1
|
Mobley LR, Tangka FKL, Berkowitz Z, Miller J, Hall IJ, Wu M, Sabatino SA. Geographic Disparities in Late-Stage Breast Cancer Diagnosis Rates and Their Persistence Over Time. J Womens Health (Larchmt) 2021; 30:807-815. [PMID: 33926216 DOI: 10.1089/jwh.2020.8728] [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] [Indexed: 11/13/2022] Open
Abstract
Background: Other than skin cancer, breast cancer is the most common cancer in the United States. Lower uptake of mammography screening is associated with higher rates of late-stage breast cancers. This study aims to show geographic patterns in the United States, where rates of late-stage breast cancer are high and persistent over time, and examines factors associated with these patterns. Materials and Methods: We examined all primary breast cancers diagnosed among all counties in 43 U.S. states with available data. We used spatial cluster analysis to identify hot spots (i.e., spatial clusters with above average late-stage diagnosis rates among counties). Demographic and socioeconomic characteristics were compared between persistent hot spots and those counties that were never hot spots. Results: Of the 2,599 counties examined in 43 states, 219 were identified as persistent hot spots. Counties with persistent hot spots (compared with counties that were never hot spots) were located in more deprived areas with worse housing characteristics, lower socioeconomic status, lower levels of health insurance, worse access to mammography, more isolated American Indian/Alaska Native, Black, or Hispanic neighborhoods, and larger income disparity. In addition, persistent hot spots were significantly more likely to be observed among poor, rural, African American, or Hispanic communities, but not among poor, rural, White communities. This analysis includes a broader range of socioeconomic conditions than those included in previous literature. Conclusion: We found geographic disparities in late-stage breast cancer diagnosis rates, with some communities experiencing persistent disparities over time. Our findings can guide public health efforts aimed at reducing disparities in stage of diagnosis for breast cancer.
Collapse
Affiliation(s)
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Zahava Berkowitz
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Jacqueline Miller
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Ingrid J Hall
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Manxia Wu
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Susan A Sabatino
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
2
|
Disparities in the Use of Adjuvant External Beam Radiation Therapy in Node-positive Cervical Cancer Patients Following Hysterectomy. Am J Clin Oncol 2019; 43:43-46. [DOI: 10.1097/coc.0000000000000617] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
3
|
Musselwhite LW, Oliveira CM, Kwaramba T, de Paula Pantano N, Smith JS, Fregnani JH, Reis RM, Mauad E, Vazquez FDL, Longatto-Filho A. Racial/Ethnic Disparities in Cervical Cancer Screening and Outcomes. Acta Cytol 2016; 60:518-526. [PMID: 27825171 DOI: 10.1159/000452240] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/03/2016] [Indexed: 12/15/2022]
Abstract
Invasive cervical cancer disproportionately affects women without sufficient access to care, with higher rates among minority groups in higher-income countries and women in low-resource regions of the world. Many elements contribute to racial/ethnic disparities in the cervical cancer continuum - from screening and diagnosis to treatment and outcome. Sociodemographic factors, access to healthcare, income and education level, and disease stage at diagnosis are closely linked to such inequities. Despite the identification of such elements, racial/ethnic disparities persist, and are widening in several minority subgroups, particularly in older women, who are ineligible for human papillomavirus (HPV) vaccination and are underscreened. Recent studies suggest that racial/ethnic differences in HPV infection exist and may also have a role in observed differences in cervical cancer. In this review, we provide an overview of the current literature on racial disparities in cervical cancer screening, incidence, treatment and outcome to inform future strategies to reduce persistent inequities.
