title: Does access to screening through health maintenance organization membership translate into improved breast cancer outcomes for African American patients?
abstract: OBJECTIVE
  To investigate breast cancer outcomes in a group of African American and white patients offered the same access to mammography screening in a health maintenance organization located in suburban Philadelphia, Pennsylvania.
  
  
  METHODS
  We used medical chart reviews and retrospective tumor tissue studies to investigate disparities in the mode of diagnosis and breast cancer outcomes among African American and white patients in a health maintenance organization.
  
  
  RESULTS
  African American women were more likely to have detected their breast cancers accidentally and to have breast tumors larger than 2 cm than were whites. Invasive breast cancers with both lymph node involvement and systemic metastases were more prevalent in African American than in white women.
  
  
  CONCLUSIONS
  These results suggest that even in health care settings that provide access to routine screening, African American women are more likely to have their breast cancers diagnosed accidentally and at more advanced stages than their white counterparts.
authors.affiliation: Behavioral Sciences Division, Institute for Cancer Prevention, New York City, USA.
authors.forename: Renee
authors.initials: R
authors.lastname: Royak-Schaler
authors.forename: Shuquan
authors.initials: S
authors.lastname: Chen
authors.forename: Edith
authors.initials: E
authors.lastname: Zang
authors.forename: Raymond J
authors.initials: RJ
authors.lastname: Vivacqua
authors.forename: Monica
authors.initials: M
authors.lastname: Bynoe
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D001943:Breast Neoplasms / Q000145:classification / Q000175:diagnosis / Q000473:pathology; D005260:Female; D006279:Health Maintenance Organizations / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008403:Mass Screening; D008499:Medical Records; D008875:Middle Aged; D044465:White People; D014932:Women's Health Services / Q000706:statistics & numerical data*