Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study.
BACKGROUND
Following reforms to our city's Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source--SN versus non-Safety-Net (NSN)--or, among SN patients, by stage at diagnosis.


METHODS
From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant.


RESULTS
Fifty-seven women completed interviews (33 SN, 24 NSN); 52% of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83% vs. 21%, P < 0.001), to have an annual household income <$25,000 (89% vs. 38%, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67% vs. 25%, P = 0.012); they were less likely to be married/partnered (22% vs. 79%, P < 0.001) and to have post-college education (0% vs. 25%, P < 0.03), any insurance (61% vs. 96%, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50% vs. 79%, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038).


CONCLUSIONS
SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.
Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA.
Oluwadamilola M
OM
Fayanju
Donna B
DB
Jeffe
Leisha
L
Elmore
Deborah N
DN
Ksiazek
Julie A
JA
Margenthaler
D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology / Q000523:psychology; D057210:Delayed Diagnosis; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008327:Mammography; D008875:Middle Aged; D009367:Neoplasm Staging; D061214:Patient Safety; D010865:Pilot Projects; D011379:Prognosis; D011446:Prospective Studies; D019984:Quality Indicators, Health Care; D012307:Risk Factors