Early-stage breast cancers were a third less likely to be diagnosed among
Wisconsin women living in low-income, less educated and less urbanized
areas, say Patrick Remington, M.D., M.P.H., and colleagues at the University
of Wisconsin.
Their findings are published in the January issue of the American
Journal of Preventive Medicine.
Remington and colleagues compared early-stage breast cancer
diagnosis across Wisconsin ZIP codes from 1980 to 1998, using Wisconsin’s
mandatory tumor registry. The researchers used early breast cancer diagnoses
as a
proxy for mammogram screenings, since most of these tumors can be detected
only by mammograms.
The percentage of early breast cancer diagnoses rose dramatically from
1980 to 1998, with the most substantial gains coming in the later decade.
At first, women in urban, wealthy and college-educated communities were
more likely to get early diagnoses, a trend that continued until 1991.
After that, this difference decreased between low-income communities and
higher-income areas, but the gap between urban and rural women remained.
Remington and colleagues suggest that a 1990 state law for mandatory mammography
insurance coverage for women ages 45 to 65, along with Medicare coverage
introduced in 1991, may have helped reverse the screening trend among low-income
women.
“Continued outreach efforts are important, as studies have shown
that eliminating financial barriers alone is insufficient to eliminate
socioeconomic inequities in mammography use,” Remington says.
The difference in rural and urban mammography rates may reflect limited
access to care in rural areas and possibly fewer physician recommendations
for mammography, the researchers conclude.
Breast cancer is the most commonly diagnosed malignancy among women and
the second leading cause of cancer death in the United States
The study was supported by the National Cancer Institute and the National
Institute of Environmental Health Sciences.
