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 Researchers examined data on 50,970 women with mammogram results
from 2000 to 2010 that indicated the need for further diagnostic
imaging. Overall, just 57 percent of Asian women got necessary
follow-up tests within a month, compared with 77 percent of white
patients, the study found.
This gap in follow-up care persisted at three months for all Asian
women except Japanese patients. After one year, 15 percent of Asian
women still hadn’t gotten additional imaging done, compared with 10
percent of white patients. Filipina women had the highest odds of no
follow-up care, with 18 percent not receiving additional imaging one
year after an abnormal mammogram.
“We suspected that there would be differences in delays between
white and Asian women, however we were surprised to find the degree
of varying delay times among the different Asian subgroups,” said
lead study author Kim Hanh Nguyen of the University of California,
San Francisco.
“Filipino and Vietnamese women had the poorest outcomes in our
study,” Nguyen said by email.
The goal of mammograms is to detect tumors before they can be felt
in a physical breast exam, catching cancer sooner when it’s easier
to treat. Even though most suspicious findings on mammograms turn
out not to be cancer, doctors still urge women to get follow-up
tests as quickly as possible so tumors have less time to grow.
Half of white women in the study got follow-up tests within 15 days,
compared with 19 days for Japanese women, 28 days for Filipina women
and 32 days for Vietnamese women.
Asians are one of the fastest-growing immigrant groups in the U.S.,
and people who identify as Asian or Asian with another race are
projected to account for about 12 percent of the population, or
about 49 million people, by 2060, the researchers note in the
journal Cancer.
Previous studies highlighting disparities in mammogram follow-up
care have often had too few Asian women to detect differences among
ethnic subgroups, Nguyen said. The current study offers fresh
insight into which Asian women are most at risk for delays that
could lead to worse survival odds.
“Ethnic groups tend to share cultural traits such as physical
appearance, beliefs and language or dialect, and group history, and
these group characteristics can affect their breast cancer care
experience in meaningful ways,” Nguyen said. “These findings can
inform public health programs to tailor outreach to Asian women,
particularly Filipinos and Vietnamese or other Southeast Asians.”
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One limitation of the study is that researchers lacked data on
certain factors that might influence how quickly women got follow-up
tests, such as breast symptoms or prior mammogram results, the
authors note. It’s also possible that recent immigration or limited
English skills might have contributed to longer follow-up times for
some women.
Some women and their doctors might also have decided against
follow-up imaging after considering the risks of additional tests
such as unnecessary biopsies or treatment of tumors that would have
been unlikely to prove fatal, said Dr. Gerd Gigerenzer, director of
the Max Planck Institute for Human Development in Berlin.
“It could well be that Asian women are more aware of the lack of
benefit and the likely harms of screening than white American women,
or intuitively feel that harms are likely,” Gigerenzer, who wasn’t
involved in the study, said by email.
There also isn’t consensus in the medical community about exactly
how quickly women need to get follow-up tests, noted Dr. Joann
Elmore, a researcher at the University of Washington School of
Medicine in Seattle who wasn’t involved in the study.
“My advice to women is to work with their physicians and to schedule
follow-up for an abnormal mammogram result as quickly as their
schedule allows,” Elmore said by email. “As most women with these
abnormalities do not end up having breast cancer, the anxiety
experienced by women during this wait is their biggest risk.”
SOURCE: http://bit.ly/2spiqRl Cancer, online June 12, 2017.
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