title: Mortality outcome among medically underserved women screened through a publicly funded breast cancer control program, 1997-2007.
abstract: OBJECTIVE
  The purpose of this study was to assess treatment and mortality differences between women diagnosed with breast cancer through Nebraska's Every Woman Matters (EWM) program and women diagnosed through other sources.
  
  
  METHODS
  A retrospective analysis was performed using 10 years of Nebraska Cancer Registry and EWM program data on women aged 40-74 years. This study used chi-square and multivariate logistic regression with mortality as the outcome of interest.
  
  
  RESULTS
  From 1997 to 2007, 4,739 women were diagnosed with breast cancer, 435 (9.1 %) of whom were diagnosed through EWM. The EWM and non-EWM groups differed significantly in age, race, marital status, location of residence at the time of diagnosis, neighborhood poverty level at the time of diagnosis, tumor stage at diagnosis, and chemotherapy. No significant differences were found between the two groups in radiation therapy, surgical resection, and hormone therapy. In both 1- and 5-year multivariate mortality models, the odds of dying for those in the EWM program were not statistically significantly different from the odds of dying for those not in the EWM program. In the 1-year mortality model, residents of urban metropolitan counties (OR 2.079; 95 % CI 1.663-2.598) had an increased odds of dying compared to residents of rural counties. In the 5-year mortality model, black women (OR 2.239; 95 % CI 1.453-3.450), residents of areas with a high (more than 20 %) neighborhood poverty level at the time of diagnosis (OR 1.589; 95 % CI 1.204-2.097), and unmarried women (OR 1.334; 95 % CI 1.164-1.528) had higher odds of death. Both groups have received similar treatments.
  
  
  CONCLUSIONS
  Targeted outreach to vulnerable groups for cancer screening may improve cancer outcomes and reduce disparities.
authors.affiliation: Department of Health Services Research and Administration, College of Public Health, University of Nebraska Medical Center, Omaha, NE, 68198, USA, soumitrasudip.bhuyan@unmc.edu.
authors.forename: Soumitra Sudip
authors.initials: SS
authors.lastname: Bhuyan
authors.forename: Jim P
authors.initials: JP
authors.lastname: Stimpson
authors.forename: Shireen S
authors.initials: SS
authors.lastname: Rajaram
authors.forename: Ge
authors.initials: G
authors.lastname: Lin
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis / Q000266:history / Q000401:mortality* / Q000628:therapy; D055088:Early Detection of Cancer; D005260:Female; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D008403:Mass Screening; D008507:Medically Underserved Area; D008875:Middle Aged; D009329:Nebraska