Friday, March 18, 2016

Racial Disparities in Breast Cancer Screening

By: Sadia R. Choudhery, MD

I get this weird phone call every July from my mom. “Do I really have to?” “Yes, mom, you do. Each and every single year.” My mom absolutely abhors mammograms, and she calls me every summer asking me if she really needs her annual mammogram, especially as she grows older. Her explanation is always that none of her mammograms have ever been positive and that her four sisters and my grandmother did just “fine” without ever having had regular mammograms. She is absolutely correct in saying that. Growing up in a South Asian household, regular “anything” (dental cleanings, annual checkups, mammograms) was an anomaly. Regardless, my mother is absolutely wrong in thinking that her oldest daughter (i.e. me) would ever give her a “pass” on her annual mammogram.

With so much contradicting information about when to screen and how often, it has become perplexing for patients to grasp the gist of screening mammography. This is even truer in minority communities. Here are some insights on racial disparities in breast cancer screening:

• African American women have an up to 42% higher rate of breast cancer mortality in comparison to their Caucasian counterparts. Although differences in reproductive and cancer biology play a part, this has been attributed to lower screening rates leading to diagnoses of more advanced cancers among African-American women. However, recent data suggests that the gap in screening rates is closing, and that this higher mortality rate may in part be attributed to delays in and overall lower rates of follow-up exams after an abnormal mammogram. It is essential to arrange a follow-up visit in a timely manner if your screening mammogram has been abnormal. Many women who are called back after an abnormal mammogram require additional mammographic views or exams, but most are then discharged with benign or negative findings.

• Asian American women have higher rates of breast cancer screening and lower rates of breast cancer and breast cancer mortality that Caucasians.

• Hispanic American women have a lower rate of breast cancer and breast cancer mortality than Caucasian women, but their breast cancer screenings rates are lower than their Caucasian counterparts, and breast cancer remains the leading cause of mortality among Hispanic American women.

• Native American women have a slightly lower rate of breast cancer than Caucasians, which varies slightly depending on the geographic location. However, Native American women also have a lower rate of screening in comparison to Caucasian women and their survival rate is one of the lowest when all cancers are combined.

Discrepancies in breast cancer screening for these groups can at least partially be attributed to lack of access to medical care, including screening and education about disease prevention. We, as a society, should not forget that increasing access to breast cancer screening and reaching out to women of all ethnic and economic backgrounds is as vital in our fight against breast cancer as is development of enhanced screening, diagnostic, and treatment approaches.

The Society of Breast Imaging (SBI), the American College of Obstetricians and Gynecologists (ACOG), and the American College of Radiology (ACR) recommend annual screening beginning at the age of 40 because screening mammography SAVES lives. This fact must be repeated over and over again. I emphasize this to my mother frequently, and I have successfully convinced three of my four South Asian aunts to get annual mammograms. That is no easy task! While I work on my fourth aunt, you should work on getting your annual mammogram and convincing your mom, sister, aunt, grandmother, co-worker, and a complete stranger to get theirs!

Dr. Sadia R. Choudhery is a breast imager with an expertise in MRI and CT diagnosis. She is a member of the Society of Breast Imaging.

Howlader N, Noone AM, Krapcho M, et al., editors. SEER Cancer Fast Stats, 1975-2012. National Cancer Institute: Bethesda, MD, http://seer.cancer.gov/csr/1975_2012/, 2015.

American Cancer Society. Cancer Prevention & Early Detection Facts & Figures, 2015-2016. American Cancer Society, 2015.

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