Although the benefits of screening mammography are well established among white women, very little is known about the efficacy of mammography among black women. This is the starting point for the proposed project which is a direct outgrowth of an earlier study, supported by an AHCPR dissertation research grant, Race Differences in Stage at Diagnosis of Breast Cancer. The results of this earlier study suggested a race difference in efficacy of screening mammography: a positive history of screening mammography was protective against later stage at diagnosis in white women, but not in black women. Given the importance of ensuring that the benefits of screening mammography be the same for women of both races, this finding calls for further exploration. The general aims of this investigation are to: 1) assess variability in the quality of the screening mammography process in the state of Connecticut, and 2) examine how this variability is distributed between black and white women. A strategy of surveying mammography facilities in Connecticut to collect facility-based data (e.g., technical data on equipment, personnel, and techniques) will be combined with assembling a cohort of 1000 (minimum) black and white women, in approximately equal numbers, who have presented for a screening mammogram in selected facilities in urban centers. These women will be interviewed one month after the screening exam, and again two years later. The first interview will provide data on individual characteristics as well as the subject's encounter with the health care setting (e.g., did she receive notification of results and recommendations for future screening). These data will be used to evaluate race differences in various aspects of the mammography process and to predict subsequent screening behavior. The follow-up interview at 24 months will provide outcome data on repeat screening, interval of screening, and resolution of any breast problem which occurred since the index exam. A third component is a pilot study to review the mammographic films of a subset of study subjects to determine if there are differences in the quality of the film itself which may be related to underlying biologic processes. Together, these sources of data will be used to address the hypothesis that, in practice, there are barriers to the full promise of mammography for some women, and these women are more likely to be black than white.
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