Disparities in Abnormal Mammogram Follow-Up Time for Asian Women Compared With Non-Hispanic White Women and Between Asian Ethnic Groups

Authors: Nguyen, KH et. al.

Source: Cancer 2017;123:3468-75

www.ncbi.nlm.nih.gov/pubmed/28603859

Asians are one of the fastest growing immigrant groups in the United States, but many population-based cancer studies do not include Asian participants. Studies that do include Asians often report findings as a single, aggregated group. This calls into question the conclusions that are drawn. The investigators for this study sought to determine differences in mammography follow up between Asian and non-Hispanic White (NHW) women, as well as differences in follow up among different Asian populations.

The San Francisco Mammography Registry records breast imaging data for women in the San Francisco Bay area—a region with a large, diverse, Asian population. Records of Asian and NHW women aged 40-80 over a 10 year period were reviewed, and mammograms that led to recommendations for further imaging were selected.

Over 49,000 women were included in the study. Thirty percent of the group were Asian. The predominant Asian ethnic group was Chinese, followed by Filipina. The third largest group were Thai, Cambodian and other Southeast Asian groups, followed by Japanese, mixed ethnicity and Vietnamese. Within the Asian group, Japanese women were the oldest. Women in the NHW group had a larger number of college graduates, and a higher percentage of NHW women had family histories of breast cancer.

Overall, Asian women had substantially longer time to follow-up imaging compared to NHW: 26 days vs. 15 days, respectively. Within the Asian group, Vietnamese women had the longest follow up time, while Japanese women had the shortest. About 77% of NHW had completed their recommended follow up within 30 days while just over 57% of Asian women had done the same. Asian women had higher rates of no follow up at all compared to NHW (15% vs. 10%). When creating a model to predict likelihood of follow up, all Asian groups were less likely than NHW to have follow up. Filipina and Vietnamese women were the least likely to have follow-up.

The investigators remark that many factors may be responsible for the observed differences. Women within the Asian subgroups were part of different socioeconomic classes and had differing access to healthcare providers. Acculturation and English proficiency created barriers for some women. System barriers, such as a delay in notification of results, difficulty in scheduling appointments and not having information available in a woman’s primary language also contributed to poor follow-up.

This study brings attention to a discrepancy in breast care delivery for a specific patient population and provides ideas about how to address this issue.