While the focus of this paper is not on screening, it should be stated that to the extent breast cancer screening has a meaningful impact on stage at diagnosis, it is important in addressing the disparities discussed here. However, the contribution that mammography has made is not clear at this point.
A recent study on cancer screening in California was prepared by the UCLA Center for Health Policy Research.40 While three-fourths of California women now report that they've had a mammogram in the past two years, rates are lower among Asians, American Indians, Alaska Natives, and Latinas. Interestingly enough, data from the 2001 California Health Interview Survey show that 78 percent of both white and black women have received mammograms.
A yet-to-be-published report41 from the Cancer Surveillance Section, Department of Health Services and the Survey Research Group, Public Health Institute, on utilization of screening mammography from 1987–2000 in California, found that during the most recent period studied, more black women aged 40 and over (93.5 percent) actually reported having had a mammogram, than did white women over 40 (90 percent). This was particularly true among black women aged 40–49, suggesting that the message about younger onset of breast cancer in black women has been effectively communicated. Of course it is important to keep in mind that the debate about screening premenopausal women, who are more likely to have dense breasts, is far from settled. All too frequently, we hear stories about false negatives in these young women, who may be lulled into complacency by a clear mammography report.
If mammography does ensure earlier detection, and if this early detection will lead to lowered mortality for all ages and racial/ethnic groups, then the disparity between black and white outcomes in breast cancer should decrease over time. However, the disparities have not decreased to date. The fact that there has been no noticeable improvement in outcomes for black women, despite the high utilization of screening among black women in California, is striking. If there is no improvement in outcome within the next several years, this will raise some important doubts about the utility of screening in saving lives. This is a fertile area for research.
The UCLA study shows that despite available free testing for lower income women, utilization lags behind that of higher income women. And within the lower income groups, the study found that Latinas, Asians, American Indians, and Alaska Natives are much less likely to seek screening. However, among those covered by Medi-Cal, screening utilization across races is more equivalent, suggesting that access to screening and treatment may play a role in whether women take an active role in their health care by seeking mammographic screening.