Asian women in US face longer mammography follow-up times

Women of Asian ethnicity in the U.S. experience delays in mammography follow-up across all ethnic sub-groups, but certain groups have much worse follow-up times than others, indicating a need for more granular tailoring of breast screening programs.

Delays in mammography follow-up are a well-documented problem, especially in minorities. However, most prior studies have focused on African American and Latino women, motting focus on the wide range of Asian ethnicities—a concern when the projected number of Asians in America is expected to reach 48.6 million by 2060.

Researchers from several University of California schools analyzed demographic data from the San Francisco Mammography Registry. They published the results in Cancer.

About 50,000 women matched their criteria, roughly 30 percent Asian and 70 percent non-Hispanic White. The largest Asian subgroup was Chinese, followed by Filipina.

The median duration of follow-up in the white group was 18 days, while the Asian cohort took 26. However, it varied widely by ethnic subgroup. Vietnamese had the longest time-to-follow-up while Japanese women had the shortest, approaching the time it took for non-Hispanic White women. At the end of one year, 15 percent of Asian women had no follow-up, compared to 10 percent of white women.

The authors posit a number of explanations for these disparity, including socioeconomic status, access to a healthcare provider, and low English proficiency (LEP).

“Differential patterns of immigration and acculturation have resulted in certain groups, such as Vietnamese-Americans, being more likely to lack health coverage and to have LEP and lower socioeconomic standards compared with other groups,” wrote lead author and scientist at the University of California, San Francisco Kim Nguyen, MPH, et al.

Interpreters can smooth the process, but many providers report “getting by” without them, according to the article. In addition, mammography notification letters are almost always written in English and at too high of a level for LEP women.

Certain cultural barriers also may contribute to the lengthy time to follow-up. Norms regarding modesty and embarrassment have been known to reduce screening utilization in these groups and some Asian groups view a cancer diagnosis as a death sentence, according to the authors.

The variability of mammography utilization among Asian ethnic groups reinforce the need for disaggregation of race in studies, according to the authors.

“Future investigations, particularly among high risk Asian ethnic groups, are needed to understand the breast cancer experience of Asian women to identify and develop culturally and linguistically appropriate strategies to improve the timely follow up for these populations.”