Tracking community sentinel events: breast cancer mortality and neighborhood risk for advanced-stage tumors in Denver.
OBJECTIVE
The incidence of related sentinel events--breast cancer mortality and neighborhood-specific morbidity for advanced stage at diagnosis--were calculated for women likely to use a community health center in Denver, Colo.


METHODS
For the center's service area, neighborhoods (n = 37) were defined by program use. Mortality rates and proportional hazards regression models were estimated for 4189 breast cancer cases recorded between 1979 and 1990. Neighborhood-specific standard morbidity ratios of advanced-stage tumors were based on age-specific rates applied to the entire community.


RESULTS
Service area residents were more likely to present with advanced tumors (odds ratio [OR] = 1.4; 95% [CI] = 1.2, 1.5). After adjustment, advanced-stage disease and socioeconomic-demographic status, but not race-ethnicity, contributed significantly to survival. Two neighborhoods (6.5% of the population at risk) with standard morbidity ratios of 2.1 (95% CI = 1.3, 3.4) and 1.7 (95% CI = 1.2, 2.5) accounted for 42% of the excess cases of advanced-stage tumors between 1986 and 1990.


CONCLUSIONS
Neighborhood variation in advanced-stage cancer can serve as the basis for efforts to improve access to breast cancer screening.
Andres
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TL
General Preventive Medicine, University of Colorado Health Sciences Center, Denver 80204, USA.
Baron
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AE
Wright
R A
RA
Marine
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WM
D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology* / Q000401:mortality* / Q000473:pathology; D015331:Cohort Studies; D003120:Colorado / Q000453:epidemiology; D003151:Community Health Centers / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D018426:SEER Program; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014505:Urban Population