Racial and ethnic differences in mammography use among U.S. women younger than age 40

Racial and regional disparities of triple negative breast cancer incidence rates in the United States: An analysis of 2011-2019 NPCR and SEER incidence data

Objective

Triple negative breast cancer (TNBC) is a more aggressive subtype resistant to conventional treatments with a poorer prognosis. This study was to update the status of TNBC and the temporal changes of its incidence rate in the US.

Methods

Women diagnosed with breast cancer during 2011-2019 were obtained from the National Program of Cancer Registries (NPCR) and Surveillance, Epidemiology and End Results (SEER) Program SEER^*Stat Database which covers the entire population of the US. The TNBC incidence and its temporal trends by race, age, region (state) and disease stage were determined during the period.

Results

A total of 238,848 (or 8.8%) TNBC women were diagnosed during the study period. TNBC occurred disproportionally higher in women of Non-Hispanic Black, younger ages, with cancer at a distant stage or poorly/undifferentiated. The age adjusted incidence rate (AAIR) for TNBC in all races decreased from 14.8 per 100,000 in 2011 to 14.0 in 2019 (annual percentage change (APC) = -0.6, P = 0.024). Incidence rates of TNBC significantly decreased with APCs of -0.8 in Non-Hispanic White women, -1.3 in West and -0.7 in Northeastern regions. Women with TNBC at the age of 35-49, 50-59, and 60-69 years, and the disease at the regional stage displayed significantly decreased trends. Among state levels, Mississippi (20.6) and Louisiana (18.9) had the highest, while Utah (9.1) and Montana (9.6) had the lowest AAIRs in 2019. New Hampshire and Indiana had significant and highest decreases, while Louisiana and Arkansas had significant and largest increases in AAIR. In individual races, TNBC displayed disparities in temporal trends among age groups, regions and disease stages. Surprisingly, Non-Hispanic White and Hispanic TNBC women (0-34 years), and Non-Hispanic Black women (≥70 years) during the entire period, as well as Asian or Pacific Islander women in the South region had increased trends between 2011 and 2017.

Conclusion

Our study demonstrates an overall decreased trend of TNBC incidence in the past decade. Its incidence displayed disparities among races, age groups, regions and disease stages. Special attention is needed for a heavy burden in Non-Hispanic Black and increased trends in certain groups.

Tendency to Breast Cancer Screening Among Rural Women in Southern Iran: A Structural Equation Modeling (SEM) Analysis of Theory of Planned Behavior

Background:

Early detection of breast cancer is a crucial factor in surviving the disease. This study aimed to investigate the mammography screening based on the theory of planned behavior (TPB) among rural women in Fasa and Shiraz cities, Iran.

Methods:

This study is a cross-sectional study performed on 800 female clients referring to rural health centers in Fasa and Shiraz cities in southern Iran in early 2021. The authors decided to send and distribute the electronic questionnaire form through the WhatsApp application in collaboration with the health staff of rural health centers for the people covered by these centers. Data gathering tools were a questionnaire on demographic characteristics, a questionnaire based on constructs of TPB, and behavior of mammography screening. Using the structural equation model (SEM), the TPB constructs and demographic variables were entered into the model. Data analysis was executed employing SPSS software version 26 and Amos version 24 (IBM Co., Ann Arbor, MI, USA). Analyzing the data was carried out using the 1-way analysis of variance (ANOVA), logistic regression, and structural equation analysis. During data analysis, various model indicators such as the goodness of fit, including comparative fit index (CFI), goodness-of-fit index (GFI), root mean square error of approximation (RMSEA), and chi-square index/df were evaluated. The significance level in all tests was considered 0.05.

