The gaps in mammography screening rates among older women in the District [Metro, May 19] are alarming because the District, measured against the 50 states, has the highest rate of mortality from breast cancer in the nation. Not surprisingly, the lowest screening rates occur in the poorest parts of the city, including areas east of the Anacostia River. These areas also have higher percentages of African American women, who are at much higher risk of dying from breast cancer than white women. One reason for this is that these women are not getting their malignancies detected early enough.

The shortage of mammography centers forces women to travel far from home to be screened. Mammography centers, even when conveniently located, often have limited or inconvenient hours. And eligible women often aren't aware that Medicare recommends and covers much of the cost of an annual screening.

Physicians should better educate patients about breast cancer and work more actively to get them in for screening. Clinics should expand hours. Foundations should step in with support. Community advocates should spread the word among their neighbors. Mammography can mean the difference between life and death.

WALTER EUGENE EGERTON

Medical Director

Delmarva Foundation

Washington

The Delmarva Foundation, which conducted the study cited in the article, is a national not-for-profit organization seeking to improve health care.