Cancer Control Research
5R01CA070731-04
Jones, Beth A.
RACE DIFFERENCES IN THE SCREENING MAMMOGRAPHY PROCESS
AbstractAlthough the benefits of screening mammography are well established among
white women, very little is known about the efficacy of mammography among
black women. This is the starting point for the proposed project which is
a direct outgrowth of an earlier study, supported by an AHCPR dissertation
research grant, Race Differences in Stage at Diagnosis of Breast Cancer.
The results of this earlier study suggested a race difference in efficacy
of screening mammography: a positive history of screening mammography was
protective against later stage at diagnosis in white women, but not in
black women. Given the importance of ensuring that the benefits of
screening mammography be the same for women of both races, this finding
calls for further exploration.
The general aims of this investigation are to: 1) assess variability in the
quality of the screening mammography process in the state of Connecticut,
and 2) examine how this variability is distributed between black and white
women. A strategy of surveying mammography facilities in Connecticut to
collect facility-based data (e.g., technical data on equipment, personnel,
and techniques) will be combined with assembling a cohort of 1000 (minimum)
black and white women, in approximately equal numbers, who have presented
for a screening mammogram in selected facilities in urban centers. These
women will be interviewed one month after the screening exam, and again two
years later. The first interview will provide data on individual
characteristics as well as the subject's encounter with the health care
setting (e.g., did she receive notification of results and recommendations
for future screening). These data will be used to evaluate race differences
in various aspects of the mammography process and to predict subsequent
screening behavior. The follow-up interview at 24 months will provide
outcome data on repeat screening, interval of screening, and resolution of
any breast problem which occurred since the index exam. A third component
is a pilot study to review the mammographic films of a subset of study
subjects to determine if there are differences in the quality of the film
itself which may be related to underlying biologic processes. Together,
these sources of data will be used to address the hypothesis that, in
practice, there are barriers to the full promise of mammography for some
women, and these women are more likely to be black than white.
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