Results:

The knowledge, attitude, and perceived behavioral control were the predictors of intention and behavior of mammography screening among the women. Among demographic variables, age, literacy, being menopausal, cancer in family, city, and ethnicity contribute more to the variance variation in TPB constructs. In this study, 7.2% of Persians, 8% of Qashqai Turks, and 4.5% of Arabs are contemplating going to mammography screening. In total, 6.8% (54 people) of all individuals intended to go mammography screening, and 5.4% (43 people) had a history of mammography screening. Goodness-of-fit indices (χ² = 18.45, df = 10, n = 800, χ²/df = 1.845, RMSEA = 0.032, GFI = 0.90, non-normed fit index (NNFI) = 0.91) of conceptual model of this study indicate the suitability of the model.

Conclusions:

The results of the study indicated that the constructs of the TPB can predict mammography screening behaviors in rural women. It has also demonstrated that mammographic behavior can be improved in rural women using education based on the TPB model, emphasizing critical psychological factors of creating or changing behavior.

Application of the theory of regulatory fit to promote adherence to evidence-based breast cancer screening recommendations: experimental versus longitudinal evidence

OBJECTIVES

To reduce overtreatment caused by overuse of screening, it is advisable to reduce the demand for mammography screening outside the recommended guidelines among women who are not yet eligible for inclusion in systematic screening programmes. According to principles of regulatory fit theory, people make decisions motivated by either orientation to achieving and maximising gains or avoiding losses. A study developed in two phases investigated whether video messages, explaining the risks and benefits of mammography screening for those not yet eligible, are perceived as persuasive DESIGN: Phase 1 was an experimental study in which women's motivation orientation was experimentally induced and then they were exposed to a matching video message about mammography screening. A control group received a neutral stimulus. Phase 2 introduced a longitudinal component to study 1, adding a condition in which the messages did not match with the group's motivation orientation. Participants' natural motivation orientation was measured through a validated questionnaire PARTICIPANTS: 360 women participated in phase 1 and another 292 in phase 2. Participants' age ranged from 30 to 45 years, and had no history of breast cancer or known BReast CAncer gene (BRCA) 1/2 mutation.

RESULTS

In phase 1, a match between participants' motivation orientation and message content decreased the intention to seek mammography screening outside the recommended guidelines. Phase 2, however, did not show such an effect. Fear of breast cancer and risk perception were significantly related to intention to seek mammography screening CONCLUSIONS: Public health researchers should consider reducing the impact of negative emotions (ie, fear of breast cancer) and risk perception when promoting adherence to evidence-based breast cancer screening recommendations.

Mammography perceptions and practices among women aged 30-49: The role of screening programme availability and cultural affiliation

OBJECTIVE

To explore the role of systematic screening programme availability and cultural affiliation as drivers of mammography perceptions/practices among women aged 30-49, who are not eligible for screening.

METHODS

Cross-sectional survey about mammography perceptions/practices among N = 918 Swiss women (30-49), across three cultural-linguistic regions (Swiss-German, Swiss-French, Swiss-Italian) and 26 cantons.

RESULTS

In cantons offering systematic screening programmes, women appeared more likely to ask for a mammogram, felt more susceptible to breast cancer, and perceived more benefits to screening. Swiss-German women engaged less in screening and felt less susceptible to breast cancer than women in other cultural-linguistic regions. Within the Swiss-German region, women living in cantons with programmes were more likely to ask for a mammogram than in cantons without.

CONCLUSIONS

Programme availability and cultural affiliation both appear related to young women's screening perceptions/practices. While the interaction between these factors should be further explored, this study provides some preliminary evidence that cultural affiliation is the more important driver.

PRACTICE IMPLICATIONS

Health communication efforts should consider the impact of these drivers on women's intentions to have a mammogram, prior to the recommended age. Tailored communication - public and interpersonal - should be directed towards facilitating informed decision-making and avoidance of mammography overuse.

Mammography use among women aged 18-39 years in the United States

PURPOSE

Recommendations for breast cancer screening using mammography target asymptomatic women aged ≥ 40 years who are not at increased risk for breast cancer. Evidence is not available to demonstrate benefits of screening with mammography at younger ages, and little is known about mammography use among younger women. This study described mammography use among women aged 18-39 years.

