1
|
Lee CS, Goldman L, Grimm LJ, Liu IX, Simanowith M, Rosenberg R, Zuley M, Moy L. Screening mammographic performance by race and age in the National Mammography Database: 29,479,665 screening mammograms from 13,181,241 women. Breast Cancer Res Treat 2024; 203:599-612. [PMID: 37897646 DOI: 10.1007/s10549-023-07124-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 09/09/2023] [Indexed: 10/30/2023]
Abstract
PURPOSE There are insufficient large-scale studies comparing the performance of screening mammography in women of different races. This study aims to compare the screening performance metrics across racial and age groups in the National Mammography Database (NMD). METHODS All screening mammograms performed between January 1, 2008, and December 31, 2021, in women aged 30-100 years from 746 mammography facilities in 46 U.S. states in the NMD were included. Patients were stratified by 10-year age intervals and 5 racial groups (African American, American Indian, Asian, White, unknown). Incidence of risk factors (breast density, personal history, family history of breast cancer, age), and time since prior exams were compared. Five screening mammography metrics were calculated: recall rate (RR), cancer detection rate (CDR), positive predictive values for recalls (PPV1), biopsy recommended (PPV2) and biopsy performed (PPV3). RESULTS 29,479,655 screening mammograms performed in 13,181,241 women between January 1, 2008, and December 31, 2021, from the NMD were analyzed. The overall mean performance metrics were RR 10.00% (95% CI 9.99-10.02), CDR 4.18/1000 (4.16-4.21), PPV1 4.18% (4.16-4.20), PPV2 25.84% (25.72-25.97), PPV3 25.78% (25.66-25.91). With advancing age, RR significantly decreases, while CDR, PPV1, PPV2, and PPV3 significantly increase. Incidence of personal/family history of breast cancer, breast density, age, prior mammogram availability, and time since prior mammogram were mostly similar across all races. Compared to White women, African American women had significantly higher RR, but lower CDR, PPV1, PPV2 and PPV3. CONCLUSIONS Benefits of screening mammography increase with age, including for women age > 70 and across all races. Screening mammography is effective; with lower RR and higher CDR, PPV2, and PPV3 with advancing age. African American women have poorer outcomes from screening mammography (higher RR and lower CDR), compared to White and all women in the NMD. Racial disparity can be partly explained by higher rate of African American women lost to follow up.
Collapse
Affiliation(s)
- Cindy S Lee
- Department of Radiology, New York University Langone Health, New York, USA.
- Department of Radiology, State University of New York at Stony Brook, Renaissance School of Medicine, Stony Brook, NY, USA.
| | - Lenka Goldman
- American College of Radiology, 1891 Preston Drive, Reston, VA, USA
| | - Lars J Grimm
- Department of Radiology, Duke University, Durham, NC, USA
| | - Ivy Xinyue Liu
- American College of Radiology, 1891 Preston Drive, Reston, VA, USA
| | | | | | - Margarita Zuley
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Linda Moy
- Department of Radiology, New York University Langone Health, New York, USA
| |
Collapse
|
2
|
Jackson T, Wahab RA, Bankston K, Mehta TS. Raising Cultural Awareness and Addressing Barriers to Breast Imaging Care for Black Women. JOURNAL OF BREAST IMAGING 2024; 6:72-79. [PMID: 38142231 DOI: 10.1093/jbi/wbad091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Indexed: 12/25/2023]
Abstract
Health care disparities, which are differences in the attainment of full health potential among population groups, have been documented across medical conditions, clinical settings, and diagnostic and treatment modalities. Deeply rooted health care disparities due to many factors have affected how Black women (BW) view medical care including screening mammography. This article explores health care disparities around breast cancer in BW and how patient distrust, provider biases, race, and social determinants of health continue to have negative effects on breast cancer outcomes in BW, despite medical advances in breast cancer detection and management. In addition, this article addresses the importance of culturally competent care for BW around breast cancer awareness, screening, and treatment, and offers strategies to address disparities and rebuild trust.
Collapse
Affiliation(s)
- Tatianie Jackson
- Department of Radiology, Geisinger Wyoming Valley Medical Center, Wilkes-Barre, PA, USA
| | - Rifat A Wahab
- Department of Radiology, University of Cincinnati Medical Center, Cincinnati, OH, USA
| | - Karen Bankston
- College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Tejas S Mehta
- Department of Radiology, UMass Memorial Medical Center/UMass Chan Medical School, Worcester, MA, USA
| |
Collapse
|
3
|
Lozano P, Randal FT, Peters A, Aschebrook-Kilfoy B, Kibriya MG, Luo J, Shah S, Zakin P, Craver A, Stepniak L, Saulsberry L, Kupfer S, Lam H, Ahsan H, Kim KE. The impact of neighborhood disadvantage on colorectal cancer screening among African Americans in Chicago. Prev Med Rep 2023; 34:102235. [PMID: 37252073 PMCID: PMC10213351 DOI: 10.1016/j.pmedr.2023.102235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/13/2023] [Accepted: 05/08/2023] [Indexed: 05/31/2023] Open
Abstract
Historically, colorectal cancer (CRC) screening rates have been lower among African Americans. Previous studies that have examined the relationship between community characteristics and adherence to CRC screening have generally focused on a single community parameter, making it challenging to evaluate the overall impact of the social and built environment. In this study, we will estimate the overall effect of social and built environment and identify the most important community factors relevant to CRC screening. Data are from the Multiethnic Prevention and Surveillance Study (COMPASS), a longitudinal study among adults in Chicago, collected between May 2013 to March 2020. A total 2,836 African Americans completed the survey. Participants' addresses were geocoded and linked to seven community characteristics (i.e., community safety, community crime, household poverty, community unemployment, housing cost burden, housing vacancies, low food access). A structured questionnaire measured adherence to CRC screening. Weighted quantile sum (WQS) regression was used to evaluate the impact of community disadvantages on CRC screening. When analyzing all community characteristics as a mixture, overall community disadvantage was associated with less adherence to CRC screening even after controlling for individual-level factors. In the adjusted WQS model, unemployment was the most important community characteristic (37.6%), followed by community insecurity (26.1%) and severe housing cost burden (16.3%). Results from this study indicate that successful efforts to improve adherence to CRC screening rates should prioritize individuals living in communities with high rates of insecurity and low socioeconomic status.
Collapse
Affiliation(s)
- Paula Lozano
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | | | | | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Muhammad G. Kibriya
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Jiajun Luo
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Sameep Shah
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Paul Zakin
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Andrew Craver
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Liz Stepniak
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Loren Saulsberry
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Sonia Kupfer
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Helen Lam
- Department of Medicine, University of Chicago, Chicago, IL, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, University of Chicago, Chicago, IL, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Karen E. Kim
- Department of Medicine, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| |
Collapse
|
4
|
Larsen K, Rydz E, Peters CE. Inequalities in Environmental Cancer Risk and Carcinogen Exposures: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095718. [PMID: 37174236 PMCID: PMC10178444 DOI: 10.3390/ijerph20095718] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 04/11/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023]
Abstract
Background: Cancer is the leading cause of death in Canada and a major cause of death worldwide. Environmental exposure to carcinogens and environments that may relate to health behaviors are important to examine as they can be modified to lower cancer risks. Built environments include aspects such as transit infrastructure, greenspace, food and tobacco environments, or land use, which may impact how people move, exercise, eat, and live. While environments may play a role in overall cancer risk, exposure to carcinogens or healthier environments is not equitably spread across space. Exposures to carcinogens commonly concentrate among socially and/or economically disadvantaged populations. While many studies have examined inequalities in exposure or cancer risk, this has commonly been for one exposure. Methods: This scoping review collected and synthesized research that examines inequities in carcinogenic environments and exposures. Results: This scoping review found that neighborhoods with higher proportions of low-income residents, racialized people, or same-sex couples had higher exposures to carcinogens and environments that may influence cancer risk. There are currently four main themes in research studying inequitable exposures: air pollution and hazardous substances, tobacco access, food access, and other aspects of the built environment, with most research still focusing on air pollution. Conclusions: More work is needed to understand how exposures to these four areas intersect with other factors to reduce inequities in exposures to support longer-term goals toward cancer prevention.
Collapse
Affiliation(s)
- Kristian Larsen
- Health Canada, Office of Environmental Health, Healthy Environments and Consumer Safety Branch, Environmental and Radiation Health Science Directorate, Ottawa, ON K1A 0K9, Canada
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Department of Geography and Planning, University of Toronto, Toronto, ON M5S 3G3, Canada
- Department of Geography and Environmental Studies, Toronto Metropolitan University, Toronto, ON M5B 2K3, Canada
| | - Ela Rydz
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
| | - Cheryl E Peters
- CAREX Canada, School of Population and Public Health, University of British Columbia, Vancouver, BC V6T 1Z3, Canada
- Cumming School of Medicine, University of Calgary, Calgary, AB T2N 4N1, Canada
- Prevention, Screening and Hereditary Cancer, BC Cancer, Vancouver, BC V5Z 4E6, Canada
- Population and Public Health, British Columbia Centre for Disease Control, Vancouver, BC V5Z 4R4, Canada
| |
Collapse
|
5
|
Jones VC, Kruper L, Mortimer J, Ashing KT, Seewaldt VL. Understanding drivers of the Black:White breast cancer mortality gap: A call for more robust definitions. Cancer 2022; 128:2695-2697. [PMID: 35578909 PMCID: PMC9325488 DOI: 10.1002/cncr.34243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/29/2022] [Accepted: 04/01/2022] [Indexed: 11/30/2022]
Abstract
Kim et al completed a pooled analysis of 8 National Surgical Adjuvant Breast and Bowel Project trials and highlight that, when compared with White patients, Black patients with estrogen receptor–positive (ER+) breast cancer have worse distant recurrence‐free survival, especially in the setting of neoadjuvant chemotherapy when pathologic complete response is not achieved. This editorial highlights that, to comprehend the drivers of this disparity, we must have more robust definitions of ER+ breast cancer and race.
Collapse
Affiliation(s)
- Veronica C Jones
- Department of Surgery, Division of Breast Surgery, City of Hope, Duarte, California
| | - Laura Kruper
- Department of Surgery, City of Hope, Duarte, California
| | - Joanne Mortimer
- Department of Medical Oncology, City of Hope, Duarte, California
| | - Kimlin T Ashing
- Department of Population Sciences, City of Hope, Duarte, California
| | | |
Collapse
|
6
|
Williams AD, Buckley M, Ciocca RM, Sabol JL, Larson SL, Carp NZ. Racial and socioeconomic disparities in breast cancer diagnosis and mortality in Pennsylvania. Breast Cancer Res Treat 2022; 192:191-200. [PMID: 35064367 DOI: 10.1007/s10549-021-06492-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 12/03/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE Many studies have demonstrated disparities in breast cancer (BC) incidence and mortality among Black women. We hypothesized that in Pennsylvania (PA), a large economically diverse state, BC diagnosis and mortality would be similar among races when stratified by a municipality's median income. METHODS We collected the frequencies of BC diagnosis and mortality for years 2011-2015 from the Pennsylvania Cancer Registry and demographics from the 2010 US Census. We analyzed BC diagnoses and mortalities after stratifying by median income, municipality size, and race with univariable and multivariable logistic regression models. RESULTS In this cohort, of 5,353,875 women there were 54,038 BC diagnoses (1.01% diagnosis rate) and 9,828 BC mortalities (0.18% mortality rate). Unadjusted diagnosis rate was highest among white women (1.06%) but Black women had a higher age-adjusted diagnosis rate (1.06%) than white women (1.02%). Race, age and income were all significantly associated with BC diagnosis, but there were no differences in BC diagnosis between white and Black women across all levels of income in the multivariable model. BC mortality was highest in Black women, a difference which persisted when adjusted for age. Black women 35 years and older had a higher mortality rate in all income quartiles. CONCLUSION We found that in PA, age, race and income are all associated with BC diagnosis and mortality with noteworthy disparities for Black women. Continued surveillance of differences in both breast cancer diagnosis and mortality, and targeted interventions related to education, screening and treatment may help to eliminate these socioeconomic and racial disparities.
