Institutional racism, segregation, and breast cancer outcomes.

2017 ◽  
Vol 35 (5_suppl) ◽  
pp. 199-199
Author(s):  
Kirsten M. M. Beyer ◽  
Amin Bemanian ◽  
Emily L McGinley ◽  
Ann B Nattinger
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Institutional Racism ◽  
Tumor Type ◽  
Tumor Characteristics ◽  
Stage At Diagnosis ◽  
Cancer Outcomes ◽  
Location Quotient ◽  
Breast Cancer Outcomes

199 Background: Racial breast cancer mortality disparities are significant vary in magnitude across the US, indicating that place-specific factors may influence mortality. Racism and segregation are widely considered to contribute to health disparities, and may influence breast cancer outcomes. Several pathways linking racism, segregation and health care outcomes have been proposed, including (1) stressors in the local environment, (2) social resources and opportunities, and (3) knowledge and information. Given these hypothesized pathways, it is possible that racism and segregation may also influence elements of the breast cancer diagnosis, such as stage at diagnosis and tumor characteristics. Methods: We examined the influence of measures of institutional racism (racial bias in mortgage lending) and segregation (the Location Quotient) on 4-year mortality after breast cancer diagnosis, stage at diagnosis, and hormone receptor status among a cohort of women diagnosed with breast cancer between 2007 and 2009, included in the SEER-Medicare linked database. Analyses focused on three metropolitan areas: Detroit (MI), Atlanta (GA), and Seattle (WA). Logistic regression analyses were used to predict the odds of each outcome, while controlling for a number of covariates: age, race and ethnicity, ER-/PR- status, diagnosis stage, enrollment in Medicaid, metropolitan area, marital status, diagnosis year, tumor size, histological type, and tumor grade. Results: Results indicate that institutional racism is associated with an increased odds of being diagnosed with an ER-/PR- tumor. No associations were detected for 4-year mortality or diagnosis stage, nor for the Location Quotient and any outcome. Conclusions: Researchers are currently exploring whether social conditions may influence tumor characteristics through pathways such as inflammation and comorbidities. Our results contribute to this growing body of work. Our results can also be interpreted in light of recent studies that identified an association between a different measure of segregation and ER-/PR- tumor type, and no association between census tract level SES and tumor type. Additional study of institutional racism, segregation and breast cancer outcomes is warranted.

Abstract 3722: Weight gain after a breast cancer diagnosis and breast cancer outcomes

2011 ◽  
Author(s):  
Bette J. Caan ◽  
Marilyn L. Kwan ◽  
Erin Weltzien ◽  
Wendy Y. Chen ◽  
John P. Pierce ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Weight Gain ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Cancer Outcomes ◽  
Breast Cancer Outcomes

Receipt of Screening Mammography by Insured Women Diagnosed With Breast Cancer and Impact on Outcomes

2021 ◽  
Author(s):  
Marissa B. Lawson ◽  
Christoph I. Lee ◽  
Daniel S. Hippe ◽  
Shasank Chennupati ◽  
Catherine R. Fedorenko ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Late Stage ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Socioeconomic Deprivation ◽  
Tumor Characteristics ◽  
Stage Disease ◽  
Increased Risk ◽  
Late Stage Disease

Background: The purpose of this study was to determine factors associated with receipt of screening mammography by insured women before breast cancer diagnosis, and subsequent outcomes. Patients and Methods: Using claims data from commercial and federal payers linked to a regional SEER registry, we identified women diagnosed with breast cancer from 2007 to 2017 and determined receipt of screening mammography within 1 year before diagnosis. We obtained patient and tumor characteristics from the SEER registry and assigned each woman a socioeconomic deprivation score based on residential address. Multivariable logistic regression models were used to evaluate associations of patient and tumor characteristics with late-stage disease and nonreceipt of mammography. We used multivariable Cox proportional hazards models to identify predictors of subsequent mortality. Results: Among 7,047 women, 69% (n=4,853) received screening mammography before breast cancer diagnosis. Compared with women who received mammography, those with no mammography had a higher proportion of late-stage disease (34% vs 10%) and higher 5-year mortality (18% vs 6%). In multivariable modeling, late-stage disease was most associated with nonreceipt of mammography (odds ratio [OR], 4.35; 95% CI, 3.80–4.98). The Cox model indicated that nonreceipt of mammography predicted increased risk of mortality (hazard ratio [HR], 2.00; 95% CI, 1.64–2.43), independent of late-stage disease at diagnosis (HR, 5.00; 95% CI, 4.10–6.10), Charlson comorbidity index score ≥1 (HR, 2.75; 95% CI, 2.26–3.34), and negative estrogen receptor/progesterone receptor status (HR, 2.09; 95% CI, 1.67–2.61). Nonreceipt of mammography was associated with younger age (40–49 vs 50–59 years; OR, 1.69; 95% CI, 1.45–1.96) and increased socioeconomic deprivation (OR, 1.05 per decile increase; 95% CI, 1.03–1.07). Conclusions: In a cohort of insured women diagnosed with breast cancer, nonreceipt of screening mammography was significantly associated with late-stage disease and mortality, suggesting that interventions to further increase uptake of screening mammography may improve breast cancer outcomes.