Collapse
|
4
|
Ashing-Giwa KT, Lim JW, Gonzalez P. Exploring the relationship between physical well-being and healthy lifestyle changes among European- and Latina-American breast and cervical cancer survivors. Psychooncology 2011; 19:1161-70. [PMID: 20101673 DOI: 10.1002/pon.1687] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Cancer and its treatments have a lingering and often negative impact on survivors' physical well-being. The physical sequelae impinge on daily functioning and overall HRQOL, and perhaps influence lifestyle changes post-cancer. This study aims to examine: (1) physical well-being items that are associated with low overall health-related quality of life; and (2) the relationship between physical well-being outcomes and healthy lifestyle changes by cancer type. METHODS This study employed a cross-sectional design with mixed sampling methods. In total 922 European- (n=452) and Latina-American (n=470) breast (BCS) or cervical cancer survivors (CCS) were recruited from the California Cancer Surveillance Program and Los Angeles area hospital registries. Item responses from survivors in the lowest quartile of total quality of life scores and percentages reflecting low physical well-being levels were calculated. RESULTS A statistical approach to individual items provides unique and valuable measurement and clinical information above and beyond physical well-being total scores. Physical well-being item responses varied according to ethnicity, income, and education. BCS and CCS showed different patterns in the relationship between physical well-being items and lifestyle changes. Specifically, exercise was significantly related to physical well-being items for BCS, while diet changes were significantly associated with physical well-being for CCS. CONCLUSIONS Results reveal unique correlates of physical well-being items by cancer type, ethnicity, and lifestyle changes. Clinically, this study highlights the need for greater consideration of individual and medical characteristics in developing culturally sensitive and patient responsive interventions to promote healthy lifestyles and improve survivorship outcomes.
Collapse
Affiliation(s)
- Kimlin T Ashing-Giwa
- Center of Community Alliance for Research and Education (CCARE), Department of Population Sciences, City of Hope, Duarte, CA 91010-3000, USA.
| | | | | |
Collapse
|
5
|
Kuo TM, Mobley LR, Anselin L. Geographic disparities in late-stage breast cancer diagnosis in California. Health Place 2010; 17:327-34. [PMID: 21144791 DOI: 10.1016/j.healthplace.2010.11.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Revised: 10/15/2010] [Accepted: 11/21/2010] [Indexed: 11/18/2022]
Abstract
Using cancer registry data for the population of California women aged 67+ with breast cancers, we estimated random intercept logistic models to examine how two socio-ecological predictors (residential isolation and poverty) were associated with probability of late-stage diagnosis for breast cancer. Using the multilevel modeling results, we calculated fully adjusted predicted probabilities associated with women in each Medical Service Study Area (MSSA) in California and classified the areas into two distinct groups: MSSAs with predicted rates below the 25th percentile (presumably the better outcome areas) and MSSAs with predicted rates above the 75th percentile (presumably the worse outcome areas) for two minority groups. Some areas had better outcomes for one group but worse outcomes for the other, suggesting that interventions to improve outcomes need different strategies for different groups in the same areas. Using information from geographic risk factors and multilevel modeling, this study informs interventions designed to reduce disparities in breast cancer outcomes.
Collapse
Affiliation(s)
- Tzy-Mey Kuo
- RTI International, 3040 Cornwallis Road, Research Triangle Park, NC 27709-2194, USA.
| | | | | |
Collapse
|
6
|
Kirsner RS, Ma F, Fleming LE, Federman DG, Trapido E, Duncan R, Rouhani P, Wilkinson JD. Earlier stage at diagnosis and improved survival among Medicare HMO patients with breast cancer. J Womens Health (Larchmt) 2010; 19:1619-24. [PMID: 20815756 DOI: 10.1089/jwh.2009.1768] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE We sought to evaluate differences in the stage at diagnosis and the survival of breast cancer patients enrolled in two different Medicare healthcare delivery systems: fee for service (FFS) and health maintenance organizations (HMO). METHODS We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services (CMS), and the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) program database, to evaluate differences in demographic data, stage at diagnosis, and survival in patients with breast cancers over the period 1985-2001. RESULTS Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast cancer had improved survival, and these differences remained even after controlling for potential confounders. Specifically, breast cancer patients enrolled in HMOs had 9% increased probability of survival (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.88-0.93) than their counterparts enrolled in FFS. These findings persisted even when patients had a cancer diagnosis before their breast cancer. CONCLUSIONS Improved survival among breast cancer patients in HMOs compared with FFS is likely due to a combination of factors, including but not limited to earlier stage at the time of diagnosis.
