Do patient tracking, follow-up, and referral practices contribute to breast cancer disparities in a large urban area?

6120 Background: Chicago Black women are 62% more likely to die from breast (BC) cancer than White women. Previous data from 39 Chicago hospitals suggested significant quality deficits in breast cancer screening and treatment (Chicago Breast Cancer Quality Consortium, 2010). Patient tracking, follow up and referral practices may influence quality of care for minority women (Mojica et al, Cancer Control, 2007). Our goal is to evaluate tracking, follow up and referral practices during screening, diagnosis and treatment of BC at Chicago hospitals servicing Black women. Methods: Using the framework approach of qualitative research, we conducted interviews with providers of BC screening and care from 20 Chicago institutions with Black patients averaging 50% of patient base (15 community, 3 academic and 2 public hospitals). Informants included surgeons, medical oncologists, radiologists, mammography technicians, internists, nurses, administrators, and patient navigators. Interviews were transcribed, and thematic and statistical analyses were performed (simple frequencies and Fisher's exact test). Results: Six of the 20 sites (30%) follow up with patients who did not show for a scheduled mammography visit. Five of these sites (83%, 5/6) have a low “no-show” rate (below 20%), compared to 4 sites (29%, 4/14) with low “no-show” rates among the 14 sites without follow-up (p=0.05). Seven of the 20 sites (25%) direct diagnosed patients to their next step in care by providing referrals and guidance, while other 13 sites rely on a primary care physician or leave the patient without a clear care plan. BC patients at 6 of the 7 sites directing care (83%, 5/6) are referred to a mid- or high-volume surgeon (3+ BC surgeries / month), compared to patients from only 1 of the 13 sites not directing care (p=0.001). Nine of the 20 sites track diagnosed BC patients through their care. Five of them (56%, 5/9) also track survivors, compared to none (0%, 0/11) of the 11 sites who do not track patients (p=0.008). Conclusions: Poor tracking, follow up and referral practices for breast cancer screening and treatment are associated with suboptimal care and may contribute to outcome disparities for Black women in Chicago.

Download Full-text

Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women

Preventive Medicine ◽

10.1016/s0091-7435(03)00087-2 ◽

2003 ◽

Vol 37 (2) ◽

pp. 92-101 ◽

Cited By ~ 59

Author(s):

Jon F Kerner ◽

Michael Yedidia ◽

Deborah Padgett ◽

Barbara Muth ◽

Kathleen Shakira Washington ◽

...

Keyword(s):

Breast Cancer ◽

Black Women ◽

Cancer Screening ◽

Breast Cancer Screening

Download Full-text

Breast Cancer Screening Recommendations: African American Women Are at a Disadvantage

Journal of Breast Imaging ◽

10.1093/jbi/wbaa067 ◽

2020 ◽

Vol 2 (5) ◽

pp. 416-421

Author(s):

Murray Rebner ◽

Vidya R Pai

Keyword(s):

Breast Cancer ◽

African American ◽

Black Women ◽

Cancer Screening ◽

African American Women ◽

Breast Cancer Screening ◽

White Women ◽

Breast Cancers ◽

American Women ◽

Younger Age

Abstract Since 1990, breast cancer mortality has decreased by 40% in white women but only 26% in African American women. The age at diagnosis of breast cancer is younger in black women. Breast cancer diagnosed before age 50 represents 23% of all breast cancers in African American women but only 16% of all breast cancers in white women. White women have a higher incidence of breast cancer over the age of 60. Tumor subtypes also vary among racial and ethnic groups. The triple-negative (TN) subtype, which has a poorer outcome and occurs at a younger age, represents 21% of invasive breast cancers in black women but only 10% of invasive breast cancers in white women. The hormone receptor–positive subtype, which is more common in older women and has the best outcome, has a higher incidence in white women (70%) than in black women (61%). The BRCA2 mutation is also more common in black women than in white women (other than those who are of Ashkenazi Jewish ancestry). There are also many barriers to screening. Major ones include the lack of contact with a primary health care provider as well as a decreased perceived risk of having breast cancer in the African American population. Given the younger age of onset and the higher incidence of the TN molecular subtype, following breast cancer screening guidelines that do not support screening before the age of 50 may disadvantage black women.

