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Does Utilization of Screening Mammography Explain Racial and Ethnic Differences in Breast Cancer?

Rebecca Smith-Bindman, MD; Diana L. Miglioretti, PhD; Nicole Lurie, MD, MSPH; Linn Abraham, MS; Rachel Ballard Barbash, MD, MPH; Jodi Strzelczyk, PhD; Mark Dignan, PhD; William E. Barlow, PhD; Cherry M. Beasley, MS, RNCS; and Karla Kerlikowske, MD
[+] Article and Author Information

From the University of California and San Francisco Veterans Affairs Medical Center, San Francisco, California; Group Health Cooperative, Seattle, Washington; RAND Corporation, Arlington, Virginia; National Cancer Institute, Bethesda, Maryland; University of Colorado Health Sciences Center, Denver, Colorado; University of Kentucky Prevention Research Center, Lexington, Kentucky; Cancer Research and Biostatistics, Seattle, Washington; and University of North Carolina, Pembroke, North Carolina.


Grant Support: By the Mount Zion Dean's Account, the California Breast Cancer Research Program, The Department of Defense Congressionally Directed Medical Research Programs, The National Cancer Institute (K07 CA86032), and National Cancer Institute–funded Breast Cancer Surveillance Consortium cooperative agreements (U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040.)

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Rebecca Smith-Bindman, MD, Department of Radiology, University of California, 1600 Divisadero Street, San Francisco, CA 94115; e-mail, Rebecca.Smith-Bindman@Radiology.UCSF.edu.

Current Author Addresses: Dr. Smith-Bindman: Department of Radiology, University of California, San Francisco, 1600 Divisadero Street, Room C250, San Francisco, CA 94115-1667.

Dr. Miglioretti and Ms. Abraham: Group Health Cooperative Center for Health Studies, 1730 Minor Avenue, Suite 1600, Seattle, WA 98101.

Dr. Lurie: RAND Corporation, 1200 South Hayes Street, Arlington, VA 22202.

Dr. Ballard Barbash: National Cancer Institute, Applied Research Program, Division of Cancer Control and Population Sciences, 6130 Executive Boulevard, Bethesda, MD 20892-7344.

Dr. Strzelczyk: School of Medicine, University of Colorado Health Sciences Center, Denver, CO 80262.

Dr. Dignan: University of Kentucky Prevention Research Center, 2365 Harrodsburg Road, Suite B100, Lexington, KY 40504.

Dr. Barlow: Cancer Research and Biostatistics, 1730 Minor Avenue, Suite 1900, Seattle WA 98101.

Ms. Beasley: Department of Nursing, University of North Carolina Pembroke, 1 University Drive, Pembroke, NC 28372.

Dr. Kerlikowske: General Internal Medicine Section, Department of Veterans Affairs, University of California, San Francisco, 4150 Clement Street, 111A1, San Francisco, CA 94121.

Author Contributions: Conception and design: R. Smith-Bindman, D.L. Miglioretti, N. Lurie, R.B. Barbash, J. Strzelczyk, M. Dignan, W.E. Barlow, K. Kerlikowske.

Analysis and interpretation of the data: R. Smith-Bindman, D.L. Miglioretti, N. Lurie, L. Abraham, R.B. Barbash, W.E. Barlow, K. Kerlikowske.

Drafting of the article: R. Smith-Bindman, D.L. Miglioretti, N. Lurie, R.B. Barbash, M. Dignan, W.E. Barlow, K. Kerlikowske.

Critical revision of the article for important intellectual content: R. Smith-Bindman, D.L. Miglioretti, N. Lurie, R.B. Barbash, J. Strzelczyk, M. Dignan, W.E. Barlow, C.M. Beasley, K. Kerlikowske.

Final approval of the article: R. Smith-Bindman, D.L. Miglioretti, N. Lurie, R.B. Barbash, M. Dignan, W.E. Barlow, C.M. Beasley, K. Kerlikowske.

Provision of study materials or patients: M. Dignan, K. Kerlikowske.

