Asian Women Face Greater Barriers to Follow-up Care on Abnormal Mammogram

Being called back after an abnormal mammogram can be a significant source of stress for women. While statistics¹ from the American Cancer Society show that less than 10% of women called back for additional tests are found to have breast cancer, delayed follow-up could contribute to poor outcomes. According to a research study published in the journal Cancer,² Asian women are less likely than non-Hispanic white (NHW) women to receive timely follow-up after an abnormal screening mammogram.

Asian women are often left out of population-based breast cancer studies, and if they are included, they are lumped into a single group. Researchers at the University of California, San Francisco, took a deeper dive into this population to understand its barriers to care. The prospective study used a prospective cohort of 50,970 NHW and Asian women with a Breast Imaging, Reporting and Data System abnormal result of category 0 or 3-plus in the San Francisco Mammography Registry between 2000 and 2010. This information was prospectively gathered by the radiology facilities that the women visited.

The 2 populations were compared based on follow-up care received at 30, 60, and 90 days and no follow-up at 1 year after a radiologic test was performed. Importantly, the Asian group was subcategorized based on their country of origin.

The authors found that within the Asian population, Vietnamese and Filipina women had the longest median time to follow-up imaging tests (32 days and 28 days), while Japanese women had the shortest time (19 days), which was still longer than the median time for NHW women (15 days). A 20% difference was noted in the percentage of NHW women (77%) receiving follow-up at 30 days compared with Asian women (57%; P <.0001). The authors noted that the disparity observed at 30 days held at the 60-day and 90-day time points, although Japanese women were an exception. Filipina women had the highest rate (18.1%) of no follow-up at 1 year among Asians, while the median for the overall Asian population was 15%, compared with 10% for NHWs.

“The reasons for these long delays may be due to linguistic, cultural, and other barriers that affect patient-provider communication for disadvantaged Asian groups,” author Kim Hanh Nguyen, MPH, ScD, said in a statement. “More research attention is needed to understand the specific reasons for these differences.”

Pointing out the diversity within the subgroup of minorities that are classified as Asian, Nguyen added that recognizing these differences may help clinicians develop better rapport and communication with their Asian patients, which can improve adherence to screening recommendations

References

1. Getting called back after a mammogram. American Cancer Society website. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/getting-called-back-after-a-mammogram.html. Accessed June 20, 2017.

2. Nguyen KH, Pasick RJ, Stewart SL, Kerlikowske K, Karliner LS. Disparities in abnormal mammogram follow-up time for Asian women compared with non-Hispanic white women and between Asian ethnic groups [published online June 12, 2017]. Cancer. doi: 10.1002/cncr.30756