Download Full-text

Call to action: breast cancer screening recommendations for Black women

Breast Cancer Research and Treatment ◽

10.1007/s10549-021-06207-6 ◽

2021 ◽

Vol 187 (1) ◽

pp. 295-297

Author(s):

Bridget A. Oppong ◽

Samilia Obeng-Gyasi ◽

Theresa Relation ◽

Lucile Adams-Campbell

Keyword(s):

Breast Cancer ◽

Black Women ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Call To Action

Download Full-text

Distant metastases after diagnosis: Racial disparities in breast cancer outcomes.

Journal of Clinical Oncology ◽

10.1200/jco.2021.39.15_suppl.1084 ◽

2021 ◽

Vol 39 (15_suppl) ◽

pp. 1084-1084

Author(s):

Julia Blanter ◽

Ilana Ramer ◽

Justina Ray ◽

Emily J. Gallagher ◽

Nina A. Bickell ◽

...

Keyword(s):

Breast Cancer ◽

Multivariate Analysis ◽

Black Women ◽

Racial Disparities ◽

Late Stage ◽

White Women ◽

Univariate Analysis ◽

Distant Metastases ◽

Stage At Diagnosis

1084 Background: Black women diagnosed with breast cancer are more likely to have a poor prognosis, regardless of breast cancer subtype. Despite having a lower incidence rate of breast cancer when compared to white women, black women have the highest breast cancer death rate of all racial and ethnic groups, a characteristic often attributed to late stage at diagnosis. Distant metastases are considered the leading cause of death from breast cancer. We performed a follow up study of women with breast cancer in the Mount Sinai Health System (MSHS) to determine differences in distant metastases rates among black versus white women. Methods: Women were initially recruited as part of an NIH funded cross-sectional study from 2013-2020 to examine the link between insulin resistance (IR) and breast cancer prognosis. Women self-identified as black or white race. Data was collected via retrospective analysis of electronic medical records (EMR) between September 2020-January 2021. Distant metastases at diagnosis was defined as evidence of metastases in a secondary organ (not lymph node). Stage at diagnosis was recorded for all patients. Distant metastases after diagnosis was defined as evidence of metastases at any time after initiation of treatment. Univariate analysis was performed using Fisher’s exact test, multivariate analysis was performed by binary logistic regression, and results expressed as odds ratio (OR) and 95% confidence interval (CI). A p value <0.05 was considered statistically significant. Results: We identified 441 women enrolled in the IR study within the MSHS (340 white women, 101 black women). Median follow up time for all women was 2.95 years (median = 3.12 years for white and 2.51 years for black women (p=0.017)). Among these patients, 11 developed distant metastases after diagnosis: 4 (1.2%) white and 7 (6.9%) black (p=0.004). Multivariate analysis adjusting for age, race and stage at diagnosis revealed that black women were more likely to have distant metastasis (OR 5.8, CI 1.3-25.2), as were younger women (OR for age (years) 0.9, CI 0.9-1.0), and those with more advanced stage at diagnosis. Conclusions: Black women demonstrated a far higher percentage of distant metastases after diagnosis even when accounting for age and stage. These findings suggest that racial disparities still exist in the development of distant metastases, independent from a late-stage diagnosis. The source of existing disparities needs to be further understood and may be found in surveillance, treatment differences, or follow up.

Download Full-text

Effectiveness of diet and physical activity interventions amongst adults attending colorectal and breast cancer screening: a systematic review and meta-analysis

Cancer Causes & Control ◽

10.1007/s10552-020-01362-5 ◽

2020 ◽

Author(s):

Samuel T. Orange ◽

Kirsty M. Hicks ◽

John M. Saxton

Keyword(s):

