What Predicts an Advanced-Stage Diagnosis of Breast Cancer? Sorting Out the Influence of Method of Detection, Access to Care, and Biologic Factors

Abstract

Background: Multiple studies have yielded important findings regarding the determinants of an advanced-stage diagnosis of breast cancer. We seek to advance this line of inquiry through a broadened conceptual framework and accompanying statistical modeling strategy that recognize the dual importance of access-tocare and biologic factors on stage.Methods: The Centers for Disease Control and Preventionsponsored Breast and Prostate Cancer Data Quality and Patterns of Care Study yielded a seven-state, cancer registry-derived population-based sample of 9,142 women diagnosed with a first primary in situ or invasive breast cancer in 2004. The likelihood of advanced-stage cancer (American Joint Committee on Cancer IIIB, IIIC, or IV) was investigated through multivariable regression modeling, with base-case analyses using the method of instrumental variables (IV) to detect and correct for possible selection bias. The robustness of base-case findings was examined through extensive sensitivity analyses.

Determinants of stage at diagnosis of breast cancer in Nigerian women: sociodemographic, breast cancer awareness, health care access and clinical factors

“…25,26 Although some authors have associated younger age at diagnosis with later stage at presentation, 27 others have found the reverse. 14 We did not find an association between age at diagnosis and stage.…”

“…38 In New Zealand, researchers have reported poorly differentiated tumour grade (II and III) in women with late stage disease, 16 similar to findings in the United States, by Lipscomb et al who found advanced stage breast cancer to be positively related with poorly differentiated tumour grade and HER2 type tumours. 14 Our sample size for this analysis was, however, very limited, and thus, the influence of tumour characteristics on stage at diagnosis still needs to be fully explored in the SSA setting. The majority of biopsies in our study were core needle biopsies whose results tend to differ from excisional biopsies perhaps due to under-sampling of a heterogeneous tumour and insufficient amount of tumour in the cores taken.…”

“…On the other hand, clinical factors 13 , e.g. young age, poorly differentiated tumour grade 14 , and negative hormone receptor status 14 , may contribute to advanced stage as a result of a more rapid tumour growth rate. A significant number of papers that have investigated factors associated with stage at diagnosis have been reported from studies in western countries 15-17 and SSA, 12 but has been less well studied in Nigeria.…”

Drivers of advanced stage at breast cancer diagnosis in the multicountryAfrican breast cancer – disparities in outcomes (ABC‐DO) study

“…The rate of tumor growth can be affected by biological determinants such as hormone receptor and/or environmental factors such hormone exposure during pregnancy. The likelihood of metastatic spread increases as cancers grow, meaning that delays to prompt diagnosis and treatment are associated with worsened prognosis, delays that can be attributed to both system‐ and woman‐level (lifestyle, sociodemographic) factors . In SSA, BC diagnosis typically concerns symptomatic disease, therefore the time interval between onset of symptoms and seeking help provides a critical time window of opportunity for achieving early diagnosis .…”

Local in Time Statistics for detecting weak gene expression signals in blood – illustrated for prediction of metastases in breast cancer in the NOWAC Post-genome Cohort

“…Although significantly improved, the majority of cancer deaths are due to metastases, not due to the primary tumor. 4,5 No unifying theory exists for the human carcinogenesis, although many proposals exist. 6 To date, most mechanistic or pathway-level analyses have been experimental in vitro or animal studies.…”