Prognosis of Premenopausal Breast Cancer and Childbirth Prior to Diagnosis

2004 ◽  
Vol 22 (4) ◽  
pp. 699-705 ◽  
Author(s):  
Kelly-Anne Phillips ◽  
Roger L. Milne ◽  
Michael L. Friedlander ◽  
Mark A. Jenkins ◽  
Margaret R.E. McCredie ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Premenopausal Women ◽  
Breast Cancer Diagnosis ◽  
Axillary Node ◽  
Time Interval ◽  
Tumor Characteristics ◽  
Premenopausal Breast Cancer ◽  
Nulliparous Women ◽  
Hazard Ratios

Purpose The time interval between last childbirth and subsequent breast cancer diagnosis is emerging as an important prognostic factor for premenopausal women. Patients and Methods We studied, prospectively, 750 women diagnosed with primary invasive breast cancer before age 45 years who participated in the population-based Australian Breast Cancer Family Study (ABCFS). Results Median follow-up time was 4.9 years (range, 0.8 to 10.8 years). Compared with nulliparous women, women who gave birth within 2 years prior to diagnosis were more likely to have axillary node-positive (58% v 41%; P = .01), and estrogen receptor-negative (58% v 39%; P = .005) tumors. The unadjusted hazard ratios for death were 2.3 (95% CI, 1.3 to 3.8; P = .002), 1.7 (95% CI, 1.1 to 2.6; P = .03), and 0.9 (95% CI, 0.6 to 1.5; P = .8) for patients who gave birth less than 2 years, 2 to 5 years, and 5 or more years before diagnosis, respectively. After adjusting for tumor characteristics, these hazard ratios were reduced to 1.9 (95%CI, 1.1 to 3.2; P = .02), 1.3 (95% CI, 0.8 to 2.1; P = .3), and 0.9 (95%CI, 0.5 to 1.4; P = .5). Modeling showed that, compared with nulliparous women, the mortality hazard ratio in parous women was 1.9, decreasing by 8% (95%CI, 4% to 13%; P < .001) for each year between last birth and breast cancer diagnosis. Conclusion Proximity of last childbirth to subsequent breast cancer diagnosis is a predictor of mortality independent of histopathological tumor characteristics. Clinicians should be aware that women diagnosed with breast cancer within a few years following childbirth may have a worse outcome than that suggested solely by the standard histopathological prognostic factors of their cancer.

scholarly journals Association of Breast Cancer Screening Behaviors With Stage at Breast Cancer Diagnosis and Potential for Additive Multi-Cancer Detection via Liquid Biopsy Screening: A Claims-Based Study

2021 ◽  
Vol 11 ◽  
Author(s):  
Christine Hathaway ◽  
Peter Paetsch ◽  
Yali Li ◽  
Jincao Wu ◽  
Sam Asgarian ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Cancer Detection ◽  
Cancer Diagnosis ◽  
Claims Data ◽  
Breast Cancer Diagnosis ◽  
P Value ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Screening Mammogram ◽  
Incident Breast Cancer

PurposeTo evaluate mammography uptake and subsequent breast cancer diagnoses, as well as the prospect of additive cancer detection via a liquid biopsy multi-cancer early detection (MCED) screening test during a routine preventive care exam (PCE).MethodsPatients with incident breast cancer were identified from five years of longitudinal Blue Health Intelligence® (BHI®) claims data (2014-19) and their screening mammogram and PCE utilization were characterized. Ordinal logistic regression analyses were performed to identify the association of a biennial screening mammogram with stage at diagnosis. Additional screening opportunities for breast cancer during a PCE within two years before diagnosis were identified, and the method extrapolated to all cancers, including those without recommended screening modalities.ResultsClaims for biennial screening mammograms and the time from screening to diagnosis were found to be predictors of breast cancer stage at diagnosis. When compared to women who received a screening mammogram proximal to their breast cancer diagnosis (0-4 months), women who were adherent to guidelines but had a longer time window from their screening mammogram to diagnosis (4-24 months) had a 87% increased odds of a later-stage (stages III or IV) breast cancer diagnosis (p-value &lt;0.001), while women with no biennial screening mammogram had a 155% increased odds of a later-stage breast cancer diagnosis (p-value &lt;0.001). This highlights the importance of screening in the earlier detection of breast cancer. Of incident breast cancer cases, 23% had no evidence of a screening mammogram in the two years before diagnosis. However, 49% of these women had a PCE within that time. Thus, an additional 11% of breast cancer cases could have been screened if a MCED test had been available during a PCE. Additionally, MCED tests have the potential to target up to 58% of the top 5 cancers that are the leading causes of cancer death currently without a USPSTF recommended screening modality (prostate, pancreatic, liver, lymphoma, and ovarian cancer).ConclusionThe study used claims data to demonstrate the association of cancer screening with cancer stage at diagnosis and demonstrates the unmet potential for a MCED screening test which could be ordered during a PCE.