Collapse
Affiliation(s)
| | - Meghan Buckley
- Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Robin M Ciocca
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Jennifer L Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Sharon L Larson
- Main Line Health Center for Population Health Research at Lankenau Institute for Medical Research, Wynnewood, PA, USA
| | - Ned Z Carp
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| |
Collapse
|
7
|
Ashing KT, Jones V, Bedell F, Phillips T, Erhunmwunsee L. Calling Attention to the Role of Race-Driven Societal Determinants of Health on Aggressive Tumor Biology: A Focus on Black Americans. JCO Oncol Pract 2022; 18:15-22. [PMID: 34255546 PMCID: PMC8758120 DOI: 10.1200/op.21.00297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Blacks have the highest incidence and mortality from most cancers. The reasons for these disparities remain unclear. Blacks are exposed to adverse social determinants because of historic and contemporary racist polices; however, how these determinants affect the disparities that Blacks experience is understudied. As a result of discriminatory community policies, like redlining, Blacks have higher exposure to air pollution and neighborhood deprivation. Studies investigating how these factors affect tumor biology are emerging. We highlight the literature that connects racism-related community exposure to the tumor biology in breast, lung, prostate, and colorectal cancer. Further investigations that clarify the link between adverse social determinants that result from systemic racism and aggressive tumor biology are required if health equity is to be achieved. Without recognition that racism is a public health risk with carcinogenic impact, health care delivery and cancer care will never achieve excellence. In response, health systems ought to establish corrective actions to improve Black population health and bring medical justice to marginalized racialized groups.
Collapse
Affiliation(s)
- Kimlin T. Ashing
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA,Kimlin T. Ashing, PhD, CCARE—Department of Population Sciences, City of Hope Comprehensive Cancer Center, 1500 E Duarte Rd, Duarte, CA 91010-3000; e-mail:
| | - Veronica Jones
- African-Caribbean Cancer Consortium, Fox Chase Cancer Center, Philadelphia, PA
| | - Fornati Bedell
- Division of Urology and Urologic Oncology, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Tanyanika Phillips
- Department of Medical Oncology and Therapeutics Research, City of Hope Comprehensive Cancer Center, Duarte, CA
| | - Loretta Erhunmwunsee
- Department of Population Sciences, City of Hope Comprehensive Cancer Center, Duarte, CA,Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA
| |
Collapse
|
8
|
Cultural Barriers to Breast Cancer Screening and Medical Mistrust Among Arab American Women. J Immigr Minor Health 2021; 23:95-102. [PMID: 32451692 DOI: 10.1007/s10903-020-01019-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Breast cancer is a common cancer among women in the US and cultural barriers and medical mistrust have been associated with breast cancer screening (BCS) rates among minority populations. A heterogeneous sample of Arab women (N = 196) were recruited from across the Detroit metropolitan area and administered a questionnaire. Multiple regression analyses revealed an association between Arab Cultural Specific Barriers (ACSB) to BCS and Group-Based Medical Mistrust Scale. The environmental ACSB to BCS was associated with the medical mistrust-suspicion of HC providers (β = 0.363, p = 0.01), lack of HC provider support (β = 0.396, p = 0.001), and Arab inequities (β = 0.250, p = 0.05). Findings suggest that ACSB to BCS are predictive of medical mistrust for Arab American women. This study illuminates the need to emphasize strategies that will target the medical care system and the cultural barriers to BCS that Arab American women face in the health care system.
Collapse
|
9
|
Williams AD, Ciocca R, Sabol JL, Carp NZ. Institutions Treating Breast Cancer Patients of a Low Socioeconomic Status Achieve Multidisciplinary Quality Standards at Lower Rates. Ann Surg Oncol 2021; 28:5635-5647. [PMID: 34269942 DOI: 10.1245/s10434-021-10451-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/13/2021] [Indexed: 12/17/2022]
Abstract
BACKGROUND The National Accreditation Program of Breast Centers (NAPBC) certifies institutions that provide quality breast care. Whereas low socioeconomic status (SES) has a negative impact on patient outcomes, it is unknown whether an institution's patient SES mix is associated with meeting NAPBC standards. METHODS All institutions submitting at least 100 breast cancer patients to the National Cancer Database (2006-2017) were ranked based on the patients' insurance status, income, and education. The 10% treating the largest proportion of low-SES patients were termed low-SES institutions (LSES). Patient cohorts were created based on the 2018 NAPBC standards. Uni- and multivariate comparisons of patient, tumor, and treatment factors were made to calculate adjusted odds of meeting each standard between low- and non-low-SES institutions. RESULTS The analysis included 1319 institutions. Both the LSES and non-LSES reached the benchmark rate of 50% lumpectomies (61.2 vs 62.9%; p < 0.001), but the unadjusted and adjusted rates of lumpectomy were lower in LSES. The rate for sentinel lymphadenectomy was lower for LSES (49.2 vs 53.7%; p < 0.001). Similarly, the unadjusted and adjusted rates of adjuvant chemotherapy and endocrine therapy were lower at LSES. Although the unadjusted rate of adjuvant radiation was higher at LSES, adjusted odds demonstrated that patients treated at LSES were less likely to undergo adjuvant radiation when appropriate. CONCLUSIONS Small but significant differences in achieving multidisciplinary standards for quality breast cancer care exist between LSES and non-LSES and may exacerbate disparities already faced by patients of low SES.
Collapse
Affiliation(s)
| | - Robin Ciocca
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Jennifer L Sabol
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| | - Ned Z Carp
- Department of Surgery, Lankenau Medical Center, Wynnewood, PA, USA
| |
Collapse
|
10
|
Abraham P, Bishay AE, Farah I, Williams E, Tamayo-Murillo D, Newton IG. Reducing Health Disparities in Radiology Through Social Determinants of Health: Lessons From the COVID-19 Pandemic. Acad Radiol 2021; 28:903-910. [PMID: 34001438 DOI: 10.1016/j.acra.2021.04.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 04/13/2021] [Accepted: 04/22/2021] [Indexed: 12/20/2022]
Abstract
During the COVID-19 pandemic, the disproportionate morbidity and mortality borne by racial minorities, patients of lower socioeconomic status, and patients lacking health insurance reflect the critical role of social determinants of health, which are manifestations of entrenched structural inequities. In radiology, social determinants of health lead to disparate use of imaging services through multiple intersecting contributors, on both the provider and patient side, affecting diagnosis and treatment. Disparities on the provider side include ordering of initial or follow-up imaging studies and providing standard-of-care interventional procedures, while patient factors include differences in awareness of screening exams and confidence in the healthcare system. Disparate utilization of mammography and lung cancer screening lead to delayed diagnosis, while differential provision of minimally invasive interventional procedures contributes to differential outcomes related to treatment. Interventions designed to mitigate social determinants of health could help to equalize the healthcare system. Here we review disparities in access and health outcomes in radiology. We investigate underlying contributing factors in order to identify potential policy changes that could promote more equitable health in radiology.
Collapse
|
11
|
Zhang D, Abraham L, Demb J, Miglioretti DL, Advani S, Sprague BL, Henderson LM, Onega T, Wernli KJ, Walter LC, Kerlikowske K, Schousboe JT, O'Meara ES, Braithwaite D. Function-related Indicators and Outcomes of Screening Mammography in Older Women: Evidence from the Breast Cancer Surveillance Consortium Cohort. Cancer Epidemiol Biomarkers Prev 2021; 30:1582-1590. [PMID: 34078641 DOI: 10.1158/1055-9965.epi-21-0152] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/02/2021] [Accepted: 05/19/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Previous reports suggested risk of death and breast cancer varied by comorbidity and age in older women undergoing mammography. However, impacts of functional limitations remain unclear. METHODS We used data from 238,849 women in the Breast Cancer Surveillance Consortium-Medicare linked database (1999-2015) who had screening mammogram at ages 66-94 years. We estimated risk of breast cancer, breast cancer death, and non-breast cancer death by function-related indicator (FRI) which incorporated 16 claims-based items and was categorized as an ordinal variable (0, 1, and 2+). Fine and Gray proportional sub-distribution hazards models were applied with breast cancer and death treated as competing events. Risk estimates by FRI scores were adjusted by age and NCI comorbidity index separately and stratified by these factors. RESULTS Overall, 9,252 women were diagnosed with breast cancer, 406 died of breast cancer, and 41,640 died from non-breast cancer causes. The 10-year age-adjusted invasive breast cancer risk slightly decreased with FRI score [FRI = 0: 4.0%, 95% confidence interval (CI) = 3.8-4.1; FRI = 1: 3.9%, 95% CI = 3.7-4.2; FRI ≥ 2: 3.5%, 95% CI = 3.1-3.9). Risk of non-breast cancer death increased with FRI score (FRI = 0: 18.8%, 95% CI = 18.5-19.1; FRI = 1: 24.4%, 95% CI = 23.9-25.0; FRI ≥ 2: 39.8%, 95% CI = 38.8-40.9]. Risk of breast cancer death was low with minimal differences across FRI scores. NCI comorbidity index-adjusted models and stratified analyses yielded similar patterns. CONCLUSIONS Risk of non-breast cancer death substantially increases with FRI score, whereas risk of breast cancer death is low regardless of functional status. IMPACT Older women with functional limitations should be informed that they may not benefit from screening mammography.
Collapse
Affiliation(s)
- Dongyu Zhang
- Department of Epidemiology, University of Florida College of Public Health and Health Professions, Gainesville, Florida.,University of Florida Health Cancer Center, Gainesville, Florida
| | - Linn Abraham
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Joshua Demb
- Division of Gastroenterology, Department of Internal Medicine, University of California, San Diego, La Jolla, California
| | - Diana L Miglioretti
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington.,Division of Biostatistics, Department of Public Health Sciences, University of California, Davis, California
| | - Shailesh Advani
- Transplant Education Research Center, Terasaki Institute of Biomedical Innovation, Los Angeles, California
| | - Brian L Sprague
- Department of Surgery, University of Vermont College of Medicine, Burlington, Vermont
| | - Louise M Henderson
- Department of Radiology, University of North Carolina at Chapel Hill, North Carolina
| | - Tracy Onega
- Department of Population Health Sciences, University of Utah, and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Karen J Wernli
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | - Louise C Walter
- Department of Medicine, University of California, San Francisco, San Francisco, California
| | - Karla Kerlikowske
- Department of Medicine, University of California, San Francisco, San Francisco, California.,Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - John T Schousboe
- Park Nicollet Clinic and HealthPartners Institute, HealthPartners Inc, Bloomington, Minnesota.,Division of Health Policy and Management, University of Minnesota, Minneapolis, Minnesota
| | - Ellen S O'Meara
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington
| | | | | |
Collapse
|
12
|
Reece JC, Neal EFG, Nguyen P, McIntosh JG, Emery JD. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review. BMC Cancer 2021; 21:373. [PMID: 33827476 PMCID: PMC8028768 DOI: 10.1186/s12885-021-08100-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/23/2021] [Indexed: 01/07/2023] Open
Abstract
Background Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes. Methods A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design. Results Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up. Conclusions Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08100-3.
