A new analysis has identified a significant delay in follow-up times among African-American women after the finding of a suspicious breast abnormality. Published in the December 15, 2009 issue of Cancer, a peer-reviewed journal of the American Cancer Society, the study indicates that African-American women may face obstacles to receiving appropriate breast cancer-related care.
In the United States, and particularly South Carolina, African-American women suffer disproportionately higher mortality rates from breast cancer compared to white women. Studies have indicated that African-American women experience significantly longer time intervals from an abnormal mammogram to diagnostic testing or are less likely to comply with recommended diagnostic follow-up exams within six months of an abnormal mammogram.
To investigate further, Swann Arp Adams, MS, PhD, of the University of South Carolina in Columbia, and her colleagues studied medical data from participants of the Best Chance Network, a state-wide service program that provides free mammography screenings to economically disadvantaged and medically underserved women. The program is part of the National Breast and Cervical Cancer Early Detection Program (NBCCEDP). Dr. Adams and her team analyzed tumor characteristics and patients' adherence to recommended tests following abnormal mammograms.
While African-American women were just as likely as white women to complete diagnostic procedures after abnormal mammography findings, there was a significantly longer time between the first clinical exam and to complete a diagnostic follow-up (median time = 44 days for African Americans and 40 days for European Americans). When time was measured in the number of days between the mammogram and the date of final status, a significant effect of race was no longer evident. Because the clinical breast examination typically precedes the diagnostic mammogram, these findings suggest that the racial differences may occur early in the process. While the reasons for the delay are unknown, they may result from poor communication between patient and doctor, lack of patient trust in her doctor, lack of transportation, proximity of clinics to the patient, and other factors.
The researchers say evidence indicates delayed follow-up of breast abnormalities can result in detecting the breast cancer at a later stage, pointing to one study that found a delayed diagnosis of breast cancer of as little as three months is associated with lower survival than those with prompt follow-up.
The researchers add that the finding of no disparities existing in the overall completion of the follow-up is an encouraging evaluation of the NBCCEDP, as it suggests that the program is making progress toward eliminating racial disparities in breast cancer and offer areas for strengthening.
"Programs specially aimed at providing breast cancer screening to economically disadvantaged women like the National Breast and Cervical Cancer Early Detection Program are successful in eliminating some of the racial disparities seen in breast cancer," said Dr. Adams. "There are still improvements that could be made in the program to help identify and eliminate barriers to timely completion of testing procedures," she added.
- Swann Arp Adams, Emily Rose Smith, James Hardin, Irene Prabhu Das, Jeanette Fulton, and James R. Hebert. Racial differences in follow-up of abnormal mammography findings among economically disadvantaged women. Cancer, 2009; DOI: 10.1002/cncr.24633
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