Improved outcomes among breast cancer patients with more frequent mammography screening.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19146-e19146
Author(s):  
Ying Liu ◽  
Aliza Gordon ◽  
Michael Eleff ◽  
John Barron ◽  
Winnie Chi
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Screening Mammography ◽  
Administrative Claims ◽  
Cancer Stage ◽  
Stage At Diagnosis ◽  
Breast Cancer Patients ◽  
Invasive Treatment ◽  
The Impact

e19146 Background: Guidelines for optimal frequency of screening mammography (annual, biennial, never/choice of patient) vary by professional society, due to mixed or insufficient evidence regarding its benefits and harms. Little evidence exists on the impact of screening frequency, rather than any screening, on health outcomes. In this study, we measured differences in cancer stage at diagnosis, treatment rendered, mortality, and cost of treatment for women with different numbers of screenings prior to breast cancer diagnosis. Methods: Utilizing administrative claims, we identified 25,492 women aged 44 or older with various numbers of mammographic screening ≥ 11 months apart during the four years prior to their incident breast cancer diagnosis from 2010 to 2018. Outcomes were assessed during the six months following diagnosis. Regression models were used to compare women with differing numbers of mammograms (0, 1, 2, 3, or 4/5), adjusting for demographic characteristics and baseline comorbidities. Results: More screenings were associated with less advanced cancer at diagnosis, higher rates in lumpectomy and radiation, lower rates in mastectomy and chemotherapy, lower costs and mortality within 6 months post diagnosis (Table). Results were similar in a subgroup with only women aged 44-49 at diagnosis (not shown). Conclusions: Increased frequency of screening mammography is associated with earlier breast cancer stage at diagnosis, less toxic and invasive treatment, lower mortality, and lower cost, including for women under age 50. [Table: see text]

scholarly journals The COVID-19 pandemic and impact on breast cancer diagnoses: what happened in England in the first half of 2020

2020 ◽  
Author(s):  
Toral Gathani ◽  
Gill Clayton ◽  
Emma MacInnes ◽  
Kieran Horgan
Keyword(s):  
Breast Cancer ◽  
Cancer Diagnosis ◽  
Waiting Time ◽  
Breast Cancer Diagnosis ◽  
Breast Cancers ◽  
Time Data ◽  
Breast Cancer Outcomes ◽  
Time Period ◽  
Number Of Patients ◽  
The Impact

AbstractDelays in cancer diagnosis and treatment due to the COVID-19 pandemic is a widespread source of concern, but the scale of the challenge for different tumour sites is not known. Routinely collected NHS England Cancer Waiting Time data were analysed to compare activity for breast cancer in the first 6 months of 2020 compared to the same time period in 2019. The number of referrals for suspected breast cancer was 28% lower (N = 231,765 versus N = 322,994), and the number of patients who received their first treatment for a breast cancer diagnosis was 16% lower (N = 19,965 versus N = 23,881). These data suggest that the number of breast cancers diagnosed during the first half of 2020 is not as low as initially feared, and a substantial proportion of the shortfall can be explained by the suspension of routine screening in March 2020. Further work is needed to examine in detail the impact of measures to manage the COVID-19 pandemic on breast cancer outcomes.

Obstetric Outcomes in Young Women with Breast Cancer: Prior, Postpartum, and Subsequent Pregnancies

2019 ◽  
Vol 37 (04) ◽  
pp. 370-374
Author(s):  
Kimberly K. Ma ◽  
Courtney J. Preusse ◽  
Philip A. Stevenson ◽  
Veronica L. Winget ◽  
Jean A. McDougall ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Live Birth ◽  
Young Women ◽  
Cancer Diagnosis ◽  
Breast Cancer Diagnosis ◽  
Population Based ◽  
Correlated Data ◽  
Obstetric Outcomes ◽  
P Value ◽  
Tumor Type

Objective This study aimed to describe obstetric outcomes in a large cohort of young women with breast cancer, considering the chronological relationship of pregnancies with breast cancer diagnosis. Study Design From a population-based cohort study of young women with breast cancer from 2004 to 2010, we conducted secondary interviews to obtain detailed obstetric histories. Pregnancies were categorized based on timing of breast cancer diagnosis: prior, postpartum, and subsequent pregnancies after breast cancer diagnosis. A generalized estimated equation model was used to account for correlated data. Results In this cohort (n = 366), median age at breast cancer diagnosis was 40.1 years, and 84.7% were Caucasian. Tumor type was notable for 25.1% triple negative, and 56.1% had Stage I disease. There were 922 prior pregnancies, 21 with postpartum diagnosis of breast cancer, and 24 pregnancies subsequent to breast cancer diagnosis. Non-live birth outcomes occurred significantly more often in the postpartum group (p-value: 0.001) compared with the other groups, which had higher live birth rates, after adjustment for maternal age, parity, body mass index, and race. Conclusion Overall, pregnancy outcomes before and after breast cancer diagnosis are reassuring.

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