Breast cancer screening practices among black, Hispanic, and white women: Reassessing differences

Introduction: We examine racial and ethnic variations in use of screening mammography. We first review recent literature on Blacks', Hispanics', and non-Hispanic Whites' mammography use. Here we extend that body of literature through use of a comprehensive national database and discussion of the implications of race- and nonrace-stratified mammography modeling. Methods: Data were extrapolated from the 1990 National Health Interview Survey. Using the Transtheoretical Model as a conceptual guide, we derived a woman's stage of mammography adoption by integrating screening history with intention to have a future mammogram. The outcome variables included (1) not being screened at regular intervals and (2) not intending to have a mammogram in the future. Analyses were stratified by three groups: Blacks, Hispanics, and non-Hispanic Whites. Results: The results from the multiple logistic regressions demonstrate that race continues to be a factor influencing mammography use. Across all three groups, women who reported less regular cancer screening by clinical breast exam (CBE), Pap smear testing, or breast self-examination were less frequent users of mammography. However, the magnitude of the associations varied for the groups being compared. The findings also demonstrate that there were unique factors associated with not being screened routinely and not intending to have a mammogram in the future for all three racial/ethnic groups. Conclusions: Researchers must give explicit attention, both empirically and methodologically, to how race and ethnicity interact with sociodemographic factors, health practices, and access to health care to refine our understanding of barriers to breast cancer screening. Common barriers to routine screening may be perceived differently by Black, Hispanic, and White women and may contribute to underuse of mammography in distinct ways.