Breast Cancer ◽

Physical Activity ◽

Cancer Screening ◽

Breast Cancer Screening ◽

Vegetable Intake ◽

Dietary Interventions ◽

Physical Activity Interventions ◽

Mean Differences ◽

Quality Evidence

Abstract Purpose To estimate the effectiveness of tailored physical activity and dietary interventions amongst adults attending colorectal and breast cancer screening. Methods Five literature databases were systematically searched to identify randomised controlled trials (RCTs) of tailored physical activity and/or dietary interventions with follow-up support initiated through colorectal and breast cancer screening programmes. Outcomes included markers of body fatness, physical activity, and dietary intake. Mean differences (MDs) or standardised mean differences (SMDs) with 95% confidence intervals (CIs) were pooled using random effects models. Results Five RCTs met the inclusion criteria encompassing a total of 722 participants. Diet and physical activity interventions led to statistically significant reductions in body mass (MD − 1.6 kg, 95% CI − 2.7 to − 0.39 kg; I2 = 81%; low quality evidence), body mass index (MD − 0.78 kg/m2, 95% CI − 1.1 to − 0.50 kg/m2; I2 = 21%; moderate quality evidence), and waist circumference (MD − 2.9 cm, 95% CI − 3.8 to − 1.91; I2 = 0%; moderate quality evidence), accompanied by an increase in physical activity (SMD 0.31, 95% CI 0.13 to 0.50; I2 = 0%; low quality evidence) and fruit and vegetable intake (SMD 0.33, 95% CI 0.01 to 0.64; I2 = 51%; low quality evidence). Conclusion There is low quality evidence that lifestyle interventions involving follow-up support lead to modest weight loss and increased physical activity and fruit and vegetable intake. Due to the modest intervention effects, low quality of evidence and small number of studies, further rigorously designed RCTs with long-term follow-up of modifiable risk factors and embedded cost–benefit analyses are warranted (PROSPERO ref: CRD42020179960).

Download Full-text

Breast cancer overdiagnosis in stop-screen trials: More uncertainty than previously reported

Journal of Medical Screening ◽

10.1177/0969141320950784 ◽

2020 ◽

pp. 096914132095078

Author(s):

Stuart G Baker ◽

Philip C Prorok

Keyword(s):

Breast Cancer ◽

Cancer Screening ◽

Confidence Interval ◽

Breast Cancer Screening ◽

Confidence Intervals ◽

Latent Class ◽

Screening Program ◽

Screen Interval ◽

Binomial Confidence Interval

Objective According to the Independent UK Panel on Breast Cancer Screening, the most reliable estimates of overdiagnosis for breast cancer screening come from stop-screen trials Canada 1, Canada 2, and Malmo. The screen-interval overdiagnosis fraction is the fraction of cancers in a screening program that are overdiagnosed. We used the cumulative incidence method to estimate screen-interval overdiagnosis fraction. Our goal was to derive confidence intervals for estimated screen-interval overdiagnosis fraction and adjust for refusers in these trials. Methods We first show that the UK Panel’s use of a 95% binomial confidence interval for estimated screen-interval overdiagnosis fraction was incorrect. We then derive a correct 95% binomial-Poisson confidence interval. We also use the method of latent-class instrumental variables to adjust for refusers. Results For the Canada 1 trial, the estimated screen-interval overdiagnosis fraction was 0.23 with a 95% binomial confidence interval of (0.18, 0.27) and a 95% binomial-Poisson confidence interval of (0.04, 0.41). For the Canada 2 trial, the estimated screen-interval overdiagnosis fraction was 0.16 with a 95% binomial confidence interval of (0.12, 0.19) and a 95% binomial-Poisson confidence interval of (−0.01, 0.32). For the Malmo trial, the estimated screen-interval overdiagnosis fraction was 0.19 with a 95% binomial confidence interval of (0.15, 0.22). Adjusting for refusers, the estimated screen-interval overdiagnosis fraction was 0.26 with a 95% binomial-Poisson confidence interval of (0.03, 0.50). Conclusion The correct 95% binomial-Poisson confidence interval s for the estimated screen-interval overdiagnosis fraction based on the Canada 1, Canada 2, and Malmo stop-screen trials are much wider than the previously reported incorrect 95% binomial confidence intervals. The 95% binomial-Poisson confidence intervals widen as follow-up time increases, an unappreciated downside of longer follow-up in stop-screen trials.

Download Full-text