October 20, 2008 – October is National Breast Cancer Awareness Month, and the Health Department urges women 40 and older to mark it by scheduling a mammogram. Breast cancer is the second leading cause of cancer death (after lung cancer) among New York City women. By spotting the disease at its most treatable stages, mammograms help make it less deadly. Yet fewer and fewer New York City women are getting this screening. New research from the Health Department shows that the mammography rate has recently fallen by 4% in New York City, with recent rates mirroring those of the nation. The full report is available online, at www.nyc.gov/health.
“Some cancers are hard to detect until it’s too late,” said Dr. Thomas R. Frieden, New York City Health Commissioner. “Breast cancer is different. We have the tools to detect it early, and stop it. So don’t assume that what you can’t see can’t hurt you. If you’re 40 or older, get a mammogram.”
A mammogram is a breast X-ray that can identify tumors long before they are big enough to feel. Mammography greatly increases the likelihood of successful cancer treatment and decreases the risk of death. Women 40 and older should be tested every one to two years, according to current guidelines. Women with a family history of breast cancer should talk to a health care provider about starting at a younger age.
Free or low-cost mammograms are available, even for women without insurance. New Yorkers can call 311 to find a place to get a mammogram. The New York City Health and Hospitals Corporation, the city’s public hospital system, offers mammograms at little or no cost at its 11 hospitals and health centers. Uninsured or underinsured women can also call the New York State Cancer Services Program Referral Hotline at 866-442-CANCER (866-442-2262).
Fewer women getting mammograms
New York City’s mammography rate (74% of eligible women report being screened in the past two years) is higher than its colonoscopy rate (only 62% of adults 50 and older). But the city’s colonoscopy rate has climbed rapidly in recent years, while the mammography rate has declined – from 77% in 2002 to 74% in 2007. That suggests that some 69,000 women are missing out on a chance to protect themselves by detecting breast cancer early.
The report – Breast Cancer Screening among New York City Women – shows that mammography is down among white, Asian, and Hispanic women. Black women have bucked the trend and now have the highest screening rate of any racial or ethnic group in New York City (80%). Screening rates among Asian women remain the lowest (67%). Wealthier women are more likely to be screened than low-income women (76% versus 70%), but education is not a significant predictor. Screening rates are similar among college-educated women and those without a college degree, but rates have declined 5% among the most educated. The lowest screening rate was observed among women with no insurance and no regular health care provider (41%).
Differences in screening across the city
The survey finds similar mammography rates across boroughs, ranging from 73% to 76%, but some neighborhoods had notably lower screening rates. The rates were lowest in Southwest Brooklyn, North Queens, Northwest Queens, and the Kingsbridge and Riverdale sections of the Bronx. More than one in three women in these neighborhoods report not being screened for breast cancer in the past two years. The highest screening rates were in upper Manhattan (Washington Heights, Inwood) the Bronx (Highbridge, Morrisania, Hunts Point, Mott Haven), and Southeast Queens. In these neighborhoods, at least 80% of women got a timely mammogram. Differences in screening rates among neighborhoods are likely related to whether the racial/ethnic groups with high or low screening rates reside there; there is no evidence that low rates are tied to lack of screening facilities.
Deaths from breast cancer
Deaths from breast cancer have held steady in the city since 2000 (about 27 deaths per 100,000 women in 2006), but major differences in death rates persist along racial and ethnic lines. Despite having the highest reported screening rate, black women have the highest breast cancer death rate, a pattern also seen with several other cancers. Black women over 40 die from breast cancer at a rate of 69 per 100,000 women in New York City. The comparable death rates are 56 per 100,000 among white women, 43 among Hispanic women, and 28 among Asian women. Research suggests many possible reasons for these differences, including the quality of screening tests, timeliness of medical follow-up on abnormal mammograms, and differences in quality of care that some women may receive for breast cancer.
Why are fewer women getting mammograms?
Last year, the Health Department undertook several studies to understand both declines and gaps in mammography in order to address them. Using surveys and focus groups, researchers checked for changes in women’s attitudes, changes in physicians’ behavior, and gaps in screening capacity, but no study has identified a clear cause for the decline in mammography. Wait times for mammograms, for example, were not found to be a major factor; in fact the majority of facilities providing the screening in New York City can offer an appointment within two weeks (85%). Complete study results are forthcoming.
Some evidence suggests that rising health care costs and increasing co-pays may discourage women from seeking out testing. Another hypothesis is that groups with traditionally low screening rates (such as Asian women, immigrant women, uninsured women, women who work, women who need childcare and older women) have expanded in New York City, accounting for the decline. The Health Department is convening a panel of experts in the coming months to further examine this concerning trend.
About the data
The Health Department’s Vital Signs report is based on the Community Health Survey, a telephone survey of approximately 10,000 New York City adults (18 years or older). Breast Cancer Screening among New York City Women is available online at www.nyc.gov/health.