title: Racial and Ethnic Disparity in Symptomatic Breast Cancer Awareness despite a Recent Screen: The Role of Tumor Biology and Mammography Facility Characteristics.
abstract: BACKGROUND
  In a racially and ethnically diverse sample of recently diagnosed urban patients with breast cancer, we examined associations of patient, tumor biology, and mammography facility characteristics on the probability of symptomatic discovery of their breast cancer despite a recent prior screening mammogram.
  
  
  METHODS
  In the Breast Cancer Care in Chicago study, self-reports at interview were used to define patients as having a screen-detected breast cancer or having symptomatic awareness despite a recent screening mammogram (SADRS), in the past 1 or 2 years. Patients with symptomatic breast cancer who did not report a recent prior screen were excluded from these analyses. Characteristics associated with more aggressive disease [estrogen receptor (ER)- and progesterone receptor (PR)-negative status and higher tumor grade] were abstracted from medical records. Mammogram facility characteristics that might indicate aspects of screening quality were defined and controlled for in some analyses.
  
  
  RESULTS
  SADRS was more common among non-Hispanic black and Hispanic than among non-Hispanic white patients (36% and 42% vs. 25%, respectively, P = 0.0004). SADRS was associated with ER/PR-negative and higher-grade disease. Patients screened at sites that relied on dedicated radiologists and sites that were breast imaging centers of excellence were less likely to report SADRS. Tumor and facility factors together accounted for two thirds of the disparity in SADRS (proportion mediated = 70%, P = 0.02).
  
  
  CONCLUSIONS
  Facility resources and tumor aggressiveness explain much of the racial/ethnic disparity in symptomatic breast cancer among recently screened patients.
  
  
  CONCLUSIONS
  A more equitable distribution of high-quality screening would ameliorate but not eliminate this disparity.
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Mylove
authors.initials: M
authors.lastname: Mortel
authors.affiliation: Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois. garthr@uic.edu.
authors.forename: Garth H
authors.initials: GH
authors.lastname: Rauscher
authors.affiliation: Metropolitan Chicago Breast Cancer Task Force, Chicago, Illinois.
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Murphy
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Kent
authors.initials: K
authors.lastname: Hoskins
authors.affiliation: Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.
authors.forename: Richard B
authors.initials: RB
authors.lastname: Warnecke
mesh_terms: D000328:Adult; D000368:Aged; D001364:Awareness; D001943:Breast Neoplasms / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000523:psychology; D002173:Cancer Care Facilities; D002641:Chicago / Q000453:epidemiology; D055088:Early Detection of Cancer / Q000379:methods*; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008327:Mammography; D008875:Middle Aged; D011379:Prognosis; D044469:Racial Groups; D012189:Retrospective Studies; D014505:Urban Population