Online Program

319517
Predictors of late stage breast cancer diagnosis: A multilevel approach


Tuesday, November 3, 2015 : 4:30 p.m. - 4:45 p.m.

Chinedum O. Ojinnaka, MBBS, MPH, Department of Health Policy and Management, Texas A&M University, College Station, TX
Jane N. Bolin, PhD, JD, BSN, Health Policy and Management, Texas A&M University, College Station, TX
Introduction: Early stage breast cancer diagnosis has a better prognosis and improved survival rate compared to late stage diagnosis; survival rate for localized breast cancer is 98.6% compared to 24.3%, if distant metastasis has occurred. Identifying factors that influence stage at diagnosis could inform strategies to reduce the occurrence of late stage diagnosis.

Methods: Using the Surveillance, Ends Result and Epidemiology data, a retrospective study was conducted to identify the association between stage at breast cancer diagnosis, and individual level, county level and tumor characteristics. Analyses were limited to patients diagnosed with breast cancer between years 2000 and 2011. Descriptive statistics were conducted. A two-level multilevel logistic regression was also conducted; individuals (level 1) were nested within counties (level 2). Dependent variable was stage at diagnosis (0=early; 1=late).

ResultsDescriptive statistics showed that rural residents were more likely to receive a late stage diagnosis compared to urban residents (33.49 vs. 31.4; p-value=<0.0001). On multivariate analyses, rural residents (OR=1.10; 95%=1.04-1.19) and blacks (OR=1.29; 95% CI=1.27-1.33) were more likely to be diagnosed at a late stage compared to urban residents and whites respectively. Those who had a high grade tumor were more likely to have a late stage diagnosis compared to those with a low grade tumor (OR=1.69; 95% CI=1.66-1.71).

Conclusion: Even after controlling for tumor characteristics, minority populations and rural residents were at an increased risk for late stage breast cancer diagnosis. Efforts are needed to reduce these disparities.

Learning Areas:

Chronic disease management and prevention
Public health or related research

Learning Objectives:
Identify the influence of individual and county level characteristics on stage at diagnosis of breast cancer Identify possible areas of intervention to reduce breast cancer disparities

Keyword(s): Cancer and Women’s Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I trained as a physician. I am currently a PhD student, and I work as a graduate research assistant on a cancer prevention program. I am a co-author on several published articles on the topics of "colorectal cancer screening" and "barriers to colonoscopy among uninsured patients".
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.