Disparities in Late Stage Diagnosis, Treatment, and Breast Cancer-Related Death by Race, Age, and Rural Residence Among Women in Georgia

Abstract

The objectives of this study were to examine the outcomes of late stage breast cancer diagnosis, receiving first course treatment, and breast cancer-related death by race, age, and rural/urban residence in Georgia. The authors used cross-sectional and follow-up data (1992-2007) for Atlanta and Rural Georgia cancer registries that are part of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (N = 23,500 incident breast cancer cases in non-Hispanic whites or non-Hispanic African Americans). Multilevel modeling and Cox proportional hazard models revealed that compared to whites, African American women had significantly increased odds of late stage diagnosis (odds ratio [OR] = 2.08, p = 0.0001) and unknown tumor stage (OR = 1.27, p = 0.0001), decreased odds of receiving radiation (OR = 0.93, p = 0.041) or surgery (OR = 0.50, p = 0.0001), and increased risk of death following breast cancer diagnosis (hazard rate ratio [HR] = 1.50, p = 0.0001). Increased age was significantly associated with the odds of late/unknown stage at diagnosis, worse treatment, and survival. Women residing in rural areas had significantly decreased odds of receiving radiation and surgery with radiation (OR = 0.59, p = 0.0001), and for receiving breast-conserving surgery compared to mastectomy (OR = 0.73, p = 0.005). Factors affecting each level of the breast cancer continuum are distinct and should be examined separately. Efforts are needed to alleviate disparities in breast cancer outcomes in hard-to-reach populations.

Improving outcomes in breast cancer: where should we target our efforts?

“…Similarly, using data from the NCI's Surveillance, Epidemiology and End Results (SEER) registry-based data system and focusing also on the state of Georgia, Markossian and colleagues [12] evaluated disparities among women diagnosed with late stage breast cancer. Rural residency was not found to be significantly associated with risk of death from breast cancer.…”

Rural disadvantage in breast cancer health-care service use and outcomes: quantifying the effects of individual risk factors and health service risk factors

“…Breast cancer is the most prevalent cancer in women and it is one of the few cancers for which population screening technologies are available [171] . Most of the countries represented in this review have a national-level program for two-yearly breast cancer screening, with about half recommending screening commence at 40 or 45 years and the remainder recommending that screening start at age 50 [181].…”

“…Of the 24 included studies, 16 reported later stage at diagnosis in rural breast cancer patients [77, 78, 136, 159, 164-167, 169, 170, 172, 173, 176, 177, 179, 180], and eight studies found no rural and urban differences [161,162,168,171,174,175,178] (see Table 15). The differences in findings…”

“…Some studies defined urban and rural areas based on population size or density [170,174,176]. Other studies used a standard system of rural and urban classification, such as the Rural Urban Commuting Area Codes [162,168,171], Census classifications [159,163,164], and the Accessibility/Remoteness Index of Australia [172,173]. One study defined urban areas as areas without food production [178].…”

“…There were 13 studies from the United States [77,159,[161][162][163][164][165][166][167][168][169][170][171], which is over half of all included studies. There were two studies from Australia [172,173], two from New Zealand [174,175], and one study each from Canada [176], Denmark [78], Egypt [136], Italy [177], Norway [178], Poland [179], and South Africa [180].…”