Black women lack information about breast cancer

A lack of communication about mammography test results may be hindering the fight against breast cancer among black women in Connecticut, according to recent work by Yale scientists.

After two years of interviews and research, a study soon to be published by Yale scientists found that black women more commonly experience inadequate communication of mammography results, which may lead to a higher risk of breast cancer fatality than in white women. The investigation, led by Epidemiology and Public Health professor Beth Jones, studied the racial differences in mammography screenings by interviewing women from five urban community cancer centers in Connecticut.

Jones said the study was prompted by the fact that, although the incidence rate of breast cancer is not as high as the rate in white women, black women die more often from the disease. She said this statistic raised the question of whether black women were getting the full benefit of mammography screenings.

“We wondered if maybe there was a difference in communication of the results along racial lines,” she said. “We found that African-American women were significantly less likely to receive their results or to [understand] them.”

But the study did not go farther than pointing out the correlation between race and communication of test results, Jones said. Researchers did not ascertain why the racial disparities exist, and did not issue recommendations for better transmission of results. Nor did they provide data detailing what measures the mammography facilities currently take to ensure that patients receive and understand their results.

“We have some follow-up work to do, but my gut is that a lot of African-American women feel like they are not told about the test itself,” she said. “A doctor orders a mammogram and they go and get the test, but it is not clear to them what the procedure is or what it’s for.”

Because of a lack of information about the test, Jones said, black women might be more likely to disregard tests results or not take them seriously.

Though they did not include their suspicions in the report, researchers speculated that another major factor in the number of uninformed patients of all races might be faulty methods of communication between health centers and patients. While legislation aimed to correct this problem by requiring screening centers to inform patients of their mammography results, experts said communication between patients and doctors performing the examinations is still a concern. The Mammography Quality Standards Act was passed by Congress in 1992 to ensure that all women have the ability to detect breast cancer in its earliest and most treatable stages.

Test results are mailed to each patient, but Jones said the letters might not be an effective means of getting information to all women. Incorrect contact information or packaging that makes the letter look like junk mail might cause patients to discard the results accidentally, she said, making the effort to communicate futile.

“The one-size-fits-all communication approach isn’t working,” Jones said. “We need to figure out better ways to communicate.”

Yale-New Haven Hospital officials said that if some patients do not receive results, it is not for lack of trying. Clinicians at the hospital said they try multiple tactics to inform their patients, confirming contact information as well as personally calling the patient or her physician to ensure that adequate follow-up procedures are taken.

Shirley Pinette, director of the Yale-New Haven Breast Center, said such centers in general are very aggressive in their attempts to contact patients about their results. But once the results are transmitted, she said, what patients do with the information is out of the centers’ control.

“Just because you make a recommendation, that doesn’t mean the patient is going to follow up,” she said.

Even with the law requiring dissemination of information to patients, some students said this study provides enough evidence of a racial communication problem to warrant concern and further investigation.

Cynthia Liu ’08, a member of Students Against Breast Cancer, said the study is important because of the further questions it raises about the issue, such as why the communication gap falls along racial lines and how the problems can be corrected.

“Communication is crucial, and if these problems are developing, studies and surveys must be conducted to delve deeper — either from a social or statistical perspective — into mammography centers nationwide,” she said.

Programs are being developed, both at the national level and at Yale, to combat reporting problems with patients’ test results, Jones said. The programs will provide clinics with trained professionals who can explain to the patients, at the time of their visits, the importance of understanding and following up on screening results.

The study will be published in the March issue of the American Journal of Public Health.

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