Breast Cancer Screening, Area Deprivation, and Later‐Stage Breast Cancer in Appalachia: Does Geography Matter?

Abstract

Objective To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia. Data Source Central cancer registry data (2006–2008) from three Appalachian states were linked to Medicare claims and census data. Study Design Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. Principal Findings Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged > 75 years. The most deprived counties had 3.31 times rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high population counties. Conclusions Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk.

Cancer Incidence in Appalachia, 2004–2011

“…Female-invasive and in-situ breast cancer is lower in Appalachia, regardless of region, similar to other results (5,16,21,24). Lung and bronchus cancer screening for certain at-risk groups was recommended in 2013; however, given increased tobacco use in Appalachia, it will be important to monitor differences in IRs before and after this recommendation.…”

“…One study evaluated the relationship of screening and deprivation on latestage breast cancer in three states, another focused on cancer survivors in a single university hospital, and others evaluated cancer risk perceptions, specific screening programs, or mortality (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15). All generally found higher cancer incidence and death rates, later-stage disease, and higher risk perception and worry about cancer recurrence.…”

Breast Cancer Screening for Women at Average Risk

“…In the United States, barriers to access continue to exist among low income or uninsured women or those without a usual source of care, or those residing in rural counties. 119–121 These and other barriers are a formidable challenge to the delivery of preventive services, and likely will remain so for some time without further policy changes. While the intent of the Affordable Care Act (ACA) is to eliminate cost sharing for mammography screening, there is still a lack of clarity about coverage as it pertains to breast cancer screening at some ages and at some intervals that the ACS either recommends, or endorses for informed and shared decision making.…”

Geographic Variation in Condom Availability and Accessibility

“…These results highlight that there may be an overall lack of resources in specific areas or neighborhoods, which likely influence health outcomes and contribute to health disparities in low resource settings. Previously, these disparities have been identified as physical gaps in health care and food access [45][46][47]. This study suggests that sexual health resources should also be included in assessing the needed resources in physical environments that serve as barriers to positive health outcomes.…”