Because there are wide geographic and racial variations in breast cancer mortality, we hypothesize that there are corresponding variations in mammography utilization. Of particular interest, we have identified communities with large African American populations but no racial disparities in breast cancer mortality among the elderly. In this preliminary study, we propose to improve our understanding of these successful communities and how they compare with less successful communities. We shall purchase Medicare claims data for 2000-2005, focusing on 230 US counties with relatively large African American populations. We shall merge these with data from the Area Resource File to obtain socio-demographic and economic information, and data on health care resources. We will collect information about special programs aiming to increase mammography utilization. We shall then test hypotheses pertinent to the characterization of counties that have been relatively successful and relatively unsuccessful in achieving racial equality for regular screening mammography or any screening mammography. By increasing the understanding of geographic variations in the occurrence of African American-white breast cancer disparities in the occurrence of mammography and the importance of contextual characteristics, the present investigation will provide important pilot information for future studies and for assisting policy makers in eliminating racial disparities in breast cancer mortality.
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