Mammogram follow-up tests take longer for Asian women in U.S.

(Reuters Health) - After an abnormal mammogram, Asian women in the U.S. are less likely than white women to get follow-up tests to determine if they have breast cancer, a recent study suggests.

Researchers examined data on 50,970 women with mammogram results from 2000 to 2010 that indicated the need for further diagnostic imaging. Overall, just 57 percent of Asian women got necessary follow-up tests within a month, compared with 77 percent of white patients, the study found.

This gap in follow-up care persisted at three months for all Asian women except Japanese patients. After one year, 15 percent of Asian women still hadn’t gotten additional imaging done, compared with 10 percent of white patients. Filipina women had the highest odds of no follow-up care, with 18 percent not receiving additional imaging one year after an abnormal mammogram.

“We suspected that there would be differences in delays between white and Asian women, however we were surprised to find the degree of varying delay times among the different Asian subgroups,” said lead study author Kim Hanh Nguyen of the University of California, San Francisco.

“Filipino and Vietnamese women had the poorest outcomes in our study,” Nguyen said by email.

The goal of mammograms is to detect tumors before they can be felt in a physical breast exam, catching cancer sooner when it’s easier to treat. Even though most suspicious findings on mammograms turn out not to be cancer, doctors still urge women to get follow-up tests as quickly as possible so tumors have less time to grow.

Half of white women in the study got follow-up tests within 15 days, compared with 19 days for Japanese women, 28 days for Filipina women and 32 days for Vietnamese women.

Asians are one of the fastest-growing immigrant groups in the U.S., and people who identify as Asian or Asian with another race are projected to account for about 12 percent of the population, or about 49 million people, by 2060, the researchers note in the journal Cancer.

Previous studies highlighting disparities in mammogram follow-up care have often had too few Asian women to detect differences among ethnic subgroups, Nguyen said. The current study offers fresh insight into which Asian women are most at risk for delays that could lead to worse survival odds.

“Ethnic groups tend to share cultural traits such as physical appearance, beliefs and language or dialect, and group history, and these group characteristics can affect their breast cancer care experience in meaningful ways,” Nguyen said. “These findings can inform public health programs to tailor outreach to Asian women, particularly Filipinos and Vietnamese or other Southeast Asians.”

One limitation of the study is that researchers lacked data on certain factors that might influence how quickly women got follow-up tests, such as breast symptoms or prior mammogram results, the authors note. It’s also possible that recent immigration or limited English skills might have contributed to longer follow-up times for some women.

Some women and their doctors might also have decided against follow-up imaging after considering the risks of additional tests such as unnecessary biopsies or treatment of tumors that would have been unlikely to prove fatal, said Dr. Gerd Gigerenzer, director of the Max Planck Institute for Human Development in Berlin.

“It could well be that Asian women are more aware of the lack of benefit and the likely harms of screening than white American women, or intuitively feel that harms are likely,” Gigerenzer, who wasn’t involved in the study, said by email.

There also isn’t consensus in the medical community about exactly how quickly women need to get follow-up tests, noted Dr. Joann Elmore, a researcher at the University of Washington School of Medicine in Seattle who wasn’t involved in the study.

“My advice to women is to work with their physicians and to schedule follow-up for an abnormal mammogram result as quickly as their schedule allows,” Elmore said by email. “As most women with these abnormalities do not end up having breast cancer, the anxiety experienced by women during this wait is their biggest risk.”

SOURCE: Cancer, online June 12, 2017.