Economics, not race, explains delay in mammography follow-up

African American women take longer to come in for follow-up care after a suspicious breast abnormality is found, according to a study from the University of South Carolina. The problem may have more to do with economics than race, according to a physician with extensive clinical experience with this unique patient population.

Early detection is one of the best ways to improve the prognosis for a woman with breast cancer. Delayed follow-up of breast abnormalities could result in detecting the breast cancer at a later stage, thus influencing a woman's prognosis and mortality from the disease, said lead author Swann A. Adams, Ph.D., associate director of the University of South Carolina's Cancer Prevention and Control Program.

For the study sample, 729 African American women and 901 European American women were selected from more than 50,000 screenings in South Carolina's Best Chance Network. BCN is a statewide service program providing free mammography screening to economically disadvantaged women. The median time for African American women from the date of the first clinical breast exam to determination of final status of an abnormality was 44 days. The median time for European American women was 40 days (Cancer 2009 Oct 26. Epub ahead of print).

"The delay in follow-up was significantly different, but it wasn't large," said Dr. James Benton, medical director of Radiotherapy Clinics of Georgia in Decatur, a community with a high percentage of African American women. "But it came short in terms of trying to understand why that difference exists."

The researchers speculate the delay may result from poor communication between patient and doctor, lack of patient trust in her doctor, lack of transportation, proximity of clinics to the patient, and other factors, Adams said.

The social stresses of everyday living were not factored into the study. Meeting a follow-up appointment could come down to something like whether the woman could find a babysitter, or if she has to take care of someone else's children, Benton said.

The most important factor when it comes to a delay in follow-up, however, is economics, Benton said. In the Atlanta-metropolitan area there are middle class, upper-middle class, and wealthy African American women who follow up with abnormal breast findings just as aggressively as their white counterparts, Benton said.

Race most likely cropped up in the current study because the African American women still earned less than their European American counterparts. The total annual family income of African American women was $1294 less than for European American women in the survey.

"I suspect if you go to Appalachia, where you have poor whites, you may be able to reproduce some of these same issues about delay in follow-up," Benton said.