Disparities in mammographic screening for Asian women in California: a cross-sectional analysis to identify meaningful groups for targeted intervention

Abstract

Background: Breast cancer is the most commonly diagnosed cancer among the rapidly growing population of Asian Americans; it is also the most common cause of cancer mortality among Filipinas. Asian women continue to have lower rates of mammographic screening than women of most other racial/ethnic groups. While prior studies have described the effects of sociodemographic and other characteristics of women on non-adherence to screening guidelines, they have not identified the distinct segments of the population who remain at highest risk of not being screened.

Methods: To better describe characteristics of Asian women associated with not having a mammogram in the last two years, we applied recursive partitioning to population-based data (N = 1521) from the 2001 California Health Interview Survey (CHIS), for seven racial/ethnic groups of interest: Chinese, Japanese, Filipino, Korean, South Asian, Vietnamese, and all Asians combined.

Results: We identified two major subgroups of Asian women who reported not having a mammogram in the past two years and therefore, did not follow mammography screening recommendations: 1) women who have never had a pap exam to screen for cervical cancer (68% had no mammogram), and 2) women who have had a pap exam, but have no women's health issues (osteoporosis, using menopausal hormone therapies, and/or hysterectomy) nor a usual source of care (62% had no mammogram). Only 19% of Asian women who have had pap screening and have women's health issues did not have a mammogram in the past two years. In virtually all ethnic subgroups, having had pap or colorectal screening were the strongest delineators of mammography usage. Other characteristics of women least likely to have had a mammogram included: Chinese non-U.S. citizens or citizens without usual source of health care, Filipinas with no health insurance, Koreans without women's health issues and public or no health insurance, South Asians less than age 50 who were unemployed or non-citizens, and Vietnamese women who were never married.

Conclusion: We identified distinct subgroups of Asian women at highest risk of not adhering to mammography screening guidelines; these data can inform outreach efforts aimed at reducing the disparity in mammography screening among Asian women.

Figure 1

Recursive partitioning classification tree for Asian females 41 years and older, CHIS 2001.

Figure 2

Recursive partitioning classification tree for Chinese females 41 years and older, CHIS 2001.

Figure 3

Recursive partitioning classification tree for Japanese females 41 years and older, including pap and colon screening variable, CHIS 2001.

Figure 4

Recursive partitioning classification tree for Filipina females 41 years and older, CHIS 2001.

Figure 5

Recursive partitioning classification tree for Korean females 41 years and older, including pap and colon screening variables, CHIS 2001.

Figure 6

Recursive partitioning classification tree for South Asian females 41 years and older, CHIS 2001.

Figure 7

Recursive partitioning classification tree for Vietnamese females 41 years and older, including pap and colon screening variables, CHIS 2001.