Black Women Often Miss Out on Mammogram Results

In many cases, findings don't reach women or are misinterpreted, study finds

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By
HealthDay Reporter

WEDNESDAY, Jan. 31, 2007 (HealthDay News) -- Mammography can detect breast cancer in its early, most treatable stages, but black American women may not be reaping the full benefit of this screening test.

The reason, according to a new study: Too many black women aren't understanding, or even receiving, the results of their mammograms.

"Communication of the results seems to break down more for black women than for white women," said lead researcher Beth A. Jones, an associate professor of epidemiology and public health at the Yale University School of Medicine.

"Black women were about twice as likely to get inadequate communication [on their mammogram results]," Jones said. Inadequate communication was defined as women reporting that they didn't hear back on their results, or that they did not fully understand them.

The study is expected to be published in the March issue of the American Journal of Public Health.

In the study, Jones' team compared the mammography results of 411 black women and 734 white women. All of the women underwent mammography at one of five hospital-based Connecticut facilities between October 1996 and January 1998.

In interviews, the women recounted their own impression of the mammogram results. The researchers then compared those results to the findings listed in the particular patient's medical record.

According to the researchers, black women were more likely to report that they did not get their results back or that they misunderstand them. This was true even after adjusting for factors such as income, education and other variables that might have affected the results.

Overall, 14.5 percent of all women in the study, regardless of race, either misunderstood their results or said the results were not adequately communicated to them. The majority (86 percent) of this group said they had not even received their results. A minority, 14 percent, said they had gotten a report back, but their interpretation differed from that outlined in their medical record.

Rates of poor communication almost doubled if the patient was black, the researchers noted. Of the 411 black women in the study, 86 -- almost 21 percent -- experienced inadequate communication about the results. Of the 734 white women, 80, or about 11 percent, said communication fell short.

Thirty-one percent of the black women who experienced inadequate communication had received an abnormal mammogram result, while just 6.5 percent of the white women who had inadequate communication had gotten an abnormal test.

Researchers have long known that black women are diagnosed with breast cancer at later stages than white women. Black women are also less likely than white women to be screened every one to two years for breast cancer, other research has found.

Jones' recent research may also help explain those racial disparities. "A big part of the communication problem is not receiving the results," she said.

She speculates that poor tracking might be to blame. Health-care providers, for instance, might not double check on the addresses of patients.

Or, "a letter arrives [with mammogram results], but it is not regarded as important information" and may be overlooked, Jones said.

Another expert, Dr. Rebecca Smith-Bindman, an associate professor of radiology, epidemiology and biostatistics at the University of California, San Francisco, called the findings intriguing.

But the data, she said, is relatively old. Since it has been collected, communication of results may have improved, thanks to more stringent federal requirements about notifying patients of their mammography results in writing.

Notification appeared to be the bigger problem, said Smith-Bindman, who is also an associate professor of obstetrics, gynecology and reproductive sciences at UCSF. Notification should have improved since the study was done, thanks to the stricter requirements, she said.

But what factors lead women to misunderstand the results of their mammogram? According to Smith-Bindman, denial could play a role.

The problem might improve if both consumers and health-care providers begin to pay closer attention to mammography follow-up, Jones said.

For health-care providers, she said, it might be as simple as double-checking patient addresses and telling women as they get their mammogram to look out for a letter with their test results within a specified time period. If they don't get such a letter, they should then call the clinic themselves, Jones said.

Women, Jones said, "have an obligation to see what the results are and, if the results are abnormal, to follow up. If they are not sure of the meaning of the results, they should call."

More information

Find out more about mammography at the American Cancer Society.

SOURCES: Beth A. Jones, Ph.D., M.P.H., associate professor, epidemiology and public health, Yale University School of Medicine, New Haven, Conn.; Rebecca Smith-Bindman, M.D., associate professor, radiology, epidemiology and biostatistics and obstetrics, gynecology and reproductive sciences, University of California, San Francisco; March 2007 American Journal of Public Health

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