Late-Stage Breast Cancer Diagnosis and Health Care Access in Illinois∗

Abstract

The variations of breast cancer mortality rates from place to place reflect both underlying differences in breast cancer prevalence and differences in diagnosis and treatment that affect the risk of death. This article examines the role of access to health care in explaining the variation of late-stage diagnosis of breast cancer. We use cancer registry data for the state of Illinois by zip code to investigate spatial variation in late diagnosis. Geographic information systems and spatial analysis methods are used to create detailed measures of spatial access to health care such as convenience of visiting primary care physicians and travel time from the nearest mammography facility. The effects of spatial access, in combination with the influences of socioeconomic factors, on late-stage breast cancer diagnosis are assessed using statistical methods. The results suggest that for breast cancer, poor geographical access to primary health care significantly increases the risk of late diagnosis for persons living outside the city of Chicago. Disadvantaged population groups including those with low income and racial and ethnic minorities tend to experience high rates of late diagnosis. In Illinois, poor spatial access to primary health care is more strongly associated with late diagnosis than is spatial access to mammography. This suggests the importance of primary care physicians as gatekeepers in early breast cancer detection.

Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

“…While our findings are consistent with a large body of literature documenting the association of poorer health outcomes with increasing percent of local residents who are Black, and with racial segregation, [47][48][49][50][51][52][53][54][55][56] they run counter to findings from the emerging literature that focuses exclusively on these exposures' relationship to breast cancer mortality. Haas et al 15 found no relationship between racial segregation (operationalized as isolation) and breast cancer mortality, and Warner and Gomez 16 found an inverse relationship between Black neighborhood racial composition and breast cancer mortality among Black women and a positive relationship for White women, controlling for metropolitan segregation.…”

“…Other studies have found that people who had a greater distance from their residence to mammography facility were diagnosed at a more advanced cancer stage. 49,50 Other possible mediators include (1) poorer quality of care at facilities that were located near predominately Black areas, 51 and (2) governmental and corporate disinvestment from predominately Black areas that produces increased exposure to hazards and stressors, and diminished access to treatment opportunities.…”

Geographical Location and Stage of Breast Cancer Diagnosis: A Systematic Review of the Literature

“…11, Figure 1 shows the summary of criteria used for inclusion of eligible studies in this review. Of the eligible papers selected, 23 were from the United States, two each from Australia and New Zealand, and one each from Canada, Denmark, Egypt, Estonia, Italy, Poland, South Africa, Switzerland, and the United Kingdom.…”

“…6 Other studies on cancer survival from cancer in various countries have noted that geographical location is strongly associated with survival and that could also reflect stage at diagnosis and the kind of treatment patients are likely to receive. [7][8][9][10][11][12][13] In contrast, some studies have reported that no significant difference exists between breast cancer stage at diagnosis and place of residence or travel time/ distance travel to the nearest mammography facility. [14][15][16][17][18][19][20][21][22] The aim of this review was to examine systematically the literature on the effect of geographical location variation on breast cancer stage at diagnosis, race/ ethnicity, and socioeconomic status rather than rural-urban differences in mammography use or risk factors for breast cancer development.…”

“…11,39,40 There is also an assumption that the greater the distance to travel, the higher the incidence of psychological morbidity and the poorer the compliance with treatment. 11,41 A study by Wang and colleagues 11 [N = 9,077] on late-stage breast cancer diagnosis and health care access in Illinois, argued that spatial access to primary care doctors and time travel is critically important in achieving high rates of early breast cancer detection in Illinois and surrounding states. Consequently, living in areas with poor geographical access to primary care physicians increases the likelihood of late diagnosis for breast cancer.…”