METHODS

We analyzed data from the 2011-2015 National Survey of Family Growth, an in-person survey of a nationally representative sample of the U.S. household population. We estimated the prevalence of ever receiving a mammogram and examined reasons for the first mammograms among women aged 18-39 years without personal cancer history (n = 8324). We classified the first mammogram as a screening examination if it was performed either as part of a routine exam or because of family history of cancer.

RESULTS

Among women aged 18-39 years, 14.3% (95% CI 13.2-15.4) reported ever having a mammogram. Prevalence of mammography use was highest among women aged 35-39 years (31.0%, 95% CI 27.8-34.5), and was higher among non-Hispanic black women than in other race/ethnicity groups. Women with a family history of breast cancer reported a higher prevalence of mammography use than women without this family history. For both women with and without a family history of breast cancer, about half of all first mammograms were performed for screening reasons.

CONCLUSIONS

Among U.S. women aged 18-39 years with no personal cancer history, one in seven reported having received a mammogram. Women with no family history of breast cancer were as likely as those with a family history to initiate breast cancer screening with mammography before age 40. Our findings provide evidence that supports further research to examine factors that prompt young women to receive screening mammograms.

A national cross-sectional study of adherence to timely mammography use in Malta

BACKGROUND

Routine mammography improves survival. To achieve health benefits, women must attend breast screening regularly at recommended time intervals. Maltese women are routinely invited to undergo mammography at three-year intervals at an organized breast screening programme (MBSP) or can opt to attend a private clinic. Previous research shows that health beliefs, particularly perceived barriers, were the most significant predictors of uptake to the first MBSP invitation. Whether these beliefs and other factors are predictive of adherence with recommended time intervals for mammography at organized or private screening in Malta is unknown. For the first time, this paper explores the predictors for Maltese women screened within or exceeding the recommended three-year frequency in organized or private screening in Malta.

METHODS

Information was obtained from a cross-sectional survey of 404 women, aged 50 to 60 years at the time of their first MBSP invitation, where women's characteristics, knowledge, health beliefs and illness perceptions were compared. The main variable of interest was women's mammography attendance within a three-year interval (ADHERENT) or exceeding three years (NON-ADHERENT). Data were analysed using descriptive statistics, chi-square test, Mann Whitney test, Independent Samples t-test and Shapiro Wilk test.

RESULTS

At the time of the survey, 80.2% (n = 324) had been screened within three years (ADHERENT), 5.9% (n = 24) had exceeded the three-year frequency (NON-ADHERENT) while 13.9% (n = 56) never had a mammogram. No significant associations were found between ADHERENT or NON-ADHERENT women in relation to sociodemographic or health status variables (p > 0.05). Knowledge of screening frequency was significantly associated with women's mammography adherence (χ2 = 5.5, p = 0.020). Health beliefs were the strongest significant predictors to describe the variance between ADHERENT and NON-ADHERENT screeners. When Mann Whitney test and Independent Samples t-test were applied on mammography adherence, perceived barriers and cues to action were found to be the most important predictors (p = 0.000, p = 0.039 respectively).

CONCLUSIONS

To increase routine and timely mammography practices, women who are non-adherent to recommended time frequency guidelines should be targeted, together with their health beliefs, predominantly perceived barriers and cues to action.

Investigating young women's motivations to engage in early mammography screening in Switzerland: results of a cross-sectional study

BACKGROUND

The scientific and public debate concerning organized mammography screening is unprecedentedly strong. With research evidence concerning its efficacy being ambiguous, the recommendations pertaining to the age-thresholds for program inclusion vary between - and even within - countries. Data shows that young women who are not yet eligible for systematic screening, have opportunistic mammograms relatively often and, moreover, want to be included in organized programs. Yet, to date, little is known about the precise motivations underlying young women's desire and intentions to go for, not medically indicated, mammographic screening.

