Abstract
Mammogram-detected breast cancers have a better prognosis than those identified through clinical breast exam (CBE) or through self-detection, primarily because tumors detected by mammography are more likely to be smaller and do not involve regional nodes. In a sample of 1,322 Black women, aged 40-75 years, diagnosed with breast cancer between 2002 and 2016, we evaluated factors associated with CBE and self-detection versus screening mammogram as the initial mode of breast cancer detection, using multivariable logistic regression models. Compared with screening mammogram, history of routine screening mammogram (OR 0.20, 95% CI: 0.07, 0.54) and performance of breast self-examination (BSE) (OR 0.31, 95% CI: 0.13, 0.74) before diagnosis were associated with lower odds of CBE as the initial mode of detection, while performance of CBEs before diagnosis (OR 11.04, 95% CI: 2.24, 54.55) was positively associated. Lower body mass index (<25.0 kg/m2 vs. ≥35.0 kg/m2: OR 2.46, 95% CI: 1.52, 3.98), performance of BSEs before diagnosis (less than once per month: OR 4.08, 95% CI: 2.45, 6.78; at least monthly: OR 4.99, 95% CI: 3.13, 7.97), and larger tumor size (1.0-2.0 cm vs. <1.0 cm: OR 2.92, 95% CI: 1.84, 4.64; >2.0 cm vs. <1.0 cm: OR 6.41, 95% CI: 3.30, 12.46) were associated with increased odds of self-detection relative to screening mammogram. The odds of CBE and self-detection as initial modes of breast cancer detection among Black women are independently associated with breast care and breast cancer screening services before diagnosis and with larger tumors at diagnosis.
Highlights
Breast cancer incidence rates have been historically lower among African American/Black women than White women [1,2,3,4,5], recent data showed that incidence rates among these groups converged as of 2012 [6]
Among the 1,643 Black Women’s Circle of Health Study (WCHS) participants enrolled, 1,322 women age 40-75 years, with initial mode of detection classified as screening mammogram, clinical breast exam(s) (CBE), or self-detection were included in the final analytic sample
No Yes Ever had a routine screening mammogram before breast cancer diagnosis No Yes Interval between breast cancer diagnosis and most recent routine screening mammogram 1 year Unknown Ever had a doctor perform a clinical breast exam(s) (CBE) before breast cancer diagnosis No Yes – last CBE performed within the last year Yes – last CBE performed more than one year ago Ever performed breast self-exams (BSEs) before breast cancer diagnosis No Yes – breast self-examination (BSE) performed less than once per month Yes – BSEs performed at least once per month Ever diagnosed with a benign breast disease before breast cancer diagnosis No Yes Breast tumor clinicopathologic features Tumor grade Well/moderately differentiated Poorly differentiated Unknown
Summary
Breast cancer incidence rates have been historically lower among African American/Black (hereafter “Black”) women than White women [1,2,3,4,5], recent data showed that incidence rates among these groups converged as of 2012 [6]. National data from 2010-2014 [11, 12] demonstrated that breast cancer mortality was at least 41% higher among Blacks than Whites. There are currently conflicting breast cancer screening guidelines, published by the United States Preventative Services Task Force (USPSTF) [13] and the American Cancer Society (ACS) [14], for women at average risk. The USPSTF recommends biennial screening among women aged 50-74 who are at average risk of breast cancer and the decision to begin screening prior to age 50 should be an individual one [13]. The ACS strongly recommends annual mammography screening for women aged 45-54 and biennial mammography screening starting at age 55 [14].
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