Breast Cancer Screening Use by African Americans and Whites in an HMO


Address correspondence and reprint requests to Dr. Elmore: Division of General Internal Medicine, Harborview Medical Center, 325 Ninth Ave., Box 359780, Seattle, WA 98104-2499 (e-mail:


OBJECTIVE: To examine racial differences in breast cancer screening in an HMO that provides screening at no cost.

DESIGN: Retrospective cohort study of breast cancer screening among African-American and white women. Breast cancer screening information was extracted from computerized medical records.

SETTING: A large HMO in New England.

PATIENTS/PARTICIPANTS: White and African-American women (N = 2,072) enrolled for at least 10 years in the HMO.

MAIN RESULTS: Primary care clinicians documented recommending a screening mammogram significantly more often for African Americans than whites (70% vs 64%; P < .001). During the 10-year period, on average, white women obtained more mammograms (4.49 vs 3.93; P < .0001) and clinical breast examinations (5.35 vs 4.92; P < .01) than African-American women. However, a woman's race was no longer a statistically significant predictor of breast cancer screening after adjustment for differences in age, estimated household income, estrogen use, and body mass index (adjusted number of mammograms, 4.47 vs 4.25, P = .17; and adjusted number of clinical breast examinations, 5.35 vs 5.31, P = .87).

CONCLUSIONS: In this HMO, African-American and white women obtained breast cancer screening at similar rates. Comparisons with national data showed much higher screening rates in this HMO for both white and African-American women.