METHODS

A cross-sectional online survey was carried out among women aged 30-49 years (n = 918) from Switzerland.

RESULTS

The findings show that high fear (β = .08, p ≤ .05), perceived susceptibility (β = .10, p ≤ .05), and ego-involvement (β = .34, p ≤ .001) are the main predictors of screening intentions among women who are not yet eligible for the systematic program. Also, geographical location (Swiss-French group: β = .15, p ≤ .001; Swiss-Italian group: β = .26, p ≤ .001) and age (β = .11, p ≤ .001) play a role. In turn, breast cancer knowledge, risk perceptions, and educational status do not have a significant impact.

CONCLUSIONS

Young women seem to differ inherently from those who are already eligible for systematic screening in terms of the factors underlying their intentions to engage in mammographic screening. Thus, when striving to promote adherence to systematic screening guidelines - whether based on unequivocal scientific evidence or policy decisions - and to allow women to make evidence-based, informed decisions about mammography, differential strategies are needed to reach different age-groups.

Exploring Geographic Variability in Cancer Prevalence in Eastern Morocco: A Retrospective Study over Eight Years

BACKGROUND

Malignant diseases have been believed to be more common in some areas of Eastern Morocco, but until now, cancer patterns have not been reported for this region. In this paper we present for the first time the cancer prevalence analysis in Eastern Morocco.

METHODS

Cross-sectional study carried out among all patients diagnosed and/or treated with cancer at the Hassan II Regional Oncology Center (ROC) since it was established in October 2005 until December 2012. The ROC is the only hospital specialized in cancer care in Eastern Morocco.

RESULTS

A total of 8,508 cases of cancer were registered among residents in Eastern Morocco, with a female to male ratio of 2.1. The mean age at diagnosis was 53.9 ± 15.2 years (median age = 53 years). Thus, unlike in Western countries, cancer in Eastern Morocco afflicts younger population. The areas of Eastern Morocco did not differ significantly by mean age at diagnosis (p = 0.061). However, these regions differed significantly by sex ratio (p < 0.001). The highest sex ratio was observed in Figuig, with a female to male ratio of 3.1 (75.4% of the registered case were females), followed respectively by Taourirt, Oujda-Angad, Berkane, Nador-Driouch and Jerada. Clear variation in the distribution of cancer types between areas of Eastern Morocco was observed, both in males and females (p < 0.001). Furthermore, the areas of Eastern Morocco differed significantly by cancer prevalence (p < 0.001). The highest age-standardized five-year prevalence proportion was observed in Oujda-Angad with 420.2 per 100,000, followed respectively by Berkane (311.4), Jerada (287.8), Taourirt (269.3), Nador-Driouch (213.6) and Figuig (194.4). Trends in the five-year prevalence proportions decreased in Oujda-Angad, Berkane and Jerada throughout the study period, while an increasing trend was observed in Nador-Driouch, Taourirt and Figuig.

CONCLUSIONS

For the first time, our study presents the pattern and distribution of diagnosed cancers in Eastern Morocco. Our study illustrates substantial differences in cancer patterns between areas of Eastern Morocco. These findings are important for cancer control and highlight the need to develop program aiming at controlling and preventing the spread of major cancer sites in Eastern Morocco, particularly in areas with increased cancer prevalence rates.

Increasing disparities in breast cancer mortality from 1979 to 2010 for US black women aged 20 to 49 years

Racial disparities in breast cancer mortality persist, and young Black women have higher disease incidence compared with White women. We compared trends in breast cancer mortality for young Black and White women with mortality trends for other common diseases from 1979 to 2010. In contrast to other cancers, ischemic heart disease, and stroke, the breast cancer mortality disparity has widened over the past 30 years, suggesting that unique aspects of disease biology, prevention, and treatment may explain persistent racial differences for young women.