Statistical expertise: R. Smith-Bindman, D.L. Miglioretti, L. Abraham, W.E. Barlow.

Obtaining of funding: R. Smith-Bindman, N. Lurie, K. Kerlikowske, D.L. Miglioretti, W.E. Barlow.

Administrative, technical, or logistic support: R. Smith-Bindman.

Collection and assembly of data: R. Smith-Bindman, L. Abraham, C.M. Beasley, K. Kerlikowske, D.L. Miglioretti.


Ann Intern Med. 2006;144(8):541-553. doi:10.7326/0003-4819-144-8-200604180-00004
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Between 1996 and 2002, 1 010 515 women who were 40 years of age and older had 2 588 479 eligible mammograms within the Breast Cancer Surveillance Consortium. Of these, 17 558 women received a first-time diagnosis of breast cancer. Demographic characteristics are shown in (Table 2). Overall, 83.5% of the tumors detected were invasive; of these, 43% were stage 2 or higher and 33% were grade 3 or 4. Advanced-stage tumors were more likely to be diagnosed in African-American and Hispanic women than in white women (P < 0.001 for both), and high-grade tumors were more likely to be diagnosed in African-American (P < 0.001), Hispanic (P = 0.008), and Native American (P = 0.017) women than in white women.

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Figures

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Figure 1.
Overall breast cancer rates per 1000 mammograms by racial and ethnic group and mammography screening interval group, adjusted to the age and registry distribution of the mammography registry cohort.

Rates were calculated as the number of tumors occurring within 365 days after mammography or before the next mammogram, whichever came first. Values shown in boldface are statistically significant. *Includes asymptomatic women who were undergoing their first-ever mammogram for screening purposes only.

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Figure 2.
Rates of large (>15 mm) tumors per 1000 mammograms by racial and ethnic group and mammography screening interval group, adjusted to the age and registry distribution of the mammography registry cohort.

Rates were calculated as the number of tumors occurring within 365 days after mammography or before the next mammogram, whichever came first. Values shown in boldface are statistically significant. *Includes asymptomatic women who were undergoing their first-ever mammogram for screening purposes only.

Grahic Jump Location
Grahic Jump Location
Figure 3.
Rates of advanced-stage tumors per 1000 mammograms by racial and ethnic group and mammography screening interval group, adjusted to the age and registry distribution of the mammography registry cohort.

Rates were calculated as the number of tumors occurring within 365 days after mammogram or before the next mammogram, whichever came first. Values shown in boldface are statistically significant. *Includes asymptomatic women who were undergoing their first-ever mammogram for screening purposes only.

Grahic Jump Location
Grahic Jump Location
Figure 4.
Rates of lymph node–positive tumors per 1000 mammograms by racial and ethnic group and mammography screening interval group, adjusted to the age and registry distribution of the mammography registry cohort.

Rates were calculated as the number of tumors occurring within 365 days after mammography or before the next mammogram, whichever came first. Values shown in boldface are statistically significant. *Includes asymptomatic women who were undergoing their first-ever mammogram for screening purposes only.

Grahic Jump Location
Grahic Jump Location
Figure 5.
Rates of high-grade tumors per 1000 mammograms by racial and ethnic group and mammography screening interval group, adjusted to the age and registry distribution of the mammography registry cohort.

Rates were calculated as the number of tumors occurring within 365 days after mammography or before the next mammogram, whichever came first. Values shown in boldface are statistically significant. *Includes asymptomatic women who were undergoing their first-ever mammogram for screening purposes only.

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Summary for Patients

Does Use of Screening Mammography Explain Racial and Ethnic Differences in Death from Breast Cancer?

The summary below is from the full report titled “Does Utilization of Screening Mammography Explain Racial and Ethnic Differences in Breast Cancer?” It is in the 18 April 2006 issue of Annals of Internal Medicine (volume 144, pages 541-553). The authors are R. Smith-Bindman, D.L. Miglioretti, N. Lurie, L. Abraham, R. Ballard Barbash, J. Strzelczyk, M. Dignan, W.E. Barlow, C.M. Beasley, and K. Kerlikowske.

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