Collapse
Affiliation(s)
- Robert S Kirsner
- Department of Dermatology and Cutaneous Surgery, University of Miami Miller School of Medicine, Department of Dermatology, Miami, Florida 33136, USA.
| | | | | | | | | | | | | | | |
Collapse
|
7
|
Ashing-Giwa KT, Gonzalez P, Lim JW, Chung C, Paz B, Somlo G, Wakabayashi MT. Diagnostic and therapeutic delays among a multiethnic sample of breast and cervical cancer survivors. Cancer 2010; 116:3195-204. [PMID: 20564623 DOI: 10.1002/cncr.25060] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several publications reporting on health disparities document that ethnic minorities disproportionately experience delays in healthcare access, delivery, and treatment. However, few studies examine factors underlying access and receipt of healthcare among cancer survivors from the patient perspective. This study explores diagnostic and therapeutic care delays among a multiethnic sample of breast and cervical cancer survivors and examines contextual factors influencing diagnostic and therapeutic care delays. METHODS Population-based sampling and a cross-sectional design were used to recruit 1377 survivors (breast cancer, n = 698; cervical cancer, n = 679). This multiethnic sample included 449 European American, 185 African American, 468 Latina American, and 275 Asian American survivors. RESULTS Latina Americans were more likely to report diagnostic delays (P = .003), whereas African Americans were more likely to report therapeutic delays (P = .007). In terms of cancer type, cervical cancer survivors were more likely to report diagnostic (P = .004) and therapeutic delays (P = .000) compared with breast cancer survivors. "Fear of finding cancer" was the most frequently cited reason for diagnostic delays, and "medical reasons" were most frequently cited for therapeutic delays. CONCLUSIONS Due in part to a higher proportion of diagnostic and therapeutic delays, ethnic minorities endure greater cancer burden, including poorer survival and survivorship outcomes. The medical community must recognize the impact of existing psychological and cultural dimensions on diagnostic care, as well as the personal and healthcare system level barriers that contribute to therapeutic delays.
Collapse
Affiliation(s)
- Kimlin T Ashing-Giwa
- CCARE, Division of Population Sciences, City of Hope Medical Center, Duarte, California, USA.
| | | | | | | | | | | | | |
Collapse
|
8
|
Differences in melanoma outcomes among Hispanic Medicare enrollees. J Am Acad Dermatol 2010; 62:768-76. [DOI: 10.1016/j.jaad.2009.11.594] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/14/2009] [Accepted: 11/17/2009] [Indexed: 11/23/2022]
|
9
|
Habermann EB, Virnig BA, Riley GF, Baxter NN. The impact of a change in Medicare reimbursement policy and HEDIS measures on stage at diagnosis among Medicare HMO and fee-for-service female breast cancer patients. Med Care 2007; 45:761-6. [PMID: 17667310 DOI: 10.1097/mlr.0b013e3180616c51] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine the effects of health plan enrollment [health maintenance organizations (HMO) or fee-for-service (FFS)], a change in Medicare reimbursement policy which allowed for annual rather than biennial mammograms, and Health Plan Employer Data Information Set (HEDIS) measures on stage at diagnosis among older women with breast cancer. METHODS We used the population-based Surveillance Epidemiology and End Results (SEER)-Medicare database to identify all elderly women age 65-74 who were diagnosed with breast cancer from 1994 to 2002. We compared stage at diagnosis, demographic characteristics, and tumor characteristics for FFS or HMO enrollment in the periods before and after the 1998 policy change. We compared the effect of women age 65-69 whose mammography use in the HMO system is measured by HEDIS and those who are older (age 70-74). RESULTS We identified 20,106 women enrolled in FFS Medicare, and 10,751 women enrolled in an HMO. Women ages 65-74 who were enrolled in a Medicare HMO were more likely to be diagnosed at an early stage both before and after the policy change, but the disparity decreased from 4.7% to 2.3%, a relative change of 51.1%. The disparity was not specific to the ages included in the HEDIS measure. CONCLUSIONS A decrease of 51.1% in the HMO-FFS disparity in breast cancer stage at diagnosis coincided with the 1998 change in Medicare mammography reimbursement policy. The existence of HEDIS measures for HMOs does not create a disparity in stage at diagnosis between those whose mammograms are measured by HEDIS (younger women) and those whose are not (older women).
