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Mammograms Don't Reach All Communities Equally

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Despite an overall rise in mammography use over the last two decades, women living in poor and rural communities of the U.S. lag when it comes to early breast cancer detection, but may be positively influenced by state laws making it easier to get screened, according to a new report.

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, MD, MPH, and colleagues at the University of Wisconsin.

Their findings are published in the January 2004 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 Wisconsin 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.

The study was supported by the National Cancer Institute and the National Institute of Environmental Health Sciences, both part of the U.S. National Institutes of Health. This article was prepared by Biotech Week editors from staff and other reports.

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