Female breast cancer disparities in stage at diagnosis by race, ethnicity, and socioeconomic status

Introduction: Female breast cancer diagnosis at an early stage is paramount for positive survival outcomes. However, disparities of stage at diagnosis by race, ethnicity, and socioeconomic status (SES) exist. We examined these disparities in a population-based sample.

Methods: Data were obtained from the 1996-2009 Florida Cancer Data System linked with the Agency for Health Care Administration database (n=135,899). Stage (localized, regional with/without direct extension, distant), race (White, Black, Native American, Asian, or other), ethnicity (Hispanic or non-Hispanic) and SES (%living in poverty: lowest (≥20%), middle-low (≥10% and <20%), middle-high (≥5% and <10%), highest (<5%) were studied. Results: Overall, 66% of women were diagnosed at localized and 5% at distant stage. Reporting extreme values: 67% of Whites (highest) and 53% of Blacks (lowest) were diagnosed at localized stage; 12% of Native Americans and 4% of Asians were diagnosed at distant stage. A higher percent of non-Hispanics (66%) vs. Hispanics (61%) were diagnosed at localized stage; however an equal percent (5%) were diagnosed at distant stage. There was an increasing proportion of localized diagnosis between lowest (59%) to highest SES (67%) and a decreasing proportion of distant (7%-4%). Overall, median survival time (MST) was 11.9 years. Whites had a longer MST than Blacks (12 vs. 9.5 years, respectively); Hispanics had a longer MST than non-Hispanics (12.9 vs. 11.8 years, respectively) despite less localized disease.

Conclusion: Disparities by stage at diagnosis are evident in the state of Florida. Research is needed to determine if screening practice disparities are the cause.