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Are there racial/ethnic disparities among women younger than 40 undergoing mammography?

  • Epidemiology
  • Published:
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Abstract

While the probability of a woman developing invasive breast cancer at age <40 is low (<1%), mammography use reported among younger women (age <40) is substantial, and varies by race/ethnicity. Little detail is known about mammography use among women aged <40, particularly by race/ethnicity. We describe racial/ethnic differences in: (1) mammography indication after considering underlying risk factors (breast symptoms and family history); (2) follow-up recommendations, and (3) mammography outcomes for first mammograms in women aged <40. These 1996–2005 Breast Cancer Surveillance Consortium data are prospectively pooled from seven U.S. mammography registries. Our community-based sample included 99,615 women aged 18–39 who self-reported race/ethnicity and presented for a first mammogram (screening or diagnostic) with no history of breast cancer. Multivariable analyses controlled for registry site, age, family history of breast cancer, symptoms, and exam year. Overall, 73.6% of the women in our sample were seen for a screening mammogram. Following screening mammography, African American (AA) women were more likely than white women to be recommended for additional workup [relative risk (RR): 1.15 (95% CI: 1.07–1.23)]. Following diagnostic mammography, AA [RR: 1.30 (95% CI: 1.17–1.44)] and Asian [RR: 1.44 (95% CI: 1.26–1.64)] women were more likely to be recommended for biopsy, fine-needle aspiration, or surgical consultation. Depending on race/ethnicity, and considering the rate of true positive to total first screening mammograms of younger women, a women has a likelihood of a true positive of 1 in 363–1,122; she has a likelihood of a false positive of 1 in 7–10. This study of community-based practice found racial/ethnic variability in mammography indication, recommendations, and outcomes among women undergoing first mammography before 40. These findings highlight important areas for future research to understand the motivating factors for these practice patterns and the implications of early mammography use.

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Acknowledgments

This work was supported by the National Cancer Institute (grant number R03CA134196 to JMK). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health. Data collection for this work was supported by a National Cancer Institute-funded Breast Cancer Surveillance Consortium co-operative agreement (grant numbers U01CA63740, U01CA86076, U01CA86082, U01CA63736, U01CA70013, U01CA69976, U01CA63731, U01CA70040). The collection of cancer data used in this study was supported in part by several state public health departments and cancer registries throughout the U.S. For a full description of these sources, please see: http://breastscreening.cancer.gov/work/acknowledgement.html. We thank the BCSC participating mammography facilities and radiologists for the data they provided. We thank Robert Rosenberg, M.D. for providing a perspective on clinical interpretation. We thank Rebecca Hughes from the Group Health Research Institute for her expert editing support; internal funding from the Group Health Research Institute supported her time. We also thank Susan Meadows, MLS and Susan Elliott from the University of Missouri for their superb library skills.

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Authors and Affiliations

  1. Department of Family and Community Medicine, University of Missouri, MA306 Medical Sciences Bldg, 1 Hospital Drive, Columbia, MO, 65212, USA

    Julie M. Kapp

  2. Group Health Research Institute, Seattle, WA, USA

    Rod Walker, Sebastien Haneuse & Diana S. M. Buist

  3. Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA

    Bonnie C. Yankaskas

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  1. Julie M. Kapp
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  2. Rod Walker
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  4. Diana S. M. Buist
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  5. Bonnie C. Yankaskas
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Correspondence to Julie M. Kapp.

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Kapp, J.M., Walker, R., Haneuse, S. et al. Are there racial/ethnic disparities among women younger than 40 undergoing mammography?. Breast Cancer Res Treat 124, 213–222 (2010). https://doi.org/10.1007/s10549-010-0812-4

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  • DOI: https://doi.org/10.1007/s10549-010-0812-4

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