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Most Women Start Annual Mammograms by Age 40

But many who are poor, lack insurance or don't speak English don't

MONDAY, Sept. 13, 2004 (HealthDayNews) -- The majority of women in the United States are getting their first screening mammogram for breast cancer at age 40, as recommended by health experts, a new study finds.

However, certain women -- particularly those who are poor, lack insurance or don't speak English -- are failing to get the imaging tests by 40, the researchers say.

The findings are a follow-up to a study published last year by the same group that found only 16 percent of women who have their first mammogram return at the correct annual interval for follow-up mammograms.

The research appears in the Sept. 13 online edition of CANCER.

Taken together, the two studies give women good marks for an initial mammogram but not for follow-up screenings, said James A. Colbert, lead author of the latest study.

Colbert and his colleagues looked at more than 72,000 women who got screening mammograms at Massachusetts General Hospital in Boston between January 1985 and February 2002.

"From that we selected a subpopulation of 940 who we found had a first mammogram between January 2000 and February 2002," said Colbert, a research assistant in the division of surgical oncology at the hospital.

The fact that 60 percent of the women had their first mammogram by the end of their 40th year is "considered very good," Colbert said.

However, some women fell short of the recommended guidelines. For instance, black women began screening at a median age of 41 years, about 0.7 years later than white women, the researchers found. And Hispanic women began screening at a median age of 41.4 years, 1.1 years later than non-Hispanic women.

Women without private health insurance began screening even later -- at a median age of 46.6 years, or 6.3 years later than women with private health coverage. And non-English speaking women began screening at a median age of 49.3 years, or nine years later than the English speakers, the study found.

The last to get their first mammogram were women who lacked private insurance and did not speak English. They had their first screening at a median age of 55.3 years.

In the study published last year, the researchers found the median time for return for a follow-up screening for women who had a mammogram in 1996 was 1.3 years. And about 25 percent failed to return by three years. Only 16 percent of the women who had a mammogram at the hospital in 1996 had five subsequent screenings during the next five years.

The new study wasn't designed to tell why the rate of the first screening mammogram was lower for those who didn't speak English or didn't have health insurance, Colbert said. "We hypothesize that it is due to a communication problem," he said.

The new study's findings ring true with Dr. Melvin Silverstein, a Los Angeles breast surgeon. He holds two positions -- a professor of surgery and director of the Lee Breast Center at the Norris Comprehensive Cancer Center at the University of Southern California and chief of the breast service at the USC/Los Angeles County Medical Center, a county hospital that serves many poor patients.

In these two jobs, Silverstein sees a wide spectrum of patients. The women who get mammograms at the Norris Center tend to get their cancers detected early because they don't miss their screenings. "I walk across the street to County and you would think I'd gone to a different country," he said.

At the county facility, Silverstein often sees women who have skipped their annual mammograms and, as a result, may have their breast cancers diagnosed at a later stage. "They are people who have to work, who can't take a day off" to get a screening mammogram, he said.

"It's a very good study," Silverstein said of the latest research. "It points out that some groups of women are doing a good job -- that is, English-speaking, well-insured, affluent women."

What's needed, Silverstein and Colbert agreed, is a way to get the message out to all women about the necessity of beginning mammograms at age 40, and getting follow-up screenings annually.

"At Massachusetts General, the staff spends two hours a day on the phone to remind patients about their mammogram appointments," Colbert said.

If a woman's hospital or HMO doesn't do that, he said, one way to remember is to schedule the annual mammogram on or near the same date each year. Or pick a date that's easily remembered, such as a day before or after a birthday.

More information

To learn more about mammograms, visit the American Cancer Society.

SOURCES: James A. Colbert, research assistant, Massachusetts General Hospital, Boston; Melvin Silverstein, M.D., professor, surgery, and director, Lee Breast Center, Norris Comprehensive Cancer Center, University of Southern California, and chief, breast service, USC/Los Angeles County Medical Center; Sept. 13, 2004, CANCER online
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