Racial and Geographic Differences in Mammography Screening in St. Louis City: A Multilevel Study

Abstract

To examine racial differences in mammography use and its determinants in the City of St. Louis, MO, USA, we recruited women age 40 or older using randomdigit dialing to (1) examine the difference in mammography use between white women and African American women and (2) identify individual-and census-tract-level risk factors of nonadherence to mammography. During telephone interviews, we inquired about mammography use and several demographic, psychosocial, and health behavior variables. We determined the residential census tracts of study subjects using a geographic information system. The rate of mammography use was 68.0% among white women and 74.7% among African American women (P=0.022). African American women were more likely to have mammograms than white woman (adjusted odds ratio [OR]=1.71; 95% confidence interval [CI]=1.09-2.69). System-level barriers to mammography and heavy smoking were associated with lower mammography use among both white and African American women. Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography use among white women. White women residing within a historic geographic cluster area of late-stage breast cancer were less likely to have mammograms (adjusted OR=0.42, 95% CI=0.22-0.80), while African American women residing within a historic geographic cluster area of late-stage breast cancer were equally likely to have mammograms (adjusted OR=0.79, 95% CI=0.28-2.24). Neither individualnor census-tract-level socioeconomic status was associated with mammography screening. These findings suggest that there may be a greater need for increasing mammography use among white women, especially in the historic cluster area of latestage breast cancer in St. Louis.

Utilization of Screening Mammography Among Middle-Aged and Older Women

“…Whereas marked racial/ethnic disparities in breast cancer screening were noted historically, 39 our findings are consistent with other studies that report African Americans may actually have higher screening rates than their non-Hispanic white counterparts 40,41 and that differences in screening rates are minimized for members of health maintenance organization (HMO). 42 As seen in other studies, 43 depressive symptomatology has been associated with the underuse of medical screenings, including mammograms, and poor adherence to treatment regimens and a subsequently poorer overall health status.…”

“…3 Despite the known benefits of annual or biannual screening mammography beginning at age 40 or 50, 4 approximately 25%-50% of American women report not having a mammogram in the past 2 years. 4,5 High variation in average rates of screening mammography adherence can be attributed to the lack of consensus about the efficacy of screening for women aged [40][41][42][43][44][45][46][47][48][49], variation in availability of screening facilities, and other factors that may disproportionately impact those residing in communities with fewer healthcare resources. 6 Elting et al 7 documented that mammography facilities were available in only 49% of Texas counties.…”

Medical Barriers to Mammography Screening of African American Women in a High Cancer Mortality Area: Implications for Cancer Educators and Health Providers

“…They are onerous, as is lack of structural capability in lower income residential areas. There are fewer primary care providers and mammography facilities, less preventive care, and the population often lacks transportation [6,[10][11][12][13][14][15][16][17][18][19][20]. Continuing efforts to reach lower income and African American populations include a community approach that reduces income, insurance, and other structural barriers with free or low-cost mammograms, and mobile units that schedule visits in medically underserved areas (MUAs) [6,8,19].…”

Two years' observational study of racial difference of breast cancer in patients presenting to a tertiary care hospital serving indigent population

“…Since black women are more obese than their white counterparts, one study found out that obesity played some part (30%) in the racial difference at breast cancer diagnosis; however the conclusion of the study was that even after adjustment for obesity, the racial difference in stage of breast cancer at diagnosis still persists. 9 Two studies 10,11 showed that in later years there is a higher incidence of breast cancer in white women than the black women. We observed a statistically significant racial difference among black and white women presenting to EA Conway Medical Center with regards to age at diagnosis.…”

“…Personal-experience barriers to mammography and no physician recommendation also were independently associated with mammography use among white women in this study. 10 Compliance with appointment keeping and alleviating reasons for noncompliance must be considered as factors in breast cancer survival as missed appointments was a determinantof both advanced stage and shorter survival. 12 Important factors affecting breast carcinoma development are reproductive experience, genetics and the environment, effects of endogenous and exogenous hormones, the change in immune status and host vulnerability.Additionally, socioeconomic differences, cultural dynamicsand behavioral characteristics across population subgroups modulate howbiologic disease is expressed among different races and ethnic groups.…”