in the United States, with Black males 1.6 times more likely to be diagnosed and 2.4 times more likely to die with prostate cancer than Whites. Stage at diagnosis is a key prognostic factor for prostate cancer survival, with African-Americans generally diagnosed at a more advanced stage. To identify factors that explain the race-stage disparity in prostate cancer, we conducted a population-based casecase study of 251 African-American (46%) and White (54%) prostate cancer cases diagnosed in Connecticut between January 1987 and October 1990. Multivariate logistic regression was used to identify potential explanatory factors, including clinical, sociodemographic, medical care, insurance, digital rectal examination screening history, and lifestyle factors. Cox proportional hazards models assessed the impact of study variables on race differences in long-term survival. Modifiable factors such as screening practice and sociodemographic factors accounted for >60% of the race difference in prostate cancer stage at diagnosis. Histologic grade (Gleason score) accounted for comparatively less. Survival analyses confirmed the importance of tumor characteristics, education, and insurance in explaining observed race differences in survival. Although cases were identified before the widespread use of prostate-specific antigen (PSA) screening, the results should also be relevant to countries that have large underserved populations and/or disparities in access to medical care and cancer screening. (Cancer Epidemiol Biomarkers Prev 2008;17(10):2825 -34)

Section: Discussionmentioning

confidence: 91%

Explaining the Race Difference in Prostate Cancer Stage at Diagnosis

Jones

Araujo

et al. 2008

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“…At a national level, the Black-White gap in one-time and recent mammography screening rates seems to be closing (21,131). However, several additional challenges remain.…”

Section: Discussionmentioning

confidence: 99%

“…Second, because the gap in Black-White screening rates lingers in certain U.S. states, future screening efforts would benefit from targeting those communities in particular. Third, although great strides have been made in increasing mammography utilization in the United States, data indicate that most women, regardless of race or ethnicity, fail to engage in regular, repeated mammography screening (131). The success of screening programs depends upon repeat screening over time, and, therefore, future efforts should be directed at promoting repeat mammography screening.…”

Section: Discussionmentioning

confidence: 99%

Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review

Gerend

Pai

2008

265

213

Despite the recent decline in breast cancer mortality, African American women continue to die from breast cancer at higher rates than do White women. Beyond the fact that breast cancer tends to be a more biologically aggressive disease in African American than in White women, this disparity in breast cancer mortality also reflects social barriers that disproportionately affect African American women. These barriers hinder cancer prevention and control efforts and modify the biological expression of disease. The present review focuses on delineating social, economic, and cultural factors that are potentially responsible for Black-White disparities in breast cancer mortality. This review was guided by the social determinants of health disparities model, a model that identifies barriers associated with poverty, culture, and social injustice as major causes of health disparities. These barriers, in concert with genetic, biological, and environmental factors, can promote differential outcomes for African American and White women along the entire breast cancer continuum, from screening and early detection to treatment and survival. Barriers related to poverty include lack of a primary care physician, inadequate health insurance, and poor access to health care. Barriers related to culture include perceived invulnerability, folk beliefs, and a general mistrust of the health care system. Barriers related to social injustice include racial profiling and discrimination. Many of these barriers are potentially modifiable. Thus, in addition to biomedical advancements, future efforts to reduce disparities in breast cancer mortality should address social barriers that perpetuate disparities among African American and White women in the United States. (Cancer Epidemiol Biomarkers Prev 2008;17(11):2913 -23) During the last two decades, there has been a growing Black-White disparity in breast cancer mortality (1). Although the overall rate of mortality from breast cancer has been decreasing since the early 1980s, this decrease has occurred at a much faster pace for White women than it has for African American women (Fig. 1). This finding is especially noteworthy because the lifetime incidence of breast cancer is actually lower, not higher, among African American women than among their White counterparts (1).What factors might be responsible for this racial disparity in mortality from breast cancer? Poorer outcomes in African American women, in part, reflect the fact that breast cancer tends to be a more biologically aggressive disease in African Americans than in White Americans (2-6). In addition to biological factors, these disparities also reflect social, economic, and cultural barriers that disproportionately affect African American women. Barriers such as poverty and racism both hinder cancer prevention and control efforts and modify the biological expression of disease (7-10). The current review focuses on delineating the social, economic, and cultural factors potentially responsible for Black-White disparities i...

“…(b) Nonadherence to mammography screening guidelines was measured prospectively, with predictors collected at baseline, allowing for correct temporal sequencing. (c ) The outcome addressed regular mammography screening behavior rather than one-time or recent use, an outcome more closely related to receiving the full benefit of mammography (56). (d) In addition to the benefit of having a large sample size of both African-American and White women, extensive data on many aspects of the mammography process were collected, including mammography-specific variables and factors relevant to health disparities that may confound, mediate, or moderate the relationships between neighborhood-level SES and nonadherence to mammography screening guidelines.…”

Section: Discussionmentioning

confidence: 99%

Neighborhood-Level Socioeconomic Predictors of Nonadherence to Mammography Screening Guidelines

Dailey

Kasl

Holford

et al. 2007

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As neighborhood context is increasingly recognized as an important predictor of health outcomes and health behaviors, this analysis sought to determine the relationship between neighborhood-level socioeconomic status (SES) and regular mammography screening behavior. One thousand four hundred fifty-one women ages 40 to 79 years who obtained an ''index'' screening mammogram at one of five urban hospitals in Connecticut between October 1996 and January 1998 were enrolled in this prospective study. The logistic regression analysis includes the 1,229 women [484 African-American (39%) and 745 White (61%)] who completed telephone interviews at baseline and followup (average 29.4 months later) and for whom the study outcome, nonadherence to age-specific mammography screening guidelines, was ascertained. Neighborhoodlevel SES was determined using 1990 census tract information. Neighborhood-level SES variables (quartiles) were associated with nonadherence for AfricanAmerican women [neighborhood-level education and composite socioeconomic position index (SEP Index)] and White women (neighborhood-level crowding and neighborhood-level assets). Using race-specific categorizations reflective of individual-level SES distributions, the SEP Index and neighborhood-level education were associated with nonadherence to mammography screening guidelines for African-American women (marginally significant for White women), independent of individual-level SES and other known predictors of mammography screening use [AfricanAmerican women: SEP Index odds ratio (OR), 3.55; 95% confidence interval (95% CI), 1.