Collapse
Affiliation(s)
- Jeanette C Reece
- Colorectal Cancer Unit, Centre for Epidemiology and Biostatistics and Neuroepidemiology Unit, Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Level 3 207 Bouverie Street, Parkville, VIC, 3010, Australia. .,Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.
| | - Eleanor F G Neal
- Infection and Immunity, Murdoch Children's Research Institute, Parkville, Australia.,Centre for International Child Health, Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - Peter Nguyen
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Jennifer G McIntosh
- Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of Software Systems and Cybersecurity, Faculty of Information Technology, Monash University, VIC, Clayton, Australia
| | - Jon D Emery
- Centre for Cancer Research, Victorian Comprehensive Cancer Centre, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia.,Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Australia
| |
Collapse
|
13
|
Press DJ, Aschebrook-Kilfoy B, Lauderdale D, Stepniak E, Gomez SL, Johnson EP, Gopalakrishnan R, Smieliauskas F, Hedeker D, Bettencourt L, Anselin L, Ahsan H. ChicagO Multiethnic Prevention and Surveillance Study (COMPASS): Increased Response Rates Among African American Residents in Low Socioeconomic Status Neighborhoods. J Racial Ethn Health Disparities 2021; 8:186-198. [PMID: 32542493 PMCID: PMC7736119 DOI: 10.1007/s40615-020-00770-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/01/2020] [Accepted: 05/05/2020] [Indexed: 01/06/2023]
Abstract
African American (AA) populations experience persistent health disparities in the USA. Low representation in bio-specimen research precludes stratified analyses and creates challenges in studying health outcomes among AA populations. Previous studies examining determinants of bio-specimen research participation among minority participants have focused on individual-level barriers and facilitators. Neighborhood-level contextual factors may also inform bio-specimen research participation, possibly through social norms and the influence of social views and behaviors on neighbor's perspectives. We conducted an epidemiological study of residents in 5108 Chicago addresses to examine determinants of bio-specimen research participation among predominantly AA participants solicited for participation in the first 6 years of ChicagO Multiethnic Prevention and Surveillance Study (COMPASS). We used a door-to-door recruitment strategy by interviewers of predominantly minority race and ethnicity. Participants were compensated with a $50 gift card. We achieved response rates of 30.4% for non-AA addresses and 58.0% for AA addresses, with as high as 80.3% response among AA addresses in low socioeconomic status (SES) neighborhoods. After multivariable adjustment, we found approximately 3 times the odds of study participation among predominantly AA addresses in low vs. average SES neighborhoods (odds ratio (OR) = 3.06; 95% confidence interval (CI) = 2.20-4.24). Conversely, for non-AA addresses, we observed no difference in the odds of study participation in low vs. average SES neighborhoods (OR = 0.89; 95% CI = 0.69-1.14) after multivariable adjustment. Our findings suggest that AA participants in low SES neighborhoods may be recruited for bio-specimen research through door-to-door approaches with compensation. Future studies may elucidate best practices to improve bio-specimen research participation among minority populations.
Collapse
Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
- The Center for Health Information Partnerships (CHiP), Institute of Public Health and Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Briseis Aschebrook-Kilfoy
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
| | - Diane Lauderdale
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Elizabeth Stepniak
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | | | | | - Fabrice Smieliauskas
- Department of Economics, Wayne State University, Detroit, MI, USA
- Department of Pharmacy Practice, Wayne State University, Detroit, MI, USA
| | - Donald Hedeker
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| | - Luís Bettencourt
- Mansueto Institute for Urban Innovation, University of Chicago, Chicago, IL, USA
- Department of Ecology and Evolution, University of Chicago, Chicago, IL, USA
- Department of Sociology, University of Chicago, Chicago, IL, USA
- Santa Fe Institute, Santa Fe, NM, USA
| | - Luc Anselin
- Center for Spatial Data Science, University of Chicago, Chicago, IL, USA
| | - Habibul Ahsan
- Department of Public Health Sciences, The University of Chicago Biological Sciences, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
- Institute for Population and Precision Health, University of Chicago, Chicago, IL, USA
- Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
- Department of Human Genetics, University of Chicago, Chicago, IL, USA
- Department of Medicine, University of Chicago, Chicago, IL, USA
| |
Collapse
|
14
|
Bekeny JC, Singh T, Luvisa K, Wirth PJ, Black CK, Abdou S, Song DH, Del Corral G, Willey SC, Tousimis E, Fan KL. Delivery of nipple-sparing mastectomy within a single healthcare system: The impact of provider preferences. Breast J 2020; 27:149-157. [PMID: 33274577 DOI: 10.1111/tbj.14112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Revised: 11/13/2020] [Accepted: 11/13/2020] [Indexed: 11/30/2022]
Abstract
Nipple-sparing mastectomy (NSM) offers superior esthetic outcomes without sacrificing oncologic safety for select patients requiring mastectomy. While disparities in oncologic care are well established, no study to date has investigated equitable delivery of the various mastectomy types. The objective of this study is to examine multilevel factors related to the distribution of NSM. Patients undergoing mastectomy between 2014 and 2018 across eight hospitals in a single healthcare system were retrospectively reviewed. Patients were categorized by mastectomy type-NSM or other mastectomy (OM). Patient information such as age, race, comorbidities, and median income by ZIP code was collected. Disease characteristics, such as mastectomy weight, breast cancer stage, and treatment history, were identified. Provider and system-level variables, such as specific provider, hospital of operation, and insurance status, were determined. Bivariate analysis was used to identify variables for inclusion in a backward multivariable model. A cohort of 1202 mastectomy patients was identified, with 388 receiving NSM. The average age was 55.8 years (NSM: 48.8, OM: 59.1, P < .001). 39.8% of white patients (n = 242) and 20.0% of African American patients (n = 88) received NSM (P < .001). Average mastectomy weight was 384.3 (SD 195.7) in the NSM group, compared to 839.4 (SD 521.1) in the OM group (P < .001). 41.4% (n = 359) of patients treated at academic centers, and 6.9% (n = 21) of patients treated at community centers received NSM (P < .001). In the multivariate model, the factor with the largest impact on NSM was specific provider. Odds of NSM decreased by 76%-88% for certain surgeons, while odds increased by 63 times for one surgeon. This study utilizes a large multi-institutional database to highlight disparities in NSM delivery. Expectedly, younger, relatively healthy patients, with smaller breast size were more likely to undergo NSM, in accordance with surgical guidelines. However, when all other factors were controlled, provider preferences played the most significant role in NSM delivery rates. These findings demonstrate the need for practice reexamination to ensure equitable access to NSM.
Collapse
Affiliation(s)
- Jenna C Bekeny
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Tanvee Singh
- Georgetown University School of Medicine, Washington, DC, USA
| | - Kyle Luvisa
- Georgetown University School of Medicine, Washington, DC, USA
| | - Peter J Wirth
- Georgetown University School of Medicine, Washington, DC, USA
| | - Cara K Black
- Georgetown University School of Medicine, Washington, DC, USA
| | - Salma Abdou
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - David H Song
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Gabriel Del Corral
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Shawna C Willey
- Inova Schar Cancer Institute, Inova Fairfax Hospital, Fairfax, VA, USA
| | - Eleni Tousimis
- Department of General Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| | - Kenneth L Fan
- Department of Plastic and Reconstructive Surgery, MedStar Georgetown University Hospital, Washington, DC, USA
| |
Collapse
|
15
|
Nobel TB, Asumeng CK, Jasek J, Van Beck KC, Mathur R, Qiao B, Brown JJ. Disparities in mortality-to-incidence ratios by race/ethnicity for female breast cancer in New York City, 2002-2016. Cancer Med 2020; 9:8226-8234. [PMID: 33006431 PMCID: PMC7643684 DOI: 10.1002/cam4.3309] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Revised: 05/07/2020] [Accepted: 06/30/2020] [Indexed: 12/13/2022] Open
Abstract
Background Racial disparities in New York City (NYC) breast cancer incidence and mortality rates have previously been demonstrated. Disease stage at diagnosis and mortality‐to‐incidence ratio (MIR) may present better measures of differences in screening and treatment access. Racial/ethnic trends in NYC MIR have not previously been assessed. Methods Mammogram rates were compared using the NYC Community Health Survey, 2002‐2014. Breast cancer diagnosis, stage, and mortality were from the New York State Cancer Registry, 2000‐2016. Primary outcomes were MIR, the ratio of age‐adjusted mortality to incidence rates, and stage at diagnosis. Joinpoint regression analysis identified significant trends. Results Mammogram rates in 2002‐2014 among Black and Latina women ages 40 and older (79.9% and 78.4%, respectively) were stable and higher than among White (73.6%) and Asian/Pacific‐Islander women (70.4%) (P < .0001). There were 82 733 incident cases of breast cancer and 16 225 deaths in 2000‐2016. White women had the highest incidence, however, rates among Black, Latina, and Asian/Pacific Islander women significantly increased. Black and Latina women presented with local disease (Stage I) less frequently (53.2%, 57.6%, respectively) than White (62.5%) and Asian/Pacific‐Islander women (63.0%). Black women presented with distant disease (Stage IV) more frequently than all other groups (Black 8.7%, Latina 5.8%, White 6.0%, and Asian 4.2%). Black women had the highest breast cancer mortality rate and MIR (Black 0.25, Latina 0.18, White 0.17, and Asian women 0.11). Conclusions More advanced disease at diagnosis coupled with a slower decrease in breast cancer mortality among Black and Latina women may partially explain persistent disparities in MIR especially prominent among Black women. Assessment of racial/ethnic differences in screening quality and access to high‐quality treatment may help identify areas for targeted interventions to improve equity in breast cancer outcomes.
Collapse
Affiliation(s)
- Tamar B Nobel
- Department of Environmental Medicine and Public Health, Mount Sinai Hospital, New York, NY, USA
| | - Charles K Asumeng
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - John Jasek
- Research and Evaluation, Bureau of Chronic Disease Prevention, NYC DOHMH, Queens, NY, USA
| | - Kellie C Van Beck
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - Ruchi Mathur
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| | - Baozhen Qiao
- Bureau of Cancer Epidemiology, New York State Department of Health, Albany, NY, USA
| | - Jennifer J Brown
- Cancer Prevention and Control Program, Bureau of Chronic Disease Prevention, New York City Department of Health and Mental Hygiene, Queens, NY, 11101, USA
| |
Collapse
|
16
|
Rauscher GH, Tossas-Milligan K, Macarol T, Grabler PM, Murphy AM. Trends in Attaining Mammography Quality Benchmarks With Repeated Participation in a Quality Measurement Program: Going Beyond the Mammography Quality Standards Act to Address Breast Cancer Disparities. J Am Coll Radiol 2020; 17:1420-1428. [PMID: 32771493 DOI: 10.1016/j.jacr.2020.07.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/10/2020] [Accepted: 07/14/2020] [Indexed: 11/18/2022]
Abstract
PURPOSE The Mammography Quality Standards Act requires that mammography facilities conduct audits, but there are no specifications on the metrics to be measured. In a previous mammography quality improvement project, the authors examined whether breast cancer screening facilities could collect the data necessary to show that they met certain quality benchmarks. Here the authors present trends from the first 5 years of data collection to examine whether continued participation in this quality improvement program was associated with an increase in the number of benchmarks met for breast cancer screening. METHODS Participating facilities across the state of Illinois (n = 114) with at least two time points of data collected (2006, 2009, 2010, 2011, and/or 2013) were included. Facilities provided aggregate data on screening mammographic examinations and corresponding diagnostic follow-up information, which was used to estimate 13 measures and corresponding benchmarks for patient tracking, callback, cancer detection, loss to follow-up, and timeliness of care. RESULTS The number of facilities able to show that they met specific benchmarks increased with length of participation for many but not all measures. Trends toward meeting more benchmarks were apparent for cancer detection, timely imaging, not lost at biopsy, known minimal status (P < .01 for all), and proportion of screening-detected cancers that were minimal and early stage (P < .001 for both). CONCLUSIONS Participation in the quality improvement program seemed to lead to improvements in patient tracking, callback and detection, and timeliness benchmarks.