Opportunities and challenges for the use of large-scale surveys in public health research: a comparison of the assessment of cancer screening behaviors

Large-scale surveys that assess cancer prevention and control behaviors are a readily available, rich resource for public health researchers. Although these data are used by a subset of researchers who are familiar with them, their potential is not fully realized by the research community for reasons including lack of awareness of the data and limited understanding of their content, methodology, and utility. Until now, no comprehensive resource existed to describe and facilitate use of these data. To address this gap and maximize use of these data, we catalogued the characteristics and content of four surveys that assessed cancer screening behaviors in 2005, the most recent year with concurrent periods of data collection: the National Health Interview Survey, Health Information National Trends Survey, Behavioral Risk Factor Surveillance System, and California Health Interview Survey. We documented each survey's characteristics, measures of cancer screening, and relevant correlates; examined how published studies (n = 78) have used the surveys' cancer screening data; and reviewed new cancer screening constructs measured in recent years. This information can guide researchers in deciding how to capitalize on the opportunities presented by these data resources.

The National Prevention Strategy and breast cancer screening: scientific evidence for public health action

Mammography screening rates in the United States have remained fairly stable over the past decade, and screening rates remain low for some groups. We examined insights from recent public health research on breast cancer screening to identify promising new approaches to improve screening rates and address persistent health disparities in mammography use. We considered this research in the context of the four strategic directions of the National Prevention Strategy: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services. This research points to the value of direct outreach and case management services, interventions to support more patient-centered models of care, and more organized, population-based approaches to identify women who are eligible to be screened, encourage participation, and monitor results.

Factors associated with self-reported mammography use for women with and women without a disability

BACKGROUND

Although their risk of breast cancer is similar to that of women without a disability, women with a disability might be less likely to obtain a mammogram within the recommended time frame. The purpose of this study was to expand our knowledge of the association between mammography use and having a disability by controlling for sociodemographic and health variables.

METHODS

Data from the 2008 Behavioral Risk Factor Surveillance System (BRFSS) were used to obtain prevalence of self-reported mammography use in the past 2 years among U.S. women ≥40 years of age (n=204,981) as well as women 50-74 years of age (n=122,374). Logistic regression was used to estimate associations between disability and obtaining a mammogram for each age cohort, controlling for sociodemographic factors.

RESULTS

Prevalence of self-reported mammography use is lower for women with a disability (72.2% for women ≥40 years of age and 78.1% for women 50-74 years of age) than women without a disability (77.8% and 82.6%, respectively). Women with a disability had lower odds of mammography use than women without a disability for both age cohorts (≥40, adjusted odds ratio [aOR] 0.92, p=0.01; 50-74 years, aOR 0.92, p=0.03).

CONCLUSIONS

Disparities in obtaining a mammogram at recommended screening intervals persist for women with disabilities. This demonstrates the need for continued health promotion and prevention activities directed toward women with a disability to improve their accessibility to obtaining a mammogram.

Black women and breast health: a review of the literature

AIM

In the UK, it is known that screening inequalities exist involving ethnic minority groups such as Black women (Patnick, 2009). To date, there is limited UK data on Black British women and breast health awareness. Black British women appear to be an underrepresented group in breast cancer studies (Breast Cancer Care, 2004, 2005). This literature review aimed to explore Black women's perceptions of breast health and factors that influence breast cancer screening practices.

METHODS

A literature search for the period 1994 to September 2009 was undertaken using BNI, CINAHL, PubMed, OSH-ROM, PsyInfo, Google scholar, and Scopus databases. Key words used included: breast cancer, breast health, African American women, Black British women, black women, breast cancer screening, qualitative studies. Hand-searching was also done, and reference lists of papers were examined for relevant studies.

RESULTS

Black women hold a variety of views and perceptions on the risk that breast cancer poses. These perceptions are strongly related to existing knowledge, related stigmatization, spiritual and religious beliefs, all of which can adversely influence motivation to engage in self-breast examination and breast cancer screening.

