|
|
|
|
|
Robin Taylor Wilson, MA, PhD, Division of Cancer Epidemiology and Genetics, Occupational and Environmental Epidemiology Branch, National Cancer Institute, 6120 Executive Blvd., Bethesda, MD 20892, 301-451-5034, rw266w@nih.gov, Nathaniel Cobb, MD, Cancer Prevention and Control, Indian Health Service, 5300 Homestead Road NE, Albuquerque, NM 87110, Charles Key, MD, PhD, New Mexico Tumor Registry, University of New Mexico, 2325 Camino de Salud, NE, Albuquerque, NM 87131, and James Torner, MS, PhD, Injury Prevention Research Center, University of Iowa, 100 Oakdale Campus, #124 IREH, Iowa City, IA 52242.
American Indians (AI) are most frequently diagnosed with late stage cancer. Purpose: Identify clinical and geographic factors related to late stage at diagnosis for four cancer sites. Methods: AI with a single primary cancer of the colon, breast, cervix or prostate (1994-97) were identified through the New Mexico Tumor Registry. IHS and tribal data were used to identify comorbidity and primary care utilization 14 months prior to diagnosis. Odds ratios (OR) for earlier stage outcome was analyzed by multiple logistic regression, adjusted for age and other significant factors. Results: There were 124 colorectal, 184 breast, 213 cervix and 129 prostate cancer cases identified, with 97.7% linked to IHS data. Greater distance (10-25 miles) to primary care (nearest hospital or health center) was associated with earlier stage colon and prostate cancer. For cervical cancer, early stage was least likely among urban residents (OR=0.2; 95% CI: 0.05-0.67), residents nearest a health center (OR=0.3; 95% CI: 0.13-0.67, compared with a hospital), and women in older age groups. Compared with men, women were 1/3rd as likely to have early stage colon cancer (OR=0.3; 95% CI: 0.13-0.76). Chronic renal and ischemic heart diseases were associated with late stage breast cancer. Discussion: While peri-facility barriers to care may be relevant for 3 of the 4 cancer sites investigated, further research regarding comorbidity and gender as factors in late stage diagnosis is warranted.
Learning Objectives:
Keywords: Access to Health Care, Cancer
Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.