Collapse
Affiliation(s)
- Garth H Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois.
| | - Katherine Tossas-Milligan
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago, Chicago, Illinois; University of Illinois Cancer Center, Chicago, Illinois
| | | | - Paula M Grabler
- Director, Breast Imaging, Rush University Medical Center, Chicago, Illinois
| | - Anne Marie Murphy
- Executive Director, Metropolitan Chicago Breast Cancer Task Force, Chicago, Illinois
| |
Collapse
|
17
|
Monticciolo DL. Current Guidelines and Gaps in Breast Cancer Screening. J Am Coll Radiol 2020; 17:1269-1275. [PMID: 32473894 DOI: 10.1016/j.jacr.2020.05.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 04/30/2020] [Accepted: 05/01/2020] [Indexed: 01/25/2023]
Abstract
Breast cancer is the most common nonskin cancer in women and the second leading cause of cancer death for women in the United States. Mammography screening is proven to significantly decrease breast cancer mortality, with a 40% or more reduction expected with annual use starting at age 40 for women of average risk. However, less than half of all eligible women have a mammogram annually. The elimination of cost sharing for screening made possible by the Affordable Care Act (2010) encouraged screening but mainly for those already insured. The United States Preventive Services Task Force 2009 guidelines recommended against screening those 40 to 49 years old and have left women over 74 years of age vulnerable to coverage loss. Other populations for whom significant gaps in risk information or screening use exist, including women of lower socioeconomic status, black women, men at higher than average risk of breast cancer, and sexual and gender minorities. Further work is needed to achieve higher rates of screening acceptance for all appropriate individuals so that the full mortality and treatment benefits of mammography screening can be realized.
Collapse
Affiliation(s)
- Debra L Monticciolo
- Vice Chair for Research, and Section Chief, Breast Imaging, Department of Radiology, Texas A&M University, Temple, Texas; Baylor Scott & White Healthcare-Central Texas, Temple, Texas.
| |
Collapse
|
18
|
Linnenbringer E, Geronimus AT, Davis KL, Bound J, Ellis L, Gomez SL. Associations between breast cancer subtype and neighborhood socioeconomic and racial composition among Black and White women. Breast Cancer Res Treat 2020; 180:437-447. [PMID: 32002766 PMCID: PMC7066090 DOI: 10.1007/s10549-020-05545-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/20/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE Studies of Black-White differences in breast cancer subtype often emphasize potential ancestry-associated genetic or lifestyle risk factors without fully considering how the social or economic implications of race in the U.S. may influence risk. We assess whether neighborhood racial composition and/or socioeconomic status are associated with odds of triple-negative breast cancer (TNBC) diagnosis relative to the less-aggressive hormone receptor-positive/HER2-negative subtype (HR+ /HER-), and whether the observed relationships vary across women's race and age groups. METHODS We use multilevel generalized estimating equation models to evaluate odds of TNBC vs. HR+ /HER2- subtypes in a population-based cohort of 7291 Black and 74,208 White women diagnosed with breast cancer from 2006 to 2014. Final models include both neighborhood-level variables, adjusting for individual demographics and tumor characteristics. RESULTS Relative to the HR+ /HER- subtype, we found modestly lower odds of TNBC subtype among White women with higher neighborhood median household income (statistically significant within the 45-64 age group, OR = 0.981 per $10,000 increase). Among Black women, both higher neighborhood income and higher percentages of Black neighborhood residents were associated with lower odds of TNBC relative to HR+ /HER2-. The largest reduction was observed among Black women diagnosed at age ≥ 65 (OR = 0.938 per $10,000 increase; OR = 0.942 per 10% increase in Black residents). CONCLUSION The relationships between neighborhood composition, neighborhood socioeconomic status, and odds of TNBC differ by race and age. Racially patterned social factors warrant further exploration in breast cancer subtype disparities research.
Collapse
Affiliation(s)
- Erin Linnenbringer
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA.
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA.
| | - Arline T Geronimus
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior & Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Kia L Davis
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, 660 S. Euclid Ave., Campus Box 8100, St. Louis, MO, 63110, USA
| | - John Bound
- Population Studies Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Libby Ellis
- Cancer Prevention Institute of California, Fremont, CA, USA
- London School of Hygiene & Tropical Medicine, London, UK
| | - Scarlett L Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA, USA
| |
Collapse
|
19
|
Guan A, Lichtensztajn D, Oh D, Jain J, Tao L, Hiatt RA, Gomez SL, Fejerman L. Breast Cancer in San Francisco: Disentangling Disparities at the Neighborhood Level. Cancer Epidemiol Biomarkers Prev 2019; 28:1968-1976. [PMID: 31548180 PMCID: PMC6891202 DOI: 10.1158/1055-9965.epi-19-0799] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 08/30/2019] [Accepted: 09/20/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND This study uses a novel geographic approach to summarize the distribution of breast cancer in San Francisco and aims to identify the neighborhoods and racial/ethnic groups that are disproportionately affected by this disease. METHODS Nine geographic groupings were newly defined on the basis of racial/ethnic composition and neighborhood socioeconomic status. Distribution of breast cancer cases from the Greater Bay Area Cancer Registry in these zones were examined. Multivariable logistic regression models were used to determine neighborhood associations with stage IIB+ breast cancer at diagnosis. Cox proportional hazards regression was used to estimate the hazard ratios for all-cause and breast cancer-specific mortality. RESULTS A total of 5,595 invasive primary breast cancers were diagnosed between January 1, 2006 and December 31, 2015. We found neighborhood and racial/ethnic differences in stage of diagnosis, molecular subtype, survival, and mortality. Patients in the Southeast (Bayview/Hunter's Point) and Northeast (Downtown, Civic Center, Chinatown, Nob Hill, Western Addition) areas were more likely to have stage IIB+ breast cancer at diagnosis, and those in the East (North Beach, Financial District, South of Market, Mission Bay, Potrero Hill) and Southeast were more likely to be diagnosed with triple-negative breast cancers (TNBC). Compared with other racial/ethnic groups, Blacks/African Americans (B/AA) experienced the greatest disparities in breast cancer-related outcomes across geographic areas. CONCLUSIONS San Francisco neighborhoods with lower socioeconomic status and larger minority populations experience worse breast cancer outcomes. IMPACT Our findings, which reveal breast cancer disparities at sub-county geographic levels, have implications for population-level health interventions.
Collapse
Affiliation(s)
- Alice Guan
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Daphne Lichtensztajn
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Debora Oh
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Jennifer Jain
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Li Tao
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Robert A Hiatt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, California
| | | | | |
Collapse
|
20
|
Yedjou CG, Sims JN, Miele L, Noubissi F, Lowe L, Fonseca DD, Alo RA, Payton M, Tchounwou PB. Health and Racial Disparity in Breast Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1152:31-49. [PMID: 31456178 PMCID: PMC6941147 DOI: 10.1007/978-3-030-20301-6_3] [Citation(s) in RCA: 220] [Impact Index Per Article: 44.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Breast cancer is the most common noncutaneous malignancy and the second most lethal form of cancer among women in the United States. It currently affects more than one in ten women worldwide. The chance for a female to be diagnosed with breast cancer during her lifetime has significantly increased from 1 in 11 women in 1975 to 1 in 8 women (Altekruse, SEER Cancer Statistics Review, 1975-2007. National Cancer Institute, Bethesda, 2010). This chance for a female of being diagnosed with cancer generally increases with age (Howlader et al, SEER Cancer Statistics Review, 1975-2010. National Cancer Institute, Bethesda, 2013). Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in the White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic population has continued to grow. The goal of the work presented in this book chapter is to highlight similarities and differences in breast cancer morbidity and mortality rates among non-Hispanic white and non-Hispanic black populations. This book chapter also provides an overview of breast cancer, racial/ethnic disparities in breast cancer, breast cancer incidence and mortality rate linked to hereditary, major risk factors of breast cancer among minority population, breast cancer treatment, and health disparity. A considerable amount of breast cancer treatment research have been conducted, but with limited success for African Americans compared to other ethnic groups. Therefore, new strategies and approaches are needed to promote breast cancer prevention, improve survival rates, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities. In addition, it is vital that leaders and medical professionals from minority population groups be represented in decision-making in research so that racial disparity in breast cancer can be well-studied, fully addressed, and ultimately eliminated in breast cancer.
Collapse
Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA.
| | - Jennifer N Sims
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Lucio Miele
- LSU Health Sciences Center, School of Medicine, Department of Genetics, New Orleans, LA, USA
| | - Felicite Noubissi
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Leroy Lowe
- Getting to Know Cancer (NGO), Truro, NS, Canada
| | - Duber D Fonseca
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Richard A Alo
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| | - Marinelle Payton
- Department of Epidemiology and Biostatistics, College of Public Service, Jackson State University, Jackson Medical Mall - Thad Cochran Center, Jackson, MS, USA
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, NIH/NIMHD RCMI-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, Jackson, MS, USA
| |
Collapse
|
21
|
Warnecke RB, Campbell RT, Vijayasiri G, Barrett RE, Rauscher GH. Multilevel Examination of Health Disparity: The Role of Policy Implementation in Neighborhood Context, in Patient Resources, and in Healthcare Facilities on Later Stage of Breast Cancer Diagnosis. Cancer Epidemiol Biomarkers Prev 2018; 28:59-66. [PMID: 30352817 DOI: 10.1158/1055-9965.epi-17-0945] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/26/2018] [Accepted: 10/16/2018] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND There is a substantial racial/ethnic disparity in female breast cancer mortality in Chicago between non-Hispanic black (NHblack) and Hispanic patients compared with their non-Hispanic white (NHwhite) counterparts. This observation prompted a multilevel examination of factors that might account for the disparity, with the goal of identifying potential policy interventions that might meaningfully address it METHODS: In the Breast Cancer Care in Chicago study, 411 NHblack, 397 NHwhite, and 181 Hispanic patients diagnosed between the ages of 30 and 79 were interviewed, and medical records were abstracted for information on screening and diagnostic follow-up. We conducted a multilevel analysis to assess the role of neighborhood context, patient resources, facility characteristics, and mode of detection in determining the disparity in later stage at diagnosis. RESULTS After adjustment for neighborhood context, mode of detection, and facility accreditation/resources, there was no significant disparity in later stage breast cancer diagnosis between NHblack or Hispanic patients compared with NHwhite patients. CONCLUSIONS The results suggest that racial/ethnic differences in mode of detection and facility accreditation/resources account for most of the disparity in stage at diagnosis. Understanding the causes of differential screen detection and access to highly accredited facilities could inform interventions to meaningfully address this disparity. IMPACT Multilevel approaches to studying health disparities are becoming the research standard for understanding and addressing health disparities. Optimal design of multilevel interventions addressing disparities in later stage diagnosis would benefit from enhanced understanding of pathways to detection and diagnosis available to patients in medically underserved communities.
Collapse
Affiliation(s)
- Richard B Warnecke
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois. .,UI Health Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Institute for Health Research and Policy, Winnetka, Illinois
| | - Richard T Campbell
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois.,UI Health Cancer Center, University of Illinois at Chicago, Chicago, Illinois
| | - Ganga Vijayasiri
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois
| | - Richard E Barrett
- Department of Sociology, University of Illinois at Chicago, Chicago, Illinois
| | - Garth H Rauscher
- UI Health Cancer Center, University of Illinois at Chicago, Chicago, Illinois.,Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| |
Collapse
|
22
|
Breast Cancer Disparities Among Women in Underserved Communities in the USA. CURRENT BREAST CANCER REPORTS 2018; 10:131-141. [PMID: 31501690 DOI: 10.1007/s12609-018-0277-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Purpose of Review Breast cancer disparities that exist between high-income countries (HIC) and low- and middle-income countries (LMICs) are also reflected within population subgroups throughout the United States (US). Here we examine three case studies of US populations "left behind" in breast cancer outcomes/equity. Recent Findings African Americans in Chicago, non-Latina White women in Appalachia, and Latinas in the Yakima Valley of Washington State all experience a myriad of factors that contribute to lower rates of breast cancer detection and appropriate treatment as well as poorer survival. These factors, related to the social determinants of health, including geographic isolation, lack of availability of care, and personal constraints, can be addressed with interventions at multiple levels. Summary Although HICs have reduced mortality of breast cancer compared to LMICs, there remain inequities in the US healthcare system. Concerted efforts are needed to ensure that all women have access to equitable screening, detection, treatment, and survivorship resources.