CONCLUSION

US based studies identified several influential factors: religion, educational awareness of breast cancer screening, breast health awareness. Breast health interventions and research are needed to increase breast health awareness in Black British women.

A prospective assessment of racial/ethnic differences in future mammography behavior among women who had early mammography

BACKGROUND

Twenty-nine percent of women, aged 30 to 39, report having had a mammogram, though sensitivity and specificity are low. We investigate racial/ethnic differences in future mammography behavior among women who had a baseline screening mammogram prior to age 40.

METHODS

Using 1994-2008 data from the Breast Cancer Surveillance Consortium (BCSC), we identified 29,390 women aged 35 to 39 with a baseline screening mammogram. We followed this cohort for 2 outcomes: (i) future BCSC mammography between ages 40 and 45; and (2) among those, delay in screening mammography until ages 43 to 45 compared with ages 40 to 42. Using adjusted log-linear models, we estimated the relative risk (RR) of these outcomes by race/ethnicity, while also considering the impact of false-positive/true-negative (FP/TN) baseline mammography results on these outcomes.

RESULTS

Relative to non-Hispanic white women, Hispanic women had an increased risk of no future BCSC mammography (RR: 1.21, 95% CI: 1.13-1.30); Asian women had a decreased risk (RR: 0.67, 95% CI: 0.61-0.74). Women with a FP result, compared with a TN result, had a decreased risk of no future BCSC mammography (RR: 0.89, 95% CI: 0.85-0.95). Among those with future BCSC screening mammography, African American women were more likely to delay the timing (RR: 1.26, 95% CI: 1.09-1.45). The interaction between race/ethnicity and FP/TN baseline results was not significant.

CONCLUSIONS

Race/ethnicity is differentially associated with future BCSC mammography and the timing of screening mammography after age 40.

IMPACT

These findings introduce the need for research that examines disparities in lifetime mammography use patterns from the initiation of mammography screening.

A comparison of two educational methods on immigrant Latinas breast cancer knowledge and screening behaviors

Underutilization of screening mammography by Latinas continues unabated and may contribute to disparities in disease-free survival and mortality.

OBJECTIVE

Comparison of two discussion group-centered educational interventions at enhancing breast cancer knowledge, breast self-exams (BSE), and screening mammography.

METHODS

Pre-test post-test study design. Two cohorts of 200 Latinas each participated in survey screening and discussion groups at baseline. One cohort also viewed an animated video and had BSE training. Breast cancer knowledge, self-reported BSE and mammography history were measured at baseline and three months post-intervention.

RESULTS

Breast cancer knowledge scores were good for both groups at baseline, and significantly increased at three month follow-up for both groups (p<.05) but no significant difference was observed between groups at baseline or post-intervention.

CONCLUSION

Community-based discussion groups are a cost-effective method for improving breast cancer knowledge and promoting screening behaviors.

Performance of mammography in women aged under 40 years

Evaluation of: Yankaskas BC, Haneuse S, Kapp JM, Kerlikowske K, Geller B, Buist DSM; For the Breast Cancer Surveillance Consortium: Performance of first mammography examination in women younger than 40 years. J. Natl Cancer Inst. 102(10), 692–700 (2010). By using pooled data from six mammography registries across the USA, 117,737 women aged 18–39 years were identified who had received their first mammography in the period 1995–2005. A distinction was made between diagnostic mammography for women who presented with a breast problem (n = 30,956), and screening mammography (n = 86,781). The age-adjusted positive predictive value of screening mammography was 1.3% (95% CI: 1.1–1.5%), as compared with 14.6% (95% CI: 13.3–15.8%) for diagnostic mammography. Considering the high recall rates, the high number of false-positive test results and the low cancer detection rate, the appropriateness of mammography for women younger than 40 without symptoms is questionable.

