Ethnic Differences in Mammography Use among Older Women: Overcoming the Barriers

Ethnicity is thought to be a significant factor in breast cancer. Although the incidence of the disease is lower among black women, mortality in this group is disproportionally high [1]. Improvements in mortality have been seen across all age and ethnic groups, but the 5-year disease-free survival rate among black women with breast cancer (69%) continues to lag behind that in white women (84%) [2]. Several studies [3, 4] show that older black women have substantially lower rates of mammography use and higher rates of late-stage breast cancer at diagnosis than their white counterparts. Whether this differential use of mammography explains the ethnic differences in stage at diagnosis has been the subject of ongoing debate [5, 6].

In this issue, McCarthy and colleagues present the results of their retrospective cohort study on the use of mammography and its link to stage at diagnosis among women 67 years of age and older [7]. Despite the retrospective nature of the data and the small number of black women (4%), the study adds to our understanding of mammography and breast cancer outcomes. It suggests that previous use of mammography is strongly and equally associated with stage at diagnosis in both black and white women 65 years of age and older. However, significantly more black women than white women did not use mammography (35% and 22%). A black-white stage differential is evident only in these mammography nonusers, and this excess in late-stage diagnosis persists despite adjustment for sociodemographic factors. The message is clear: All older women benefit equally from regular screening mammography, and its lower use by black women …