Collapse
|
23
|
Prieto D, Soto-Ferrari M, Tija R, Peña L, Burke L, Miller L, Berndt K, Hill B, Haghsenas J, Maltz E, White E, Atwood M, Norman E. Literature review of data-based models for identification of factors associated with racial disparities in breast cancer mortality. Health Syst (Basingstoke) 2018; 8:75-98. [PMID: 31275571 PMCID: PMC6598506 DOI: 10.1080/20476965.2018.1440925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 01/29/2018] [Accepted: 02/08/2018] [Indexed: 01/03/2023] Open
Abstract
In the United States, early detection methods have contributed to the reduction of overall breast cancer mortality but this pattern has not been observed uniformly across all racial groups. A vast body of research literature shows a set of health care, socio-economic, biological, physical, and behavioural factors influencing the mortality disparity. In this paper, we review the modelling frameworks, statistical tests, and databases used in understanding influential factors, and we discuss the factors documented in the modelling literature. Our findings suggest that disparities research relies on conventional modelling and statistical tools for quantitative analysis, and there exist opportunities to implement data-based modelling frameworks for (1) exploring mechanisms triggering disparities, (2) increasing the collection of behavioural data, and (3) monitoring factors associated with the mortality disparity across time.
Collapse
Affiliation(s)
- Diana Prieto
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Johns Hopkins Carey Business School, Baltimore, MD, USA
| | - Milton Soto-Ferrari
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
- Department of Marketing and Operations, Scott College of Business, Terre Haute, IN, USA
| | - Rindy Tija
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Lorena Peña
- College of Engineering and Applied Sciences, Western Michigan University, Kalamazoo, MI, USA
| | - Leandra Burke
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Lisa Miller
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Kelsey Berndt
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Brian Hill
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Jafar Haghsenas
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Ethan Maltz
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Evan White
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Maggie Atwood
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Earl Norman
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| |
Collapse
|
24
|
Standardized cancer incidence disparities in Upper Manhattan New York City neighborhoods: the role of race/ethnicity, socioeconomic status, and known risk factors. Eur J Cancer Prev 2018; 25:349-56. [PMID: 26186470 DOI: 10.1097/cej.0000000000000180] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We examined the effects of race/ethnicity and neighborhood, a proxy of socioeconomic status, on cancer incidence in New York City neighborhoods: East Harlem (EH), Central Harlem (CH), and Upper East Side (UES). In this ecological study, Community Health Survey data (2002-2006) and New York State Cancer Registry incidence data (2007-2011) were stratified by sex, age, race/ethnicity, and neighborhood. Logistic regression models were fitted to each cancer incidence rate with race/ethnicity, neighborhood, and Community Health Survey-derived risk factors as predictor variables. Neighborhood was significantly associated with all cancers and 14 out of 25 major cancers. EH and CH residence conferred a higher risk of all cancers compared with UES (OR=1.34, 95% CI 1.07-1.68; and OR=1.39, 95% CI 1.12-1.72, respectively). The prevalence of diabetes and tobacco smoking were the largest contributors toward high cancer rates. Despite juxtaposition and similar proximity to medical centers, cancer incidence disparities persist among EH, CH, and UES neighborhoods. Targeted, neighborhood-specific outreach may aid in reducing cancer incidence rates.
Collapse
|
25
|
Press DJ, Miller ME, Liederbach E, Yao K, Huo D. De novo metastasis in breast cancer: occurrence and overall survival stratified by molecular subtype. Clin Exp Metastasis 2017; 34:457-465. [PMID: 29288366 DOI: 10.1007/s10585-017-9871-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Accepted: 12/20/2017] [Indexed: 01/21/2023]
Abstract
Breast cancer molecular subtypes, categorized jointly by hormone receptors (HR) and human epidermal growth factor-2 (HER2), are utilized to guide systemic therapy. We hypothesized distinct patterns of de novo metastasis and overall survival by molecular subtype using a retrospective cohort of 399,772 women in the National Cancer Database diagnosed with first primary invasive breast cancer between 2010 and 2014, of whom 13,924 were diagnosed with de novo metastasis from 2010 to 2013 and had follow up data. The relationship of molecular subtype with patient and tumor characteristics, including site of de novo metastasis, were examined using Chi-squared tests. Kaplan-Meier and Cox proportional hazards analyses were used to examine overall survival by molecular subtype. Bone was the most frequent de novo metastatic site for all molecular subtypes. Compared to HR+/HER2-, patients with HR-/HER2+ experienced 4.5, 3.0, and 6.0 times the de novo brain, lung, and liver metastasis respectively. In survival analyses of women diagnosed with de novo metastasis, the mortality risk relative to HR+/HER2- was twice as high for triple-negative (hazard ratio = 2.02, 95% CI 1.89-2.16) and modestly lower for HR+/HER2+ (hazard ratio = 0.83, 95% CI 0.78-0.88). The median survival difference between metastatic patients with and without chemotherapy was 28.6 months in HR+/HER2+ and 28.2 months in HR-/HER2+, but only 10.9 months in triple-negative and 5.2 months in HR+/HER2-. In conclusion, despite unfavorable patterns of de novo metastasis, HER2+ breast cancers had relatively better survival in recent years, probably due to treatment differences. Utilizing molecular subtype and site of de novo metastasis may predict prognosis and guide treatment.
Collapse
Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA
| | - Megan E Miller
- Department of Surgery, Case Western Reserve University Hospitals, Cleveland, OH, USA
| | - Erik Liederbach
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Katherine Yao
- Department of Surgery, NorthShore University HealthSystem, Evanston, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, 5841 South Maryland Avenue, MC 2000, Chicago, IL, 60637, USA.
| |
Collapse
|
26
|
Press DJ, Ibraheem A, Dolan ME, Goss KH, Conzen S, Huo D. Racial disparities in omission of oncotype DX but no racial disparities in chemotherapy receipt following completed oncotype DX test results. Breast Cancer Res Treat 2017; 168:207-220. [PMID: 29181717 DOI: 10.1007/s10549-017-4587-8] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 11/18/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To examine racial/ethnic disparities in Oncotype DX (ODX) testing among patients with node-negative, estrogen receptor (ER)-positive, human epidermal growth factor receptor 2 (HER2)-negative breast cancers and possible racial/ethnic disparities in chemotherapy receipt following ODX testing within Recurrence Score (RS) category (Not Done, Low, Intermediate, High), as well as chemotherapy receipt time trends within RS categories. METHODS A retrospective cohort list of 125,288 women who were potentially indicated for ODX testing from 2010 to 2014 was obtained using the National Cancer Database. We fit multivariate logistic regression predicting chemotherapy receipt, adjusting for clinical factors, patient demographic factors, and hospital-level factors, separately by RS category, and calculated odds ratios (OR) and 95% confidence intervals (CI), as well as time trends. RESULTS Overall, ODX testing was completed for 46.1% of Non-Hispanic (NH) Whites, 43.9% of NH Blacks, and 41.7% of Hispanics. Among patients who did not receive ODX testing, NH Black and Hispanic women both experienced statistically significant increases in chemotherapy receipt relative to NH White women (NH Black OR 1.23; 95% CI 1.11-1.37; Hispanic OR 1.23; 95% CI 1.07-1.42). However, among patients with ODX results, no statistically significant racial/ethnic differences in chemotherapy receipt were observed within strata of RS category. Trend analyses demonstrated increasing adherence to national guidelines for ODX testing. CONCLUSIONS We identified racial disparities in omission of ODX testing but no differences in chemotherapy receipt if ODX test results were obtained, suggesting increasing access to ODX testing may improve racial equality in efficacious use of adjuvant chemotherapy for ER-positive HER2-negative breast cancer.
Collapse
Affiliation(s)
- David J Press
- Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA.
| | - Abiola Ibraheem
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - M Eileen Dolan
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - Kathleen H Goss
- University of Chicago Comprehensive Cancer Center, University of Chicago, Chicago, IL, USA
| | - Suzanne Conzen
- Section of Hematology/Oncology, Department of Medicine Chicago, University of Chicago, Chicago, IL, USA
| | - Dezheng Huo
- Department of Public Health Sciences, The University of Chicago, 5841 S. Maryland Ave., MC2000, Chicago, IL, 60637, USA
| |
Collapse
|
27
|
Hashim D, Manczuk M, Holcombe R, Lucchini R, Boffetta P. Cancer mortality disparities among New York City's Upper Manhattan neighborhoods. Eur J Cancer Prev 2017; 26:453-460. [PMID: 27104595 PMCID: PMC5074912 DOI: 10.1097/cej.0000000000000267] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The East Harlem (EH), Central Harlem (CH), and Upper East Side (UES) neighborhoods of New York City are geographically contiguous to tertiary medical care, but are characterized by cancer mortality rate disparities. This ecological study aims to disentangle the effects of race and neighborhood on cancer deaths. Mortality-to-incidence ratios were determined using neighborhood-specific data from the New York State Cancer Registry and Vital Records Office (2007-2011). Ecological data on modifiable cancer risk factors from the New York City Community Health Survey (2002-2006) were stratified by sex, age group, race/ethnicity, and neighborhood and modeled against stratified mortality rates to disentangle race/ethnicity and neighborhood using logistic regression. Significant gaps in mortality rates were observed between the UES and both CH and EH across all cancers, favoring UES. Mortality-to-incidence ratios of both CH and EH were similarly elevated in the range of 0.41-0.44 compared with UES (0.26-0.30). After covariate and multivariable adjustment, black race (odds ratio=1.68; 95% confidence interval: 1.46-1.93) and EH residence (odds ratio=1.20; 95% confidence interval: 1.07-1.35) remained significant risk factors in all cancers' combined mortality. Mortality disparities remain among EH, CH, and UES neighborhoods. Both neighborhood and race are significantly associated with cancer mortality, independent of each other. Multivariable adjusted models that include Community Health Survey risk factors show that this mortality gap may be avoidable through community-based public health interventions.
Collapse
Affiliation(s)
- Dana Hashim
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Marta Manczuk
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Department of Cancer Epidemiology, Maria Skłodowska-Curie Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Randall Holcombe
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Roberto Lucchini
- Department of Preventive Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Occupational Medicine, University of Brescia, Italy
| | - Paolo Boffetta
- Department of Preventive Medicine and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
- Division of Hematology and Medical Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
28
|
Sighoko D, Murphy AM, Irizarry B, Rauscher G, Ferrans C, Ansell D. Changes in the racial disparity in breast cancer mortality in the ten US cities with the largest African American populations from 1999 to 2013: The reduction in breast cancer mortality disparity in Chicago. Cancer Causes Control 2017; 28:563-568. [PMID: 28275936 PMCID: PMC5400784 DOI: 10.1007/s10552-017-0878-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/27/2017] [Indexed: 10/26/2022]
Abstract
PURPOSE Assess progress made to reduce racial disparity in breast cancer mortality in Chicago compared to nine other cities with largest African American populations and the US. METHODS The Non-Hispanic Black (NHB) and Non-Hispanic White (NHW) female breast cancer mortality rates and rate ratios (RR) (disparity) were compared between 1999 and 2005 and 2006 and 2013. RESULTS Between the two periods, the NHB breast cancer mortality rate in Chicago decreased by 13.9% (95% CI [-13.81, -13.92] compared to 7.7% (95% CI [-7.52, -7.83]) for NHW. A drop of 20% in the disparity was observed, from 51% (RR: 1.51, 95% CI [-7.52, -7.83]) to 41% (RR: 1.41, 95% CI [1.30, 1.52]). Whereas from 1999 to 2005 Chicago's disparity was above that of the U.S., from 2006 to 2013, it is now slightly lower. For the remaining nine cities and the US, the mortality disparity either grew or remained the same. CONCLUSIONS Chicago's improvement in NHB breast cancer mortality and disparity reduction occurred in the context of city-wide comprehensive public health initiatives and shows promise as a model for other cities with high health outcome disparities.
