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Older black women get fewer breast tests

For years, researchers have been puzzled that when black women are diagnosed with breast cancer, their tumors are often more advanced than those of newly diagnosed white women.

Last week, researchers identified a probable explanation: Older black women are three times less likely than white women to have regular mammograms, which means that by the time their tumors are found, they are bigger and more difficult to treat.

Ellen P. McCarthy, an epidemiologist at Beth Israel Deaconess Medical Center and the lead author of the study, published in the Annals of Internal Medicine, says her research shows that black and white women benefit equally from mammograms.

But many older black women do not get mammograms, even though they have been available from Medicare for free since 1991. Many black women also do not have primary care doctors, and other studies have shown that women tend to get mammograms more regularly if a doctor urges them to do so.

In the study, McCarthy and colleagues studied tumor registry data for more than 4,000 women age 67 or older in Connecticut, Georgia and Washington state. They then looked at Medicare records to see if the women had had mammograms in the preceding two years. About 35 percent of black women between ages 65 and 67 did not use mammography, while 22 percent of white women did not.

Black women's tumors were 2{ times more likely to be in a late stage when diagnosed than those of white women.

The underuse of mammography by black women is particularly troubling, she said, because overall, black women have a lower incidence of breast cancer than white women, but they are more likely to die of it.

Among women 65 and older, 365 black women out of every 100,000 get breast cancer, while 460 white women do. Older black women have a 73 percent chance of surviving five years after a breast cancer diagnosis, compared with 88 percent for white women.