Breast cancer screening by Asian-American women in a managed care environment

Context: Cross-sectional surveys show that Asian-American women are less likely to have had screening mammograms. Objective: To prospectively assess mammography screening by Asian-American women in a program with mailed recommendations and no out-of-pocket costs. Design: Two prospective cohort studies. Setting: A nonprofit health care system where women members ≥ 40 years old are surveyed for breast cancer risk factors and enrolled into a screening program on survey completion. Participants: Program enrollment—All Asian-American women identified through a compilation of Asian surnames (Chinese, Japanese, Vietnamese, and Korean) and a random sample of 2000 women with non-Asian surnames, who were mailed a survey from May 1988 to April 1995. Mammogram participation—All Asian-American women and a random sample of 3000 women with non-Asian surnames, enrolled in the screening program and were mailed a first recommendation for screening from May 1988 to April 1994. Main Outcome Measures: Odds of program enrollment and mammogram use within one year (participation) by Asian-American women compared to non-Asian controls. Results: Compared to controls, Asian-American women were less likely to enroll in Breast Cancer Screening Program (BCSP) (odds ratio 0.53; 95% CI 0.43, 0.64). In aggregate, Asian-American women had similar mammogram participation rates. Among older Chinese-American women participation was lower compared to controls (odds ratio 0.66; 95% CI 0.44, 0.97). Conclusion: Participation in mammography screening (program enrollment and participation) by Asian-American women was not necessarily enhanced by the removal of financial barriers. Variations of screening behavior among Asian-American women may be obscured when analyzed in aggregate.