Mammography screening in African American women: evaluating the research.
BACKGROUND
Notwithstanding some controversy regarding the benefits of screening mammography, it is generally assumed that the effects are the same for women of all race/ethnic groups. Yet evidence for its efficacy from clinical trial studies comes primarily from the study of white women. It is likely that mammography is equally efficacious in white and African American women when applied under relatively optimal clinical trial conditions, but in actual practice African Americans may not be receiving equal benefit, as reflected in their later stage at diagnosis and greater mortality.


METHODS
Initial searches of Medline using search terms related to screening mammography, race, and other selected topics were supplemented with national data that are routinely published for cancer surveillance. Factors that potentially compromise the benefits of mammography as it is delivered in the current health care system to African American women were examined.


RESULTS
While there have been significant improvements in mammography screening utilization, observational data suggest that African American women may still not be receiving the full benefit. Potential explanatory factors include low use of repeat screening, inadequate followup for abnormal exams, higher prevalence of obesity and, possibly, breast density, and other biologic factors that contribute to younger age at diagnosis.


CONCLUSIONS
Further study of biologic factors that may contribute to limited mammography efficacy and poorer breast cancer outcomes in African American women is needed. In addition, strategies to increase repeat mammography screening and to ensure that women obtain needed followup of abnormal mammograms may increase early detection and improve survival among African Americans. Notwithstanding earlier age at diagnosis for African American women, mammography screening before age 40 years is not recommended, but screening of women aged 40-49 years is particularly critical.
Jones
Beth A
BA
Yale University School of Medicine, Department of Epidemiology and Public Health, New Haven, Connecticut 06520, USA. Beth.Jones@Yale.edu
Patterson
Elizabeth A
EA
Calvocoressi
Lisa
L
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D001940:Breast / Q000033:anatomy & histology; D005260:Female; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data; D009765:Obesity / Q000150:complications; D017410:Practice Guidelines as Topic; D014481:United States