Foreign-born women less likely to have had a mammogram
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Foreign-born women who reside in the United States appeared less likely to have ever had a mammogram than women born in the U.S., according to a report published today by the CDC.
The report also showed that the longer women resided in the United States, the more likely they were to have had a mammogram and meet U.S. Preventive Services Task Force guidelines that suggest mammography at least once every 2 years for those between ages 50 and 74 years.
The investigators conducted the study because there are little data available on breast cancer screening according to birthplace among foreign-born women in the United States, and breast cancer mortality and receipt of mammography are known to be associated with race and ethnicity, in addition to location of birth.
“Although mammography does not detect all tumors of the breast, it can often detect breast cancer at an early age, when treatment is more effective,” Tainya C. Clarke, MPH, PhD, of the National Center for Health Statistics, and colleagues wrote. “The reduction and stability of breast cancer mortality and morbidity rates in North American and European countries over the past 2 decades have been attributed to early detection through mammography and improved treatment.”
The investigators culled responses from the cross-sectional National Health Interview Survey during years in which the survey included a cancer supplement (2005, 2008, 2010, 2013 and 2015). The analysis included 29,951 women aged 50 to 74 years, 13.1% of whom were born outside of the United States. Researchers considered respondents who never had a mammogram or did not have one in the past 2 years as not meeting the USPSTF recommendations for mammography.
Unadjusted analyses showed foreign-born women had a significantly lower rate of ever having a mammogram than U.S.-born women (88.3% vs. 94.1%; P < .05). This also was true for women who were foreign born and spent less than 25% of their lifetime in the U.S. (76.4%) or greater than 25% of their lifetime in the U.S. (90.9%).
Analysis adjusted for certain sociodemographic variables showed increased rates of mammography receipt for foreign-born women, but the adjusted rates (91.4% overall, 87.6% with less than 25% of lifetime in U.S., 92.5% with greater than 25% of lifetime in U.S.) remained significantly lower than that of U.S.-born women (93.9%).
Unadjusted analyses showed statistically significant differences between the proportion of U.S.-born women (73%) and foreign-born women (68.8%) who met USPSTF recommendations for mammography. However, the differences did not retain significance in adjusted analyses, which showed foreign-born women who spent more than 25% of their lifetime in the U.S. were more likely (75.1%) to meet USPSTF recommendations than U.S.-born women (72.4%) and foreign-born women who had been in the United States for less than 25% of their lifetime (72.1%). Foreign-born women also showed greater adherence to USPSTF recommendations overall (74.4%) than U.S. born women in the adjusted analyses.
The investigators noted that foreign-born women from Spanish-speaking countries, including Mexico and Central America, had higher rates of adherence to USPSTF recommendations than U.S.-born women and other foreign-born women.
“The reduced difference in foreign-born women from Spanish-speaking regions after adjustment may be explained, in part, by targeted health care and mammography programs in some states,” Clarke and colleagues wrote. “These findings may inform other research on the potential relationship with, and impact of, nativity, percentage of lifetime in the United States, and birthplace, and the likelihood of engaging in recommended preventive cancer screening.”
These results may come as a surprise to some clinicians.
“The increased rates of USPSTF mammography adherence among women born in Mexico and Central America was somewhat surprising to me,” Deanna J. Attai MD, FACS, assistant clinical professor of surgery at David Geffen School of Medicine at UCLA, and past-president of American Society of Breast Surgeons, who was not involved with the report, told HemOnc Today. “The researchers noted that some foreign-born women may be more receptive to screening guidelines compared with U.S.-born women, and that many U.S. states have health care programs targeting Spanish-speaking women.”
However, clinicians should keep in mind limitations of the analysis when interpreting these findings, Attai added.
“Data was obtained from the National Health Interview Survey, and they pooled results from 5 years of surveys,” she said. “Patients may not correctly recall details about screening mammography use, and not all may have accurately reported on sociodemographic factors.”
Still, the results can help clinicians be more sympathetic to challenges to receiving recommend care that may exist for patients.
“These results are a reminder that as physicians, we need to have an understanding of the various factors that may impact our patients' ability to undergo screening (and other medical tests and procedures) and the barriers that they may face,” Attai said. “Country of birth is one, but it is not the only factor that may impact access to care and willingness to undergo guideline-recommended screening.” – by Drew Amorosi
For more information:
Deanna J. Attai MD, FACS, can be reached at dattai@mednet.ucla.edu.
Reference:
Clarke TC, et al. Natl Health Stat Report. 2019;129:1-14.
Also available at: www.cdc.gov/nchs/data/nhsr/nhsr129-508.pdf. Accessed Oct. 9. 2019.
Disclosures: Please see the report for all authors’ relevant financial disclosures. Attai reports no relevant financial disclosures.