Collapse
Affiliation(s)
- Elizabeth B Habermann
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN 55455, USA.
| | | | | | | |
Collapse
|
10
|
Akers AY, Newmann SJ, Smith JS. Factors underlying disparities in cervical cancer incidence, screening, and treatment in the United States. Curr Probl Cancer 2007; 31:157-81. [PMID: 17543946 DOI: 10.1016/j.currproblcancer.2007.01.001] [Citation(s) in RCA: 146] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Aletha Y Akers
- Robert Wood Johnson Clinical Scholars Program, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | | |
Collapse
|
11
|
Kirsner RS, Ma F, Fleming L, Federman DG, Trapido E, Duncan R, Wilkinson JD. The effect of medicare health care delivery systems on survival for patients with breast and colorectal cancer. Cancer Epidemiol Biomarkers Prev 2006; 15:769-73. [PMID: 16614122 DOI: 10.1158/1055-9965.epi-05-0838] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Two of the most common types of health care delivery systems in the U.S. are fee-for-service (FFS) and managed care systems such as health maintenance organizations (HMO). Differences may exist in patient outcomes depending on the health care delivery system in which they are enrolled. We evaluated differences in the survival of patients with breast and colorectal cancer at diagnosis between the two Medicare health care delivery systems (FFS and HMO). METHODS We used a linkage of two national databases, the Medicare database from the Centers for Medicare and Medicaid Services, and the National Cancer Institute's Surveillance, Epidemiology, and End Results program database, to evaluate differences in demographic data, stage at diagnosis, and survival between breast and colorectal cancer over the period 1985 to 2001. RESULTS Medicare patients enrolled in HMOs were diagnosed at an earlier stage of diagnosis than FFS patients. HMO patients diagnosed with breast and colorectal cancer had improved survival, and these differences remained even after controlling for potential confounders (such as stage at diagnosis, age, race, socioeconomic status, and marital status). Specifically, patients enrolled in HMOs had 9% greater survival in hazards ratio if they had breast cancer, and 6% if they had colorectal cancer. CONCLUSIONS Differences exist in survival among patients in HMOs compared with FFS. This is likely due to a combination of factors, including but not limited to, earlier stage at the time of diagnoses.
Collapse
|
12
|
Sassi F, Luft HS, Guadagnoli E. Reducing racial/ethnic disparities in female breast cancer: screening rates and stage at diagnosis. Am J Public Health 2006; 96:2165-72. [PMID: 17077392 PMCID: PMC1698161 DOI: 10.2105/ajph.2005.071761] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed whether population rates of mammography screening, and their changes over time, were associated with improvements in breast cancer stage at diagnosis and whether the strength of this association varied by race/ethnicity. METHODS We analyzed state cancer registry data linked to socioeconomic characteristics of patients' areas of residence for 1990-1998 time trends in the likelihood of early stage diagnosis. We appended each cancer registry record with matching subgroup estimates of self-reported mammography screening. RESULTS Trends in screening and stage at diagnosis were consistent within groups, but African American women had a significantly lower proportion of early stage cancers despite an advantage in screening. Population screening rates were significantly associated with early diagnosis, with a weaker association in African American women than White women (odds ratio [OR] = 1.70; P<.0001 vs OR=2.02; P<.0001, respectively). CONCLUSIONS Improvements in screening rates during the 1990s across racial/ethnic groups appear to have contributed significantly to earlier diagnosis within each group, but a smaller effect in African American women should raise concerns. A key health policy challenge is to ensure that screening effectively translates into earlier diagnosis.
Collapse
Affiliation(s)
- Franco Sassi
- Department of Social Policy, The London School of Economics and Political Science, London, United Kingdom.
| | | | | |
Collapse
|