title: Disparities in late stage diagnosis, treatment, and breast cancer-related death by race, age, and rural residence among women in Georgia.
abstract: The objectives of this study were to examine the outcomes of late stage breast cancer diagnosis, receiving first course treatment, and breast cancer-related death by race, age, and rural/urban residence in Georgia. The authors used cross-sectional and follow-up data (1992-2007) for Atlanta and Rural Georgia cancer registries that are part of the National Cancer Institute's Surveillance, Epidemiology, and End Results Program (N = 23,500 incident breast cancer cases in non-Hispanic whites or non-Hispanic African Americans). Multilevel modeling and Cox proportional hazard models revealed that compared to whites, African American women had significantly increased odds of late stage diagnosis (odds ratio [OR] = 2.08, p = 0.0001) and unknown tumor stage (OR = 1.27, p = 0.0001), decreased odds of receiving radiation (OR = 0.93, p = 0.041) or surgery (OR = 0.50, p = 0.0001), and increased risk of death following breast cancer diagnosis (hazard rate ratio [HR] = 1.50, p = 0.0001). Increased age was significantly associated with the odds of late/unknown stage at diagnosis, worse treatment, and survival. Women residing in rural areas had significantly decreased odds of receiving radiation and surgery with radiation (OR = 0.59, p = 0.0001), and for receiving breast-conserving surgery compared to mastectomy (OR = 0.73, p = 0.005). Factors affecting each level of the breast cancer continuum are distinct and should be examined separately. Efforts are needed to alleviate disparities in breast cancer outcomes in hard-to-reach populations.
authors.affiliation: Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia 30460-8015, USA. tmarkossian@georgiasouthern.edu
authors.forename: Talar W
authors.initials: TW
authors.lastname: Markossian
authors.forename: Robert B
authors.initials: RB
authors.lastname: Hines
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology* / Q000628:therapy; D003430:Cross-Sectional Studies; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D005845:Georgia / Q000453:epidemiology; D054625:Healthcare Disparities; D006801:Humans; D015994:Incidence; D008408:Mastectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011878:Radiotherapy; D012111:Residence Characteristics; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D015996:Survival Rate; D013997:Time Factors; D014505:Urban Population / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D018931:Antineoplastic Agents, Hormonal