Study reveals gaps in access to, use of, screening mammograms in Pierce County

TACOMA, Wash.—A new study commissioned by the Carol Milgard Breast Center concludes that African American women in Pierce County are more likely to be diagnosed with breast cancer later than others and die from the disease at a younger age.

More than 37 percent of African American women who developed breast cancer between 2004 and 2008 were diagnosed only after the disease had reached an advanced stage when it is often too late for successful medical treatment, according to the study conducted by the Tacoma-Pierce County Health Department.

One of the most surprising findings is that the breast cancer death rate, as well as the rate of premature deaths, was highest in the residential corridor from central Tacoma to neighboring Ruston even though women living there have the highest rate of mammography screenings in the county. In all, 63 women between ages 40-64 died from breast cancer there between 2000 and 2009.

It is unclear from the data why mortality was high in these Tacoma communities in spite of high mammography utilization,” said radiologist Khai Tran, MD, medical director for the Carol Milgard Breast Center. “Possible explanations are that women in this area suffered biologically aggressive tumors or that they did not get a mammogram on a yearly basis. “We often see highly aggressive and advanced tumors in women who are getting a mammogram for the first time or who have not had a mammogram for a long period of time. More investigation is needed for us to better understand this information.”

The study, compiled in 2011, indicates that the use of screening mammograms varies widely among all women ages 40-64 for whom annual breast exams are recommended by medical experts. The lowest usage is in eastern Pierce County communities from suburban Bonney Lake to remote Ashford near Mount Rainier National Park, outside the Carol Milgard Breast Center’s core service area.

A total of 913 women died from breast cancer in Pierce County between 2000 and 2009. Of those, about one in eight (117) were from minority-population groups such as African American, Hispanic and American Indian. More than one-third (361) were ages 40-64. Overall, the county’s breast-cancer mortality rate was 26.8 deaths per 100,000 women per year, slightly below the statewide average of 29.6.

The study confirmed that women who do not have medical insurance or a primary care doctor are less likely to have regular mammograms. In 2008, for example, more than 31 percent of women ages 40-64 living in the area from Tacoma to Spanaway reported they could not afford health care because of poverty or lack of insurance.

“There are serious gaps in access to and the use of screening mammograms in our communities,” said Jackie Ostrom, executive director of the Carol Milgard Breast Center. “Thanks to this study, we will identify additional opportunities to work with our community partners to address the needs of these vulnerable and high-risk patients.”

The breast center plans additional outreach efforts that will focus on African American women, while continuing to remind all females of the importance of the three most important steps: monthly breast self-exams; yearly clinical breast exams by a physician or other professional provider; and annual mammograms for those 40 and older, Ms. Ostrom added.

“Yearly mammograms save lives,” Dr. Tran said. “The earlier that we diagnose breast cancer, the greater our chances to successfully treat the disease.”

Additionally, the breast center staff has informed physician leaders at the CHI Franciscan Health System and MultiCare Health System about the relatively low use of mammograms among women in east Pierce County communities served by those organizations. CHI Franciscan St. Elizabeth Hospital in Enumclaw and MultiCare Good Samaritan Hospital in Puyallup both provide mammography services. Each organization also has charity care policies that benefit patients who need financial assistance for necessary medical care.

The Carol Milgard Breast Center, which opened in February 2009, was established by MultiCare, CHI Franciscan and TRA Medical Imaging. The center, at 4525 South 19th St. in Tacoma, is designated a Breast Imaging Center of Excellence by the American College of Radiology and it has served 93,324 patients since opening. In 2011, the center provided more than $488,000 in compassionate care for patients who could not afford needed services.

To schedule an appointment at the Carol Milgard Breast Center or learn more about its financial aid guidelines, call 253-759-2622 (1-866-758-2622 toll-free) or go online to www.carolmilgardbreastcenter.org.