Collapse
Affiliation(s)
- Dominique Sighoko
- Metropolitan Chicago Breast Cancer Task Force, 300 S. Ashland, Suite 202, Chicago, IL, 60607, USA
- Department of Health Systems Management, Rush University Medical Center, 1700 W. Van Buren Street, Chicago, IL, 60612, USA
| | - Anne Marie Murphy
- Metropolitan Chicago Breast Cancer Task Force, 300 S. Ashland, Suite 202, Chicago, IL, 60607, USA.
| | - Bethliz Irizarry
- Metropolitan Chicago Breast Cancer Task Force, 300 S. Ashland, Suite 202, Chicago, IL, 60607, USA
| | - Garth Rauscher
- Division of Epidemiology and Biostatistics, School of Public Health, University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL, 60612, USA
| | - Carol Ferrans
- Department of Biobehavioral Health Science, College of Nursing, University of Illinois at Chicago, 845 S. Damen Avenue, Chicago, IL, 60612, USA
| | - David Ansell
- Department of Internal Medicine, Center for Community Health Equity, Rush University Medical Center, 600 S. Paulina, Suite 364, Chicago, IL, 60612, USA
| |
Collapse
|
29
|
Yedjou CG, Tchounwou PB, Payton M, Miele L, Fonseca DD, Lowe L, Alo RA. Assessing the Racial and Ethnic Disparities in Breast Cancer Mortality in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:E486. [PMID: 28475137 PMCID: PMC5451937 DOI: 10.3390/ijerph14050486] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 04/22/2017] [Accepted: 04/26/2017] [Indexed: 01/01/2023]
Abstract
Breast cancer is the second leading cause of cancer related deaths among women aged 40-55 in the United States and currently affects more than one in ten women worldwide. It is also one of the most diagnosed cancers in women both in wealthy and poor countries. Fortunately, the mortality rate from breast cancer has decreased in recent years due to increased emphasis on early detection and more effective treatments in White population. Although the mortality rates have declined in some ethnic populations, the overall cancer incidence among African American and Hispanic populations has continued to grow. The goal of the present review article was to highlight similarities and differences in breast cancer morbidity and mortality rates primarily among African American women compared to White women in the United States. To reach our goal, we conducted a search of articles in journals with a primary focus on minority health, and authors who had published articles on racial/ethnic disparity related to breast cancer patients. A systematic search of original research was conducted using MEDLINE, PUBMED and Google Scholar databases. We found that racial/ethnic disparities in breast cancer may be attributed to a large number of clinical and non-clinical risk factors including lack of medical coverage, barriers to early detection and screening, more advanced stage of disease at diagnosis among minorities, and unequal access to improvements in cancer treatment. Many African American women have frequent unknown or unstaged breast cancers than White women. These risk factors may explain the differences in breast cancer treatment and survival rate between African American women and White women. New strategies and approaches are needed to promote breast cancer prevention, improve survival rate, reduce breast cancer mortality, and ultimately improve the health outcomes of racial/ethnic minorities.
Collapse
Affiliation(s)
- Clement G Yedjou
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Paul B Tchounwou
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Marinelle Payton
- Center of Excellence in Minority Health and Health Disparities, School of Public Health, Jackson State University, Jackson Medical Mall-Thad Cochran Center, 350 West Woodrow Wilson Avenue, Jackson, MS 39213, USA.
| | - Lucio Miele
- Department of Genetics, LSU Health Sciences Center, School of Medicine, 533 Bolivar Street, Room 657, New Orleans, LA 70112, USA.
| | - Duber D Fonseca
- Natural Chemotherapeutics Research Laboratory, Research Centers in Minority Institutio (RCMI)-Center for Environmental Health, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| | - Leroy Lowe
- Lancaster Environment Centre, Lancaster University, Bailrigg, Lancaster LA1 4YW, UK.
| | - Richard A Alo
- Department of Civil and Environmental Engineering, College of Science, Engineering and Technology, Jackson State University, 1400 Lynch Street, Box 18750, Jackson, MS 39217, USA.
| |
Collapse
|
30
|
Molina Y, Glassgow AE, Kim SJ, Berrios NM, Pauls H, Watson KS, Darnell JS, Calhoun EA. Patient Navigation in Medically Underserved Areas study design: A trial with implications for efficacy, effect modification, and full continuum assessment. Contemp Clin Trials 2017; 53:29-35. [PMID: 27940186 PMCID: PMC5274626 DOI: 10.1016/j.cct.2016.12.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Revised: 11/30/2016] [Accepted: 12/03/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND The Patient Navigation in Medically Underserved Areas study objectives are to assess if navigation improves: 1) care uptake and time to diagnosis; and 2) outcomes depending on patients' residential medically underserved area (MUA) status. Secondary objectives include the efficacy of navigation across 1) different points of the care continuum among patients diagnosed with breast cancer; and 2) multiple regular screening episodes among patients who did not obtain breast cancer diagnoses. DESIGN/METHODS Our randomized controlled trial was implemented in three community hospitals in South Chicago. Eligible participants were: 1) female, 2) 18+years old, 3) not pregnant, 4) referred from a primary care provider for a screening or diagnostic mammogram based on an abnormal clinical breast exam. Participants were randomized to 1) control care or 2) receive longitudinal navigation, through treatment if diagnosed with cancer or across multiple years if asymptomatic, by a lay health worker. Participants' residential areas were identified as: 1) established MUA (before 1998), 2) new MUA (after 1998), 3) eligible/but not designated as MUA, and 4) affluent/ineligible for MUA. Primary outcomes include days to initially recommended care after randomization and days to diagnosis for women with abnormal results. Secondary outcomes concern days to treatment initiation following a diagnosis and receipt of subsequent screening following normal/benign results. DISCUSSION This intervention aims to assess the efficacy of patient navigation on breast cancer care uptake across the continuum. If effective, the program may improve rates of early cancer detection and breast cancer morbidity.
Collapse
Affiliation(s)
- Yamile Molina
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA.
| | - Anne E Glassgow
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA
| | - Sage J Kim
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA
| | - Nerida M Berrios
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA
| | - Heather Pauls
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA
| | - Karriem S Watson
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA
| | - Julie S Darnell
- Loyola University Chicago, 1032 W. Sheridan Road, Chicago, IL 60660, USA
| | - Elizabeth A Calhoun
- University of Illinois at Chicago, 1603 West Taylor Street, Chicago, IL 60622, USA; University of Arizona, 550 East Van Buren Street, Phoenix, AZ 85004, USA
| |
Collapse
|
31
|
Black:white disparities in breast cancer mortality in the 50 largest cities in the United States, 2005–2014. Cancer Epidemiol 2016; 45:169-173. [DOI: 10.1016/j.canep.2016.07.018] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
|
32
|
Examining the prevalence of metabolic syndrome among overweight/obese African-American breast cancer survivors vs. matched non-cancer controls. J Cancer Surviv 2016; 11:102-110. [PMID: 27562474 DOI: 10.1007/s11764-016-0566-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/07/2016] [Indexed: 12/19/2022]
Abstract
PURPOSE Metabolic Syndrome (MetS) is more predominant in overweight, obese and minority populations. This study examined the prevalence of MetS in an exclusively African-American (AA) cohort of breast cancer (BC) survivors; an underrepresented group in previous studies demonstrating negative BC outcomes disparities for females with MetS. METHODS Using a case-control design, overweight/obese AA women with treated Stage I-IIIa BC were matched 1:1 on age, race, sex, and body mass index (BMI) category with non-cancer population controls (n = 444). Three of the following conditions were used to define MetS: HDL cholesterol <50 mg/dL (1.3 mmol/L), serum triglycerides ≥150 mg/dL (1.7 mmol/L), blood glucose ≥100 mg/dL (or on treatment), waist circumference ≥88 cm, or ≥130 mmHg systolic or ≥85 mmHg diastolic blood pressure (or on treatment). Matched-pairs analyses were conducted. RESULTS For BC cases, most women had self-reported Stage I (n = 76) or Stage II (n = 91) disease and were 6.9 (±5.2) years post-diagnosis. MetS was significantly lower in BC survivors vs. their non-cancer population controls (43.2 vs. 51.4 %, respectively; p < 0.05). The diagnosis of MetS did not differ by BMI stratification. A lower prevalence of ≥2 risk factors (80.2 vs. 85.6 %, p < 0.05) was observed for all cases vs. CONTROLS CONCLUSIONS While MetS occurred less frequently in our BC cases vs. non-cancer controls, our estimates are nearly two times those reported in other BC survivors, suggesting important racial/ethnic differences. IMPLICATIONS FOR CANCER SURVIVORS The prognostic implications of MetS among AA BC survivors remain unknown and warrant further investigation.
Collapse
|
33
|
Matthews AK, Hotton A, Li CC, Miller K, Johnson A, Jones KW, Thai J. An Internet-Based Study Examining the Factors Associated with the Physical and Mental Health Quality of Life of LGBT Cancer Survivors. LGBT Health 2015; 3:65-73. [PMID: 26789396 DOI: 10.1089/lgbt.2014.0075] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
PURPOSE The purpose of this study was to examine factors associated with the quality of life of lesbian, gay, bisexual, and transgender (LGBT) cancer survivors. METHODS Data were collected via a nationally advertised online short-form health survey. RESULTS Factors associated with lower physical quality of life included younger age at diagnosis, cancer type, medical co-morbidities, being overweight or obese, recurrence, and current cancer treatment. Lower mental quality of life was associated with younger age, smoking, lower perceived quality of care, lower perceived support, and higher cancer-related worry. CONCLUSIONS Findings highlight a need for health promotion interventions specifically for LGBT cancer survivors.
Collapse
Affiliation(s)
- Alicia K Matthews
- 1 College of Nursing, University of Illinois at Chicago, Chicago, Illinois.,2 Howard Brown Health Center , Chicago, Illinois
| | - Anna Hotton
- 3 Department of Infectious Diseases, John H. Stroger Hospital , Chicago, Illinois
| | - Chien-Ching Li
- 4 Department of Health Systems Management, College of Health Sciences, Rush University , Chicago, Illinois
| | - Katherine Miller
- 5 Jane Addams College of Social Work, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Amy Johnson
- 6 School of Public Health, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Kyle W Jones
- 2 Howard Brown Health Center , Chicago, Illinois.,7 Department of Psychology, College of Nursing, University of Illinois at Chicago, Chicago, Illinois
| | - Jennie Thai
- 2 Howard Brown Health Center , Chicago, Illinois
| |
Collapse
|
34
|
Pretty J, Barton J, Bharucha ZP, Bragg R, Pencheon D, Wood C, Depledge MH. Improving health and well-being independently of GDP: dividends of greener and prosocial economies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL HEALTH RESEARCH 2015; 26:11-36. [PMID: 25670173 DOI: 10.1080/09603123.2015.1007841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Increases in gross domestic product (GDP) beyond a threshold of basic needs do not lead to further increases in well-being. An explanation is that material consumption (MC) also results in negative health externalities. We assess how these externalities influence six factors critical for well-being: (i) healthy food; (ii) active body; (iii) healthy mind; (iv) community links; (v) contact with nature; and (vi) attachment to possessions. If environmentally sustainable consumption (ESC) were increasingly substituted for MC, thus improving well-being and stocks of natural and social capital, and sustainable behaviours involving non-material consumption (SBs-NMC) became more prevalent, then well-being would increase regardless of levels of GDP. In the UK, the individualised annual health costs of negative consumption externalities (NCEs) currently amount to £62 billion for the National Health Service, and £184 billion for the economy (for mental ill-health, dementia, obesity, physical inactivity, diabetes, loneliness and cardiovascular disease). A dividend is available if substitution by ESC and SBs-NMC could limit the prevalence of these conditions.
