title: Impact of a cancer screening program on breast cancer stage at diagnosis in a medically underserved urban community.
abstract: BACKGROUND
  Our previous report showed that the disparity in breast carcinoma survival between black and white women because of advanced stage of disease at presentation in poor black women is related to their low socioeconomic status and lack of health insurance. This observation led to establishment of a community-oriented free cancer screening service.
  
  
  METHODS
  To evaluate the impact of screening on breast cancer stage at diagnosis, analysis of data from the Harlem Hospital Tumor Registry between 1995 and 2000 was performed and compared with our 1964-1986 report.
  
  
  RESULTS
  Twenty-three percent of cancers (324 of 1,405) diagnosed between 1995 and 2000 were breast carcinoma. Data confirm that lack of insurance remains a major problem among poor black women. We observed a marked fall, from 49% in our earlier report to 21% in this study, in late-stage (III and IV) disease at presentation. This fall is associated with significant (p < 0.001) improvement in early detection of breast cancer, with 41% of cancers in stages 0 and I in this data compared with 6% in the previous study. Of note, 53% of women with breast carcinoma had breast-conserving surgery and 45% had modified radical mastectomy in this study; 71% had radical or modified radical mastectomy in the earlier report.
  
  
  CONCLUSIONS
  This study confirms the importance of a free cancer screening program in the improvement of early-stage breast cancer detection, treatment, and survival in a poor urban community.
authors.affiliation: Department of Surgery, Cancer Control Center of Harlem, Harlem Hospital Center, College of Physicians and Surgeons of Columbia University, New York, NY 10037, USA.
authors.forename: Soji F
authors.initials: SF
authors.lastname: Oluwole
authors.forename: Ayoola O
authors.initials: AO
authors.lastname: Ali
authors.forename: Albert
authors.initials: A
authors.lastname: Adu
authors.forename: Brenda P
authors.initials: BP
authors.lastname: Blane
authors.forename: Barbara
authors.initials: B
authors.lastname: Barlow
authors.forename: Ruben
authors.initials: R
authors.lastname: Oropeza
authors.forename: Harold P
authors.initials: HP
authors.lastname: Freeman
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics / Q000453:epidemiology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000706:statistics & numerical data*; D008507:Medically Underserved Area; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging; D009519:New York City / Q000453:epidemiology; D010044:Outpatient Clinics, Hospital / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D016019:Survival Analysis; D014505:Urban Population