Division of Hematology/Oncology, University of Illinois at Chicago.
University of Illinois Cancer Center, Chicago.
JAMA Netw Open. 2021 Sep 1;4(9):e2123751. doi: 10.1001/jamanetworkopen.2021.23751.
Black women bear a disproportionate burden of breast cancer mortality in the US, in part due to inequities in the use of mammography. Population screening for breast cancer risk in primary care is a promising strategy for mitigating breast cancer disparities, but it is unknown whether this strategy would be associated with increased mammography rates in underserved women of racial and ethnic minority groups.
To examine whether providing individualized breast cancer risk estimates is associated with an increase in the rate of screening mammography.
DESIGN, SETTING, AND PARTICIPANTS: A cohort study was conducted in women receiving individualized risk estimates as part of routine primary health care at federally qualified health centers in medically underserved communities in Chicago, Illinois. The study was conducted from November 5, 2013, to December 19, 2014, with data acquisition completed on March 5, 2017; data analysis was performed from December 30, 2020, to February 2, 2021. A total of 347 women aged 25 to 69 years without a personal history of breast cancer presenting for an annual visit with their primary care clinician were enrolled.
Breast cancer risk estimates were obtained with validated risk assessment tools as a standard component of the clinic check-in process. One of 4 women at average risk and all women at high risk were invited to participate in the study.
The primary outcome was the mammography rate during 18 months of usual care compared with the rate during 18 months after implementation of risk assessment.
Of the 347 women enrolled, 188 were age-eligible for mammography and were included in the analysis (mean [SD] age, 50.8 [7.04] years); 70 women (37.2%) were Hispanic, 114 (60.6%) were non-Hispanic African American, and 4 (2.1%) were from other racial and ethnic groups (4 non-Hispanic White women). Ninety-eight women (52.1%) had an average risk of developing breast cancer and 90 (47.9%) were at high risk. Overall, there was a nonsignificant increase in the mammography rate, from 38.8% during usual care to 48.9% following implementation of risk assessment (odds ratio, 1.37; 95% CI, 0.92-2.03). In preplanned subgroup analysis, the mammography rate among women at high risk was significantly higher after vs before risk assessment (51.1% vs 36.6%; odds ratio, 1.88; 95% CI, 1.10-3.23).
In this study, providing individualized breast cancer risk estimates as a component of primary health care in federally qualified health centers was associated with increased use of mammography among women of racial and ethnic minority groups who were at high risk. Implementation of this approach in underserved communities could promote equity in the use of mammography and reduce racial disparities in breast cancer mortality. This strategy warrants further investigation.
重要性：在美国，黑人女性在乳腺癌死亡率方面承受着不成比例的负担，部分原因是在乳房 X 光检查的使用方面存在不平等。在初级保健中对乳腺癌风险进行人群筛查是减轻乳腺癌差异的一项有前途的策略，但尚不清楚这种策略是否会与服务不足的少数族裔和种族女性的乳房 X 光检查率增加相关。
目的：研究提供个体化乳腺癌风险估计是否与筛查性乳房 X 光检查率的增加有关。
设计、地点和参与者：在伊利诺伊州芝加哥服务不足的社区中的联邦合格健康中心，进行了一项队列研究，研究对象为在接受常规初级保健时接受个体化风险评估的女性。研究于 2013 年 11 月 5 日至 2014 年 12 月 19 日进行，数据采集于 2017 年 3 月 5 日完成；数据分析于 2020 年 12 月 30 日至 2021 年 2 月 2 日进行。共纳入 347 名年龄在 25 岁至 69 岁之间、无乳腺癌个人病史、因年度就诊而就诊的初级保健临床医生的女性。
暴露情况：通过经过验证的风险评估工具获得乳腺癌风险估计，这是诊所登记过程的标准组成部分。4 名平均风险的女性和所有高风险女性都被邀请参加研究。
主要结果和措施：主要结果是在 18 个月的常规护理期间与实施风险评估后的 18 个月期间的乳房 X 光检查率。
结果：在纳入的 347 名女性中，有 188 名年龄符合乳房 X 光检查条件并纳入分析（平均[SD]年龄为 50.8[7.04]岁）；70 名（37.2%）为西班牙裔，114 名（60.6%）为非西班牙裔非裔美国人，4 名（2.1%）为其他种族和族裔群体（4 名非西班牙裔白人女性）。98 名（52.1%）女性有中等乳腺癌发病风险，90 名（47.9%）为高风险。总体而言，乳房 X 光检查率略有增加，从常规护理期间的 38.8%增加到风险评估后期间的 48.9%（比值比，1.37；95%CI，0.92-2.03）。在预先计划的亚组分析中，高风险女性的乳房 X 光检查率在风险评估后明显高于风险评估前（51.1%比 36.6%；比值比，1.88；95%CI，1.10-3.23）。
结论和相关性：在这项研究中，在联邦合格健康中心的初级保健中提供个体化乳腺癌风险估计作为服务的一部分，与高风险的少数族裔和种族女性使用乳房 X 光检查的增加有关。在服务不足的社区实施这种方法可以促进乳房 X 光检查的公平使用，并减少乳腺癌死亡率方面的种族差异。该策略值得进一步研究。
