Prior Mammography Utilization: Does it Explain Black-White Differences in Breast Cancer Outcomes?

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Abstract : Older black women are diagnosed with advanced stage breast cancer more frequently than whites possibly because they receive fewer mammograms. We investigated the extent to which regular mammography use explains black-white differences in stage at diagnosis among older women with breast cancer. We studied black and white women, aged greater than or equal 67, diagnosed with breast cancer from 1987-1993, residing in three SEER Program areas. Women were classified based on their mammography use during the 2 years before diagnosis: non users (no prior mammograms), regular users (at least 2 mammograms at least 10 months apart), or peri-diagnosis users (only mammogram(s) within 3 months before diagnosis). Stage was classified as early (in situ/local) or late (regional/distant). Black women were more likely to be nonusers of mammography (OR=2.19, 95% Cl, 1.65-2.92) and to be diagnosed with late-stage disease (OR=1 .78,95% Cl, 1.34-2.35) than white women. When stratified by prior mammography use, the black-white difference in stage occurred only among nonusers (adjusted OR=1 .54,95% Cl, 1.04-2.28). Among regular users, blacks and whites were diagnosed at similar stages (adjusted OR=1 .01,95% Cl, 0.54-1.88). These results suggest that differences in stage between older blacks and whites are related to prior mammography use. Increased regular mammography use may result in a shift toward earlier stage disease and narrow observed differences in stage between older black and white women.