Performance of first mammography examination in women younger than 40 years

BACKGROUND

Few data have been published on mammography performance in women who are younger than 40 years.

METHODS

We pooled data from six mammography registries across the United States from the Breast Cancer Surveillance Consortium. We included 117 738 women who were aged 18-39 years when they had their first screening or diagnostic mammogram during 1995-2005 and followed them for 1 year to determine accuracy of mammography assessment. We measured the recall rate for screening examinations and the sensitivity, specificity, positive predictive value, and cancer detection rate for all mammograms.

RESULTS

For screening mammograms, no cancers were detected in 637 mammograms for women aged 18-24 years. For women aged 35-39 years who had the largest number of screening mammograms (n = 73 335) in this study, the recall rate was 12.7% (95% confidence interval [CI] = 12.4% to 12.9%), sensitivity was 76.1% (95% CI = 69.2% to 82.6%), specificity was 87.5% (95% CI = 87.2% to 87.7%), positive predictive value was 1.3% (95% CI = 1.1% to 1.5%), and cancer detection rate was 1.6 cancers per 1000 mammograms (95% CI = 1.3 to 1.9 cancers per 1000 mammograms). Most (67 468 [77.7%]) of the 86 871 women screened reported no family history of breast cancer. For diagnostic mammograms, the age-adjusted rates across all age groups were: sensitivity of 85.7% (95% CI = 82.7% to 88.7%), specificity of 88.8% (95% CI = 88.4% to 89.1%), positive predictive value of 14.6% (95% CI = 13.3% to 15.8%), and cancer detection rate of 14.3 cancers per 1000 mammograms (95% CI = 13.0 to 15.7 cancers per 1000 mammograms). Mammography performance, except for specificity, improved in the presence of a breast lump.

CONCLUSIONS

Younger women have very low breast cancer rates but after mammography experience high recall rates, high rates of additional imaging, and low cancer detection rates. We found no cancers in women younger than 25 years and poor performance for the large group of women aged 35-39 years. In a theoretical population of 10 000 women aged 35-39 years, 1266 women who are screened will receive further workup, with 16 cancers detected and 1250 women receiving a false-positive result.

Are there racial/ethnic disparities among women younger than 40 undergoing mammography?

While the probability of a woman developing invasive breast cancer at age <40 is low (<1%), mammography use reported among younger women (age <40) is substantial, and varies by race/ethnicity. Little detail is known about mammography use among women aged <40, particularly by race/ethnicity. We describe racial/ethnic differences in: (1) mammography indication after considering underlying risk factors (breast symptoms and family history); (2) follow-up recommendations, and (3) mammography outcomes for first mammograms in women aged <40. These 1996-2005 Breast Cancer Surveillance Consortium data are prospectively pooled from seven U.S. mammography registries. Our community-based sample included 99,615 women aged 18-39 who self-reported race/ethnicity and presented for a first mammogram (screening or diagnostic) with no history of breast cancer. Multivariable analyses controlled for registry site, age, family history of breast cancer, symptoms, and exam year. Overall, 73.6% of the women in our sample were seen for a screening mammogram. Following screening mammography, African American (AA) women were more likely than white women to be recommended for additional workup [relative risk (RR): 1.15 (95% CI: 1.07-1.23)]. Following diagnostic mammography, AA [RR: 1.30 (95% CI: 1.17-1.44)] and Asian [RR: 1.44 (95% CI: 1.26-1.64)] women were more likely to be recommended for biopsy, fine-needle aspiration, or surgical consultation. Depending on race/ethnicity, and considering the rate of true positive to total first screening mammograms of younger women, a women has a likelihood of a true positive of 1 in 363-1,122; she has a likelihood of a false positive of 1 in 7-10. This study of community-based practice found racial/ethnic variability in mammography indication, recommendations, and outcomes among women undergoing first mammography before 40. These findings highlight important areas for future research to understand the motivating factors for these practice patterns and the implications of early mammography use.