Dissertations & Theses (Open Access)

Date of Award

Spring 5-2020

Degree Name

Doctor of Philosophy (Medical Science)

Advisor(s)

Linda D Highfield, Phd Academic Advisor/Committee Chair/Dissertation Supervisor

Second Advisor

Suja S Rajan, Phd Committee Member

Third Advisor

Paula M Cuccaro, Phd Committee Member

Abstract

Breast cancer is the second most common cause of cancer related death in women in the United States with one in eight women expected to develop the disease in their lifetime. Unfortunately, breast cancer is the leading cause of cancer related death among African American women. African American women are four times more likely to die from breast cancer that Caucasian women. Mammography screenings are the most effective method of reducing breast cancer mortality in African American women. This study aimed to determine if the changes made to the mammography screening recommendations put forth by the U.S. Preventive Services Task Force in November 2009 and later re-enforced in January 2016 create an increased burden of breast cancer diagnoses among African American women. The study does so by addressing whether changing the time interval between mammography screenings affects the likelihood of African American women being diagnosed with breast cancer and if African American women typically present with knowledge of their family history of breast cancer. The U.S. Preventive Services Task Force used the fact that the majority of women develop breast cancer in their 60s and the burden caused by false positives to support their decision to change the screening recommendations, however, literature describes a higher incidence of aggressive breast cancers and earlier onset of disease in African American women. Data from the Breast Cancer Surveillance Consortium was used to run multivariate regression analyses of breast cancer diagnosis within a year of the previous mammography screening and the presence of knowledge of family history at the time of mammography screening. A significant association was not found between race and the likelihood of being diagnosed with either invasive or non-invasive breast cancer. However, African American women had a higher proportion of women without knowledge of their family history of breast cancer. This research fills an important gap in understanding how the recommendation changes can influence the mortality and morbidity of African American women that develop breast cancer. Its implications include potential policy changes on the mammography screening recommendations given specifically for African American women.

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