title: Reducing racial/ethnic disparities in female breast cancer: screening rates and stage at diagnosis.
abstract: OBJECTIVE
  We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity.
  
  
  METHODS
  We analyzed state cancer registry data linked to socioeconomic characteristics of patients' areas of residence for 1990-1998 time trends in the likelihood of early stage diagnosis. We appended each cancer registry record with matching subgroup estimates of self-reported mammography screening.
  
  
  RESULTS
  Trends in screening and stage at diagnosis were consistent within groups, but African American women had a significantly lower proportion of early stage cancers despite an advantage in screening. Population screening rates were significantly associated with early diagnosis, with a weaker association in African American women than White women (odds ratio [OR] = 1.70; P<.0001 vs OR=2.02; P<.0001, respectively).
  
  
  CONCLUSIONS
  Improvements in screening rates during the 1990s across racial/ethnic groups appear to have contributed significantly to earlier diagnosis within each group, but a smaller effect in African American women should raise concerns. A key health policy challenge is to ensure that screening effectively translates into earlier diagnosis.
authors.affiliation: Department of Social Policy, The London School of Economics and Political Science, London, United Kingdom. f.sassi@lse.ac.uk
authors.forename: Franco
authors.initials: F
authors.lastname: Sassi
authors.forename: Harold S
authors.initials: HS
authors.lastname: Luft
authors.forename: Edward
authors.initials: E
authors.lastname: Guadagnoli
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D040343:Behavioral Risk Factor Surveillance System; D001943:Breast Neoplasms / Q000000981:diagnostic imaging* / Q000208:ethnology*; D042241:Early Diagnosis; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data*; D008403:Mass Screening / Q000706:statistics & numerical data*; D008875:Middle Aged; D009367:Neoplasm Staging; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care / Q000208:ethnology*; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D014481:United States; D044465:White People / Q000706:statistics & numerical data*