Impact of Access and Social Context on Breast Cancer Stage at Diagnosis

Abstract

This study examined the impact of individual demographic characteristics (age, race/ethnicity, and type of reporting hospital), together with measures of social context, including area of residence socioeconomic status (SES), change in SES, and access to screening (area mammography capacity), on breast cancer stage at diagnosis among New York City residents diagnosed between 1980 and 1985. Three logistic regression models evaluated the impact of individual variables, social context variables, and both classes of variables combined on the outcome of having late-stage (regional or distant) compared to early-stage (local) cancer. The logistic regression models indicated that women aged 50 to 64 years were independently more likely to have late-stage cancer than those younger or older. Controlling for individual and social context variables, African American women were 25 percent more likely than White women to have late-stage breast cancer (p < 0.0001); higher odds seen in the individual model for Hispanic women disappeared after controlling for area SES. In the combined model, women diagnosed from public hospitals were 44 percent more likely to have late-stage disease than those diagnosed in nonpublic settings (p < 0.0001). In both the social context and combined models, area mammography capacity was a significant independent predictor of stage (p = 0.016); area-level SES, but not change in SES, was independently related to late-stage disease (p = 0.002). These data suggest that breast cancer control activities should more actively ensure adequate access to screening, particularly for minorities, populations living in socioeconomically disadvantaged areas, and those cared for in the public sector.

Detecting an Association between Socioeconomic Status and Late Stage Breast Cancer Using Spatial Analysis and Area-Based Measures

“…The results of this research, indicating that residing in areas with high levels of poverty is significantly associated with late stage diagnosis of breast cancer, are noteworthy and consistent with other studies (25)(26)(27)(28)(29)(30). These findings remained after attempting to control for important risk factors, such as insurance and mammography prevalence.…”

Social Determinants of Black-White Disparities in Breast Cancer Mortality: A Review

“…Thus, women residing in disadvantaged communities may be required to travel long distances and bear long waiting times to utilize breast cancer screening and treatment facilities. Indeed, extensive travel time, public transportation hassles, and inconvenient hours of operation have been reported as major factors preventing regular physician visits (14,49,(54)(55)(56).…”

A Spiritually Based Approach to Breast Cancer Awareness: Cognitive Response Analysis of Communication Effectiveness

“…In another mixed-race sample, stage that breast cancer is diagnosed (later stage) was related to being African American, lower availability of mammography facilities in the area, and lower area of residence socioeconomic status (Mandelblatt, Andrews, Kao, Wallace, & Kerner, 1995).…”

“…In a sample of African American, Latina, and European American women, perceived access to healthcare services was predicted by perception of prejudicial treatment in health service delivery, language spoken, and financial capability (Facione, 1999). In addition, low perceived access predicted low rates of mammography usage and low performance of breast self-examination.In another mixed-race sample, stage that breast cancer is diagnosed (later stage) was related to being African American, lower availability of mammography facilities in the area, and lower area of residence socioeconomic status (Mandelblatt, Andrews, Kao, Wallace, & Kerner, 1995).Self-reported likelihood of delaying reporting breast symptoms to a doctor has been associated with being African American or Latina, having lower income, lower education, experiencing prejudice in health care delivery, perceived lack of access to health care, lack of knowledge, and fatalism (Facione, Miaskowski, Dodd, & Paul, 2002). In a meta-analysis, it was concluded that community-based "outreach" intervention programs (e.g., churchbased health interventions) have been effective in increasing the use of mammography, though comparable in effectiveness to "inreach" programs (e.g., interventions in a primary care setting) (Yabroff, O'Malley, Mangan, and Mendelblatt, 2001).…”