Collapse
Affiliation(s)
- Jules Pretty
- a Department of Biological Sciences and Essex Sustainability Institute , University of Essex , Colchester , UK
| | - Jo Barton
- a Department of Biological Sciences and Essex Sustainability Institute , University of Essex , Colchester , UK
| | - Zareen Pervez Bharucha
- b Department of Sociology and Essex Sustainability Institute , University of Essex , Colchester , UK
| | - Rachel Bragg
- a Department of Biological Sciences and Essex Sustainability Institute , University of Essex , Colchester , UK
| | - David Pencheon
- c Sustainable Development Unit for NHS England and Public Health England , Cambridge , UK
| | - Carly Wood
- a Department of Biological Sciences and Essex Sustainability Institute , University of Essex , Colchester , UK
| | - Michael H Depledge
- d European Centre for Environment and Human Health , University of Exeter Medical School , Exeter , UK
| |
Collapse
|
35
|
Breast Cancer Among Special Populations: Disparities in Care Across the Cancer Control Continuum. IMPROVING OUTCOMES FOR BREAST CANCER SURVIVORS 2015; 862:39-52. [DOI: 10.1007/978-3-319-16366-6_4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
|
36
|
Allgood KL, Rauscher GH, Whitman S, Vasquez-Jones G, Shah AM. Validating self-reported mammography use in vulnerable communities: findings and recommendations. Cancer Epidemiol Biomarkers Prev 2014; 23:1649-58. [PMID: 24859870 PMCID: PMC4135480 DOI: 10.1158/1055-9965.epi-13-1253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Most health surveys ask women whether they have had a recent mammogram, all of which report mammography use (past 2 years) at about 70% to 80% regardless of race or residence. We examined the potential extent of overreporting of mammography use in low income African-American and Latina women, and whether self-report inaccuracies might bias estimated associations between patient characteristics and mammography use. METHODS Using venue-based sampling in two poor communities on the west side of Chicago, we asked eligible women living in two west side communities of Chicago to complete a survey about breast health (n = 2,200) and to provide consent to view their medical record. Of the 1,909 women who screened eligible for medical record review, 1,566 consented (82%). We obtained medical records of all women who provided both permission and a valid local mammography facility (n = 1,221). We compared the self-reported responses from the survey with the imaging reports found in the medical record (documented). To account for missing data, we conducted multiple imputations for key demographic variables and report standard measures of accuracy. RESULTS Although 73% of women self-reported a mammogram in the last 2 years, only 44% of self-reports were documented. Overreporting of mammography use was observed for all three ethnic groups. CONCLUSIONS These results suggest considerable overestimation of prevalence of use in these vulnerable populations. IMPACT Relying on known faulty self-reported mammography data as a measure of mammography use provides an overly optimistic picture of utilization, a problem that may be exacerbated in vulnerable minority communities.
Collapse
Affiliation(s)
| | - Garth H Rauscher
- Division of Epidemiology and Biostatistics, University of Illinois at Chicago School of Public Health, Chicago, Illinois; and
| | | | | | - Ami M Shah
- UCLA Center for Health Policy Research, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
37
|
Racial disparities in survival and age-related outcome in postsurgery breast cancer patients in a new york city community hospital. ISRN ONCOLOGY 2014; 2014:694591. [PMID: 24693452 PMCID: PMC3945176 DOI: 10.1155/2014/694591] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 12/23/2013] [Indexed: 01/25/2023]
Abstract
Breast cancer survival has significantly improved over the past two decades. However, the diagnosis of breast cancer is lower and the mortality rate remains higher, in African American women (AA) compared to Caucasian-American women. The purpose of this investigation is to analyze postoperative events that may affect breast cancer survival. This is a retrospective analysis of prospectively collected data from The Brooklyn Hospital Center cancer registry from 1997 to 2010. Of the 1538 patients in the registry, 1226 are AA and 269 are Caucasian. The study was divided into two time periods, 1997-2004 (period A) and 2005-2010 (period B), in order to assess the effect of treatment outcomes on survival. During period A, 5-year survival probabilities of 75.37%, 74.53%, and 78.70% were seen among all patients, AA women and Caucasian women, respectively. These probabilities increased to 87.62%, 87.15% and 89.99% in period B. Improved survival in AA women may be attributed to the use of adjuvant chemotherapy, radiation, and hormonal therapy. Improved survival in Caucasian patients was attributed to the use of radiation therapy, as well as earlier detection resulting in more favorable tumor grades and pathological stages.
Collapse
|
38
|
Lee H, Fitzpatrick JJ, Baik SY. Why isn't evidence based practice improving health care for minorities in the United States? Appl Nurs Res 2013; 26:263-8. [PMID: 23928122 DOI: 10.1016/j.apnr.2013.05.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 04/24/2013] [Accepted: 05/23/2013] [Indexed: 11/26/2022]
Abstract
Achieving health equity by improving the health care of all racial/ethnic groups is one of the key goals of Healthy People 2020. The implementation of evidence based practice (EBP) has been a major recommendation to achieve health equity in hopes of eliminating the subjectivity of clinical decision making. However, health disparities among racial/ethnic minorities are persistent in spite of the adoption of standardized care based on evidence. The EBP with racial and ethnic minorities is often seen as a possible cause of health and health care disparities. Three potential issues of using EBP to reduce health disparities have been identified: (1) a lack of data for EBP with ethnic/racial minority populations; (2) limited research on the generalizability of the evidence based on a European-American middle-class; and (3) sociocultural considerations in the context of EBP. Using EBP to reduce disparities in health care and health outcomes requires that nurse professionals should know how to use relevant evidence in a particular situation as well as to generate knowledge and theory which is relevant to racial/ethnic minorities. In addition, EBP implementation should be contextualized within the sociocultural environments in which patients are treated rather than solely focusing on the health problems.
Collapse
Affiliation(s)
- Haeok Lee
- Department of Nursing, University of Massachusetts Boston, Boston, MA, USA.
| | | | | |
Collapse
|
39
|
Danforth DN. Disparities in breast cancer outcomes between Caucasian and African American women: a model for describing the relationship of biological and nonbiological factors. Breast Cancer Res 2013; 15:208. [PMID: 23826992 PMCID: PMC3706895 DOI: 10.1186/bcr3429] [Citation(s) in RCA: 92] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Breast cancer is the most common malignancy in women in the United States but significant disparities exist for African American women compared to Caucasian women. African American women present with breast cancer at a younger age and with a greater incidence under the age of 50 years, develop histologically more aggressive tumors that are at a more advanced stage at presentation, and have a worse disease-free and overall survival than Caucasian women. The biological characteristics of the primary tumor play an important role in determining the outcome of the disparity, and significant differences have been identified between African American and Caucasian breast cancer in steroid receptor and growth factor receptor content, mutations in cell cycle components, chromosomal abnormalities, and tumor suppressor and other cancer genes. The consequences of the biological factors are influenced by a variety of nonbiological factors, including socioeconomic, health care access, reproductive, and confounding factors. The nonbiological factors may act directly to enhance (or inhibit) the consequences of the biological changes, indirectly to facilitate outcome of the disparity, or as a cofounding factor, driving the association between the biological factors and the disparity. The prevention and management of the disparities will require an understanding of the relationship of biological and nonbiological factors. The present review was undertaken to promote this understanding by describing the biological basis of the four major disparities - early age of onset, more advanced stage of disease, more aggressive histologic changes, and worse survival - and the important relationship to the nonbiological factors. A model is proposed to provide a comprehensive view of this relationship, with the goal of facilitating an understanding of each disparity and the issues that need to be addressed to eliminate the disparity.
Collapse
Affiliation(s)
- David N Danforth
- Surgery Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA
| |
Collapse
|
40
|
Akinyemiju TF, Soliman AS, Copeland G, Banerjee M, Schwartz K, Merajver SD. Trends in breast cancer stage and mortality in Michigan (1992-2009) by race, socioeconomic status, and area healthcare resources. PLoS One 2013; 8:e61879. [PMID: 23637921 PMCID: PMC3639257 DOI: 10.1371/journal.pone.0061879] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Accepted: 03/18/2013] [Indexed: 11/18/2022] Open
Abstract
The long-term effect of socioeconomic status (SES) and healthcare resources availability (HCA) on breast cancer stage of presentation and mortality rates among patients in Michigan is unclear. Using data from the Michigan Department of Community Health (MDCH) between 1992 and 2009, we calculated annual proportions of late-stage diagnosis and age-adjusted breast cancer mortality rates by race and zip code in Michigan. SES and HCA were defined at the zip-code level. Joinpoint regression was used to compare the Average Annual Percent Change (AAPC) in the median zip-code level percent late stage diagnosis and mortality rate for blacks and whites and for each level of SES and HCA. Between 1992 and 2009, the proportion of late stage diagnosis increased among white women [AAPC = 1.0 (0.4, 1.6)], but was statistically unchanged among black women [AAPC = −0.5 (−1.9, 0.8)]. The breast cancer mortality rate declined among whites [AAPC = −1.3% (−1.8,−0.8)], but remained statistically unchanged among blacks [AAPC = −0.3% (−0.3, 1.0)]. In all SES and HCA area types, disparities in percent late stage between blacks and whites appeared to narrow over time, while the differences in breast cancer mortality rates between blacks and whites appeared to increase over time.
Collapse
Affiliation(s)
- Tomi F Akinyemiju
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York, United States of America.
| | | | | | | | | | | |
Collapse
|
41
|
Grabler P, Dupuy D, Rai J, Bernstein S, Ansell D. Regular screening mammography before the diagnosis of breast cancer reduces black:white breast cancer differences and modifies negative biological prognostic factors. Breast Cancer Res Treat 2012; 135:549-53. [PMID: 22886477 DOI: 10.1007/s10549-012-2193-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Accepted: 07/23/2012] [Indexed: 11/26/2022]
Abstract
Black women present with later stage breast cancers compared to white women, and their cancers are more likely to be larger, receptor negative, and undifferentiated. This study evaluated black:white differences in the stage and biology of breast cancer among women who had a screening mammogram at one of two Chicago academic medical centers within two years of the breast cancer diagnosis (regularly screened) and compared them to the black:white differences in the stage and biology of breast cancer in women who had not received mammographic screening within two years of a breast cancer diagnosis (irregularly screened.) There were no significant black:white differences in the proportion of early breast cancers (black = 74 %; white = 69 %, p = NS) in the regularly screened population or in the irregularly screened group (black = 60 %; white = 68 %, p = NS.) The regularly screened population received significantly more mammograms (58 % ≥4 mammograms) compared to the irregularly screened population (41 % ≥4 mammograms.) Black women in the regularly screened population were less likely than irregularly screened black women to have estrogen negative breast cancers (26 vs. 36 %, p < .05), progesterone negative breast cancers (35 vs. 46 %, p < .05), and poorly differentiated breast cancers (39 vs. 53 %, p < .05.) White women in the irregularly screened population also had worse prognostic factors than white women in the regularly screened population, though these were not statistically significant. Regular mammographic screening can contribute to the narrowing of black:white differences in presentation of breast cancer.
