女性国防部受益人群的乳房 X 光筛查：一项基于种族和民族的研究。
Surveillance mammography among female Department of Defense beneficiaries: a study by race and ethnicity.
机构信息
Division of Military Epidemiology and Population Sciences, John P. Murtha Cancer Center, Walter Reed National Military Medical Center, Rockville, Maryland; National Cancer Institute, National Institutes of Health, Bethesda, Maryland.
出版信息
Cancer. 2013 Oct 1;119(19):3531-8. doi: 10.1002/cncr.28242. Epub 2013 Aug 1.
BACKGROUND
Annual surveillance mammography is recommended after a diagnosis of breast cancer. Previous studies have suggested that surveillance mammography varies by demographics and initial tumor characteristics, which are related to an individual's access to health care. The Military Health System of the Department of Defense provides beneficiaries with equal access health care and thus offers an excellent opportunity to assess whether racial differences in surveillance mammography persist when access to care is equal.
METHODS
Among female beneficiaries with a history of breast cancer, logistic regression was used to assess racial/ethnic variations in the use of surveillance mammography during 3 periods of 12 months each, beginning 1 year after diagnosis adjusting for demographic, tumor, and health characteristics.
RESULTS
The rate of overall surveillance mammography decreased from 70% during the first year to 59% during the third year (P < .01). Although there was an overall tendency for surveillance mammography to be higher among minority women compared with non-Hispanic white women, after adjusting for covariates, the difference was found to be significant only during the first year among black women (odds ratio [OR], 1.46; 95% confidence interval [95% CI], 1.10-1.95) and the second year among Asian/Pacific Islander (OR, 2.29; 95%CI, 1.52-3.44) and Hispanic (OR, 1.92; 95%CI, 1.17-3.18) women. When stratified by age at diagnosis and type of breast cancer surgery performed, significant racial differences tended to be observed among younger women (aged < 50 years) and only among women who had undergone mastectomies.
CONCLUSIONS
Minority women were equally or more likely than non-Hispanic white women to receive surveillance mammography within the Military Health System. The racial disparities in surveillance mammography reported in other studies were not observed in a system with equal access to health care.
背景
乳腺癌确诊后，建议每年进行监测性乳房 X 光检查。先前的研究表明，监测性乳房 X 光检查的情况因人口统计学特征和初始肿瘤特征而异，而这些特征与个体获得医疗保健的机会有关。国防部的医疗保健系统为受益人提供平等获得医疗保健的机会，因此，这为评估在获得医疗保健机会均等的情况下，监测性乳房 X 光检查是否存在种族差异提供了一个极好的机会。
方法
在有乳腺癌病史的女性受益人中，使用逻辑回归评估了在诊断后 1 年内开始的 3 个为期 12 个月的时间段内，种族/民族在监测性乳房 X 光检查使用方面的差异，调整了人口统计学、肿瘤和健康特征。
结果
总体监测性乳房 X 光检查率从第一年的 70%下降到第三年的 59%（P < .01）。尽管少数族裔女性的监测性乳房 X 光检查率总体上高于非西班牙裔白人女性，但在调整了协变量后，仅发现黑人女性在第一年（优势比[OR]，1.46；95%置信区间[95%CI]，1.10-1.95）和第二年（亚洲/太平洋岛民[OR]，2.29；95%CI，1.52-3.44）和西班牙裔（OR，1.92；95%CI，1.17-3.18）女性中差异有统计学意义。按诊断时的年龄和进行的乳腺癌手术类型进行分层时，在年轻女性（<50 岁）中观察到显著的种族差异，并且仅在接受乳房切除术的女性中观察到这种差异。
结论
在医疗保健系统中，少数族裔女性与非西班牙裔白人女性一样，或更有可能接受监测性乳房 X 光检查。在一个享有平等获得医疗保健机会的系统中，其他研究报告的监测性乳房 X 光检查中的种族差异并未观察到。
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