Patterns of Breast Cancer Presentation in the United States: Does Geography Matter?

Abstract

Distribution of breast cancer varies widely throughout the United States. The factors that influence this geographic variability have not been completely defined. In addition, though a number of studies look at regional and state-to-state variability, few studies have examined this issue with regard to the nation as a whole. State-specific breast cancer data were available from the American College of Surgeons National Cancer Data Base in a series of Benchmark Reports. These data were reviewed and stratified with regard to: age at the time of presentation, race, and stage at the time of presentation. The data were further collected into regional cohorts that corresponded to the United States Census Bureau regions. Statistical analyses were then performed to identify any linked or related variables. A total of 811,652 patients with breast cancer were reported. There was a statistically significant relationship between stage at the time of presentation and census region. The greatest percentage of early-stage disease was recorded in the Northeast and the lowest in the South. There was no significant association between age at presentation and geographic region, but there was a significant relationship between race and stage. The nonwhite subgroup had a greater percentage of patients presenting with advanced-stage disease. Finally, regions with a larger percentage of nonurban population had a higher percentage of later-stage disease at presentation. A relationship exists between the pattern of breast cancer presentation and geographical location within the United States. The Northeast–with the highest percentage of urban areas and white population–reported the highest percentage of early-stage breast cancer at presentation, suggesting a link between these variables. Conversely, the South–with more rural and nonwhite population–had the highest percentage of later-stage disease. The causal relationships are not clear-cut, however, and the relationship between geography and breast cancer presentation is likely multifactorial. Further analysis is indicated to uncover any link between geographic variability and overall breast cancer treatment and survival.

Epidemiological profile of Brazilian oncological patients seen by a reference oncology center of the public health system and who migrate in search of adequate health care

“…Some papers on the subject worldwide have shown the inequality of cancer treatment access in different countries resulting in a migration process, but do not seem to have reached consensus on the motivations for this migration nor do they agree on the consequences for citizens, although it appears to be harmful. [8][9][10][11][12] The present study showed that about 10% of patients treated in a cancer centre in Brazil were from different regions of the country, demonstrating a social health problem.…”

Precipitation and Climate Zone Explains the Geographical Disparity in the Invasive Cancer Incidence Rates in the United States

“…C ancer remains the leading cause of death in the United States, which is responsible for one in four deaths (Siegel et al, 2012). However, there is a significant disparity in cancer incidence and mortality rates between different states (Goodwin et al, 1998;Perdue et al, 2008;Sariego, 2009;Siegel et al, 2012). The cancer incidence rate data available through the Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute shows that the states with higher rates are clustered toward the East Coast (Fig.…”

Bayesian Spatial Analysis for the Evaluation of Breast Cancer Detection Methods

“…Previous studies have provided strong evidence of geographical variation in female breast cancer incidence and survival with women living in more disadvantaged or rural areas tending to have lower survival (Robsahm & Tretli ; Huang et al . ; Sariego ; Baade et al . ; Cramb, Mengersen & Baade ; Dasgupta et al .…”