Collapse
Affiliation(s)
- Paula Grabler
- Department of Radiology, Feinberg College of Medicine, Northwestern University, Chicago, IL, USA
| | | | | | | | | |
Collapse
|
42
|
The racial disparity in breast cancer mortality in the 25 largest cities in the United States. Cancer Epidemiol 2012; 36:e147-51. [DOI: 10.1016/j.canep.2011.10.012] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Revised: 10/18/2011] [Accepted: 10/25/2011] [Indexed: 11/21/2022]
|
43
|
Rauscher GH, Allgood KL, Whitman S, Conant E. Disparities in screening mammography services by race/ethnicity and health insurance. J Womens Health (Larchmt) 2012; 21:154-60. [PMID: 21942866 PMCID: PMC3270049 DOI: 10.1089/jwh.2010.2415] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Black and Hispanic women are diagnosed at a later stage of breast cancer than white women. Differential access to specialists, diffusion of technology, and affiliation with an academic medical center may be related to this stage disparity. METHODS We analyzed data from a mammography facility survey for the metropolitan region of Chicago, Illinois, to assess in part whether quality breast imaging services were equally accessed by non-Hispanic white, non-Hispanic black, and Hispanic women and by women with and without private insurance. Of 49 screening facilities within the city of Chicago, 43 facilities completed the survey, and 40 facilities representing about 149,000 mammograms, including all major academic facilities, provided data on patient race/ethnicity. RESULTS Among women receiving mammograms at the facilities we studied, white women were more likely than black or Hispanic women to have mammograms at academic facilities, at facilities that relied exclusively on breast imaging specialists to read mammograms, and at facilities where digital mammography was available (p<0.001). Women with private insurance were similarly more likely than women without private insurance to have mammograms at facilities with these characteristics (p<0.001). CONCLUSIONS Black and Hispanic women and women without private insurance are more likely than white women and women with private insurance to obtain mammography screening at facilities with less favorable characteristics. A disparity in use of high-quality mammography may be contributing to disparities in breast cancer mortality.
Collapse
Affiliation(s)
- Garth H Rauscher
- School of Public Health, Division of Epidemiology and Biostatistics, Uinversity of Illinois at Chicago, Chicago, IL 60612, USA.
| | | | | | | |
Collapse
|
44
|
Abstract
Black women die of breast cancer at a much higher rate than white women. Recent studies have suggested that this racial disparity might be even greater in Chicago than the country as a whole. When data describing this racial disparity are presented they are sometimes attributed in part to racial differences in tumor biology. Vital records data were employed to calculate age-adjusted breast cancer mortality rates for women in Chicago, New York City and the United States from 1980-2005. Race-specific rate ratios were used to measure the disparity in breast cancer mortality. Breast cancer mortality rates by race are the main outcome. In all three geographies the rate ratios were approximately equal in 1980 and stayed that way until the early 1990s, when the white rates started to decline while the black rates remained rather constant. By 2005 the black:white rate ratio was 1.36 in NYC, 1.38 in the US, and 1.98 in Chicago. In any number of ways these data are inconsistent with the notion that the disparity in black:white breast cancer mortality rates is a function of differential biology. Three societal hypotheses are posited that may explain this disparity. All three are actionable, beginning today.
Collapse
|
45
|
Nichols MA, Mell LK, Hasselle MD, Karrison TG, MacDermed D, Meriwether A, Witt ME, Weichselbaum RR, Chmura SJ. Outcomes in black patients with early breast cancer treated with breast conservation therapy. Int J Radiat Oncol Biol Phys 2011; 79:392-9. [PMID: 20434849 DOI: 10.1016/j.ijrobp.2009.11.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 11/02/2009] [Indexed: 11/18/2022]
Abstract
BACKGROUND The race-specific impact of prognostic variables for early breast cancer is unknown for black patients undergoing breast conservation. METHODS AND MATERIALS This was a retrospective study of 1,231 consecutive patients ≥40 years of age with Stage I-II invasive breast cancer treated with lumpectomy and radiation therapy at the University of Chicago Hospitals and affiliates between 1986 and 2004. Patients were classified as either black or nonblack. Cox proportional hazards regression was used to model the effects of known prognostic factors and interactions with race. RESULTS Median follow-up for surviving patients was 82 months. Thirty-four percent of patients were black, and 66% were nonblack (Caucasian, Hispanic, and Asian). Black patients had a poorer 10-year overall survival (64.6% vs. 80.8%; adjusted hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.23-2.06) and 10-year disease-free survival (58.1% vs. 75.4%; HR 1.49; 95% CI, 1.18-1.89) compared with nonblack patients. Tumor sizes were similar between nonblack and black patients with mammographically detected tumors (1.29 cm vs. 1.20 cm, p = 0.20, respectively). Tumor size was significantly associated with overall survival (HR 1.48; 95% CI, 1.12-1.96) in black patients with mammographically detected tumors but not in nonblack patients (HR 1.09; 95% CI, 0.78-1.53), suggesting that survival in black patients depends more strongly on tumor size in this subgroup. Tests for race-size method of detection interactions were statistically significant for overall survival (p = 0.049), locoregional control (p = 0.036), and distant control (p = 0.032) and borderline significant for disease-free survival (p = 0.067). CONCLUSION Despite detection at comparable sizes, the prognostic effect of tumor size in patients with mammographically detected tumors is greater for black than in nonblack patients.
Collapse
Affiliation(s)
- Michael A Nichols
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL 60637, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Markossian TW, Calhoun EA. Are breast cancer navigation programs cost-effective? Evidence from the Chicago Cancer Navigation Project. Health Policy 2010; 99:52-9. [PMID: 20685001 DOI: 10.1016/j.healthpol.2010.07.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Revised: 07/06/2010] [Accepted: 07/07/2010] [Indexed: 11/30/2022]
Abstract
OBJECTIVES One of the aims of the Chicago Cancer Navigation Project (CCNP) is to reduce the interval of time between abnormal breast cancer screening and definitive diagnosis in patients who are navigated as compared to usual care. In this article, we investigate the extent to which total costs of breast cancer navigation can be offset by survival benefits and savings in lifetime breast cancer-attributable costs. METHODS Data sources for the cost-effectiveness analysis include data from published literature, secondary data from the NCI's Surveillance Epidemiology and End Results (SEER) program, and primary data from the CCNP. RESULTS If women enrolled in CCNP receive breast cancer diagnosis earlier by 6 months as compared to usual care, then navigation is borderline cost-effective for $95,625 per life-year saved. Results from sensitivity analyses suggest that the cost-effectiveness of navigation is sensitive to: the interval of time between screening and diagnosis, percent increase in number of women who receive cancer diagnosis and treatment, women's age, and the positive predictive value of a mammogram. CONCLUSIONS In planning cost-effective navigation programs, special considerations should be made regarding the characteristics of the disease, program participants, and the initial screening test that determines program eligibility.
Collapse
Affiliation(s)
- Talar W Markossian
- Health Policy and Management, Georgia Southern University, Jiann-Ping Hsu College of Public Health, P.O. Box 8015, Statesboro, GA 30460-8015, United States.
| | | |
Collapse
|
47
|
Yasmeen F, Hyndman RJ, Erbas B. Forecasting age-related changes in breast cancer mortality among white and black US women: a functional data approach. Cancer Epidemiol 2010; 34:542-9. [PMID: 20887940 DOI: 10.1016/j.canep.2010.05.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2009] [Revised: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 01/03/2023]
Abstract
BACKGROUND The disparity in breast cancer mortality rates among white and black US women is widening, with higher mortality rates among black women. We apply functional time series models on age-specific breast cancer mortality rates for each group of women, and forecast their mortality curves using exponential smoothing state-space models with damping. MATERIALS AND METHODS The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program of the US [1]. Mortality data were obtained from the National Centre for Health Statistics (NCHS) available on the SEER*Stat database. We use annual unadjusted breast cancer mortality rates from 1969 to 2004 in 5-year age groups (45-49, 50-54, 55-59, 60-64, 65-69, 70-74, 75-79, 80-84). Age-specific mortality curves were obtained using nonparametric smoothing methods. The curves are then decomposed using functional principal components and we fit functional time series models with four basis functions for each population separately. The curves from each population are forecast and prediction intervals are calculated. RESULTS Twenty-year forecasts indicate an overall decline in future breast cancer mortality rates for both groups of women. This decline appears to be steeper among white women aged 55-73 and black women aged 60-84. For black women under 55 years of age, the forecast rates are relatively stable indicating there is no significant change in future breast cancer mortality rates among young black women in the next 20 years. CONCLUSION White women have smooth and consistent patterns in breast cancer mortality rates for all age-groups whereas the mortality rates for black women are much more variable. The projections suggest, for some age groups, black American women may not benefit equally from the overall decline in breast cancer mortality in the United States.
Collapse
Affiliation(s)
- Farah Yasmeen
- Department of Econometrics and Business Statistics, Monash University, VIC 3800, Australia.
| | | | | |
Collapse
|
48
|
Abstract
Triple-negative breast cancer is more likely to affect younger premenopausal women and despite being responsive to traditional chemotherapy, continues to carry a poor overall prognosis. Traditional protective factors for breast cancer such as multiparity and early primaparity actually increase the risk for the triple-negative variant. Unlike other breast cancers, the incidence of this disease is also much higher in African American and West African women. Among those with triple-negative disease in the United States, the mortality rates are also highest in African American women. Variations in risk factors and socioeconomic status, lack of treatment, delays in treatment, and inadequate dosing of chemotherapy are just a few of the many reasons that may explain why this incidence and survival disparity persists.
Collapse
|
49
|
Gehlert S, Murray A, Sohmer D, McClintock M, Conzen S, Olopade O. The importance of transdisciplinary collaborations for understanding and resolving health disparities. SOCIAL WORK IN PUBLIC HEALTH 2010; 25:408-22. [PMID: 20446184 DOI: 10.1080/19371910903241124] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Group disparities in health have been documented for several decades. Despite recent efforts to eliminate them, group differences persist and challenge the ability of scientists to address them using traditional research paradigms. Because the determinants of disparities occur at multiple levels, from the molecular to the societal, and interact with one another in ways not yet fully understood, they represent a challenge to researchers attempting to capture their complexity. After reviewing existing models of disciplinary collaboration, we outline the challenges of a transdisciplinary approach and its ability to afford the holistic view of disparities needed to develop effective interventions.
Collapse
Affiliation(s)
- Sarah Gehlert
- Center for Interdisciplinary Health Disparities Research, and School of Social Service Administration, University of Chicago, Chicago, Illinois 60637, USA.
| | | | | | | | | | | |
Collapse
|
50
|
Orsi JM, Margellos-Anast H, Whitman S. Black-White health disparities in the United States and Chicago: a 15-year progress analysis. Am J Public Health 2010; 100:349-56. [PMID: 20019299 PMCID: PMC2804622 DOI: 10.2105/ajph.2009.165407] [Citation(s) in RCA: 114] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In an effort to examine national and Chicago, Illinois, progress in meeting the Healthy People 2010 goal of eliminating health disparities, we examined whether disparities between non-Hispanic Black and non-Hispanic White persons widened, narrowed, or stayed the same between 1990 and 2005. METHODS We examined 15 health status indicators. We determined whether a disparity widened, narrowed, or remained unchanged between 1990 and 2005 by examining the percentage difference in rates between non-Hispanic Black and non-Hispanic White populations at both time points and at each location. We calculated P values to determine whether changes in percentage difference over time were statistically significant. RESULTS Disparities between non-Hispanic Black and non-Hispanic White populations widened for 6 of 15 health status indicators examined for the United States (5 significantly), whereas in Chicago the majority of disparities widened (11 of 15, 5 significantly). CONCLUSIONS Overall, progress toward meeting the Healthy People 2010 goal of eliminating health disparities in the United States and in Chicago remains bleak. With more than 15 years of time and effort spent at the national and local level to reduce disparities, the impact remains negligible.
Collapse
Affiliation(s)
- Jennifer M Orsi
- Sinai Urban Health Institute, California Ave at 15th St, K443, Chicago, IL 60608, USA.
| | | | | |
Collapse
|