CHAPEL HILL - In 1997, University of North Carolina at Chapel Hill researchers found that black women in eastern North Carolina were only about half as likely as white women to have undergone mammography. Also, doctors there were only about half as likely to recommend the potentially life-saving screening procedure to black women.
Now, a new study conducted by the same investigators shows that money -- and to a lesser degree, the level of formal education women received -- explained the racial differences. The scientists believe their findings are relevant to other parts of the United States. "This information is important because to some extent we can deal with money issues," said Dr. Michael S. O'Malley, assistant director of the Lineberger Comprehensive Cancer Center at the UNC-CH School of Medicine. "If it is chiefly a matter of cost, we may be able in some way to help black women overcome these financial barriers and increase their mammography rates."
A report on the new findings appears in the January issue of the American Journal of Public Health. Along with O'Malley, the principal author was Dr. Jo Anne L. Earp, professor and chair of health behavior and health education at the UNC-CH School of Public Health. Earp directs the N.C. Breast Cancer Screening Program of the National Cancer Institute-supported Specialized Program in Research Excellence in Breast Cancer at the Lineberger Center.
Researchers surveyed almost 2,000 black women and white women age 52 and older in 10 rural N.C. counties in 1993 and 1994. Interviews were conducted in the women's homes.
"Fifty-three percent of the women reported that a physician had recommended mammography to them within the past year," O'Malley said. "White women reported the recommendation significantly more often than did African-American women -- 55 percent versus 45 percent. Controlling for educational attainment and income eliminated the apparent racial and ethnic difference."
After researchers controlled for personal, health and access-to-care characteristics, they found women who received the recommendation were more likely to have a regular doctor and health insurance, he said. Those who did not receive one tended to be older, have less formal education and have lower family incomes.
"This finding helps us understand the issue better, but we still don't know for sure why physicians would be less likely to suggest that patients with less money get mammograms," O'Malley said.
Doctors have recognized for years that black women died from breast cancer at higher rates than white women did, probably because black women's cancers were detected later, he said. Black women as a group are less likely than whites to develop the illness in the first place, however.
"If we hope to make progress in reducing health disparities between black and white women we can't simply target our outreach programs to women," Earp said. "We also need doctors and other health-care providers to get on board. "Previous research has shown that when a doctor recommends a mammogram, the chance that a woman will actually get screened increases dramatically. This study underscores the need for health-care providers to be aware of their influence. They need to recommend mammograms to all women, even those they perceive as of limited means."
Others involved in the study were Drs. Michael J. Schell of biostatistics at UNC-CH, Sarah T. Hawley of the Baylor College of Medicine in Houston and Holly F. Mathews and Jim Mitchell of East Carolina University.
Besides the National Cancer Institute, the Susan G. Komen Breast Cancer Foundation, the Avon Breast Health Access Fund, the Pittsburgh Foundation and the Kate B. Reynolds Charitable Trust supported the research.
Note: O'Malley and Earp can be reached at (919) 966-3036 and 966-3918, respectively, or via e-mail at clover@med.unc.edu and joanne_earp@unc.edu.
Lineberger Comprehensive Cancer Center contact: Dianne Shaw, 919 966-5905.
School of Public Health contact: Lisa Katz, 919-966-7467.
News Services contact: David Williamson, 919-962-8596.
Journal
American Journal of Public Health