t African American women have the highest incidence of breast cancer and are 30% more likely to die of the disease than caucasian women, at least in part due to later stage disease detection in this group of women (Schuler, 2009).
Breast cancer screening tools such as mammography were introduced into widespread use based on the presumption that early detection afforded by routine screening would lead to more effective treatment and overall survival rates from this disease. Data collected from numerous clinical trials indicate that mammography screening done on an annual basis is associated with a significant reduction in mortality rates from breast cancer (Elting, 2009). According to the World health organization (WHO), a 35% decrease in mortality from breast cancer is associated with biannual mammography in women between the ages of 50-69 years (Elting et al, 2009). The statistics on actual use of mammography as a diagnostic tool for women over 40 reveal that this screening modality is significantly underused by women in this age group for whom the test is most highly recommended. For example, in 2002 approximately 25% of eligible women did not receive this diagnostic test (Schueler, 2008). Racial and ethnic differences in screening percentages mean that caucasian women are far more likely to receive annual mammography, which may account in part for the increased death rates in African American women from breast cancer in that it is not as likely to be detected in this group at an early stage (Schueler et al, 2008). In addition, women from lower socioeconomic groups (lower income, less education) are less likely to receive annual mammography screening. Moreover, the statistics indicate that women living in rural areas are less likely to receive diagnostic screening than women living in urban areas in the US (Schueler et al, 2008).
Research suggests that the most important factor accounting for these demographic and racial differences in screening rates