Disparities of mammography use in the multiethnic cohort.

B42

The National Health Interview Survey (NHIS) of the National Center of Health Statistics indicates that mammogram use within the past 2 years as reported by women 40 years and older increased from 29% in 1987 to 67% in 1998 and 70% in 2003; use was similar for Non-Hispanic White (71%) and African-American women (71%) followed by Hispanic (65%) and Asian women (58%). In the current analysis, we examined whether mammography use as reported by women enrolled in the Hawaii and Los Angeles (LA) CA Multiethnic Cohort (MEC) met National Cancer Institute recommendations for women ages 40 and over to receive a mammogram every 1-2 years, defined as 'regular' mammogram in this analysis. Also, we assessed whether disparities in regular mammogram use exist by race/ethnicity and whether this use is influenced by age, education, socioeconomic status (SES) and family history of breast cancer. The analysis included 89,104 women ages 45-75 at MEC enrollment with complete mammography history. Results: 91% of MEC women reported ever having a mammogram at baseline, however only 48% of those had a regular mammogram from 1994 through 1998. Regular mammogram use differed by race/ethnicity with the most frequent use of regular mammograms reported by Non-Hispanic White women (52.7%; 95% CI 52.1-53.4), followed by Japanese (48.8%; 95% CI 48.2-49.4), Hawaiian (44.1%; 95% CI 42.3-45.9), African-American (43.6%; 95% CI 42.8-44.3) and Hispanic women (41.2%; 95% CI 40.5-42.0). When we examined the odds of having a regular mammogram by race/ethnicity, race remained an important indicator of use even after controlling for age, education, SES (for LA residents only) and family history of breast cancer. The odds of regular mammograms were significantly lower for African-American (OR_adj=0.70, CI 0.67-0.73); Hispanic (OR_adj=0.74, 0.71-0.78), Native Hawaiian (OR_adj=0.75, CI 0.71-0.79), and Japanese (OR_adj=0.90, CI 0.86-0.93) women when compared to Non-Hispanic White women. Regular mammograms peaked for women 50-59 years of age and declined thereafter. Women in the 70-74 (OR= 0.81; 95% CI 0.78-0.85) and 75 and over (OR=0.78; 95% CI 0.72-0.86) age groups were less likely to get regular mammograms compared to women 45-49. A significant trend (P < 0.05) of regular mammography was observed with increasing levels of education-overall and within each racial/ethnic group. Women without a high school education were 50% less likely to get regular mammograms compared to women with graduate or professional education (OR= 0.53; 95% CI 0.50-0.55). These data suggest that while most women reported a prior mammogram, regular use is less frequent. Further, disparities in regular mammography by race/ethnicity exist that do not appear to be explained by differences in education or SES indicators.