title: Neighborhood socio-economic disadvantage and race/ethnicity as predictors of breast cancer stage at diagnosis.
abstract: BACKGROUND
  This study investigated the role of key individual- and community-level determinants to explore persisting racial/ethnic disparities in breast cancer stage at diagnosis in California during 1990 and 2000.
  
  
  METHODS
  We examined socio-demographic determinants and changes in breast cancer stage at diagnosis in California during 1990 and 2000. In situ, local, regional, and distant diagnoses were examined by individual (age, race/ethnicity, and marital status) and community (income and education by zip code) characteristics. Community variables were constructed using the California Cancer Registry 1990-2000 and the 1990 and 2000 U.S. Census.
  
  
  RESULTS
  From 1990 to 2000, there was an overall increase in the percent of in situ diagnoses and a significant decrease in regional and distant diagnoses. Among white and Asian/Pacific Islander women, a significant percent increase was observed for in situ diagnoses, and significant decreases in regional and distant diagnoses. Black women had a significant decrease in distant -stage diagnoses, and Hispanic women showed no significant changes in any diagnosis during this time period. The percent increase of in situ cases diagnosed between 1990 and 2000 was observed even among zip codes with low income and education levels. We also found a significant percent decrease in distant cases for the quartiles with the most poverty and least education.
  
  
  CONCLUSIONS
  Hispanic women showed the least improvement in breast cancer stage at diagnosis from 1990 to 2000. Breast cancer screening and education programs that target under-served communities, such as the rapidly growing Hispanic population, are needed in California.
authors.affiliation: UCLA Department of Health Policy and Management, Center for Cancer Prevention and Control Research, Fielding School of Public Health and Jonsson Comprehensive Cancer Center, 650 Charles Young Drive S,, A2-125 CHS, Box 956900-6900, Los Angeles, CA 90095, USA. ynflores@ucla.edu.
authors.forename: Yvonne N
authors.initials: YN
authors.lastname: Flores
authors.forename: Pamela L
authors.initials: PL
authors.lastname: Davidson
authors.forename: Terry T
authors.initials: TT
authors.lastname: Nakazono
authors.forename: Daisy C
authors.initials: DC
authors.lastname: Carreon
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Mojica
authors.forename: Roshan
authors.initials: R
authors.lastname: Bastani
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000191:economics; D002140:California / Q000453:epidemiology; D057210:Delayed Diagnosis / Q000191:economics / Q000706:statistics & numerical data*; D004522:Educational Status; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008875:Middle Aged; D009367:Neoplasm Staging / Q000191:economics / Q000706:statistics & numerical data; D011203:Poverty / Q000706:statistics & numerical data*; D044469:Racial Groups / Q000706:statistics & numerical data*; D012111:Residence Characteristics / Q000706:statistics & numerical data; D012959:Socioeconomic Factors