The Elevated Breast Cancer Mortality in the Northeastern U.S. is Secondary to Poorer Survival Rather Than Increased Incidence

Abstract

Public reporting burden for ft» corlectx»i of infcrmaeon i» estimated to average 1 hour per response, including the time for nwiew^ instructions. Matching existing data sources, gatrmng and maintaining the data needed and ujinp>e«ng and reviewing this ooHecaon of Monnation. Send oannw* regarding »« burden «el»IIa» or any other aspect ot this cc«oclion of intormaly^.itKliidii^ suggestions for reducing this burden to Washington Headquarters Service*. Directorate for Information Operations and Reports, 1215 Jefferson Davis highway, Suite 1204, Arlington, VA 22202-4302, and to the Office of Management and Budget, Paperwork Reduction Project (0704-0188), Washington. DC 20503 AGENCY USE ONLY (Leave blank)2. REPORT DATE December 1999 REPORT TYPE AND DATES COVEREDFinal (1 Aug 97 -15 Nov 99) TITLE AND SUBTITLEThe Elevated Breast Cancer Mortality in the Northeastern U.S. is Secondary to Poorer Survival Rather Than Increased Incidence.6. AUTHOR(S) James S. Goodwin, M.D. FUNDING NUMBERS DAMD17-97-1-7095 PERFORMING ORGANIZATION NAME(S) AND ADDRESS(ES)University of Texas Medical Branch at Galveston Galveston, Texas 77555-0136 E-MAIL:jsgo(xlwi@utmb.edu Mortality rates for breast cancer are approximately 25% higher in the northeast U.S. than the south or west. Virtually all previous investigations into this phenomenon have assumed that the elevated mortality rates reflect elevated incidence, and this putative elevation in incidence has been attributed to a number of factors. We hypothesized that the geographic variation in breast cancer mortality was secondary to differences in survival with breast cancer as well as differences in incidence. We proposed to test this by identifying women aged > 70 years newly diagnosed with breast cancer in 1991 in different regions of the country using Medicare charge data and assessing their survival. Initially we developed algorithms to determine incident breast cancer and date of diagnosis from the Medicare data and validating them using the SEER-Medicare linked data base. We found that an algorithm incorporating data from hospital inpatient, hospital outpatient, and physician services claims produced levels of sensitivity and specificity > 90%. However, the positive prediction value was low (67 to 70 percent), precluding use of Medicare data alone to examine survival from breast cancer. Our current work is using SEER-Medicare linked data to examine geographic variation in incidence, survival and mortality of women with breast cancer. PERFORMING ORGANIZATION REPORT NUMBER SPONSORING / MONITORING AGENCY NAME(S) AND ADDRESS(ES)U SUBJECT TERMSBreast cancer survival; geographic variation; incidence; older women; Medicare data Where copyrighted material is quoted, permission has been obtained to use such material.Where material from documents designated for limited distribution is quoted, permission has been obtained to use the material.Citations of commercial organizations and trade names in this report do not constitute an official Department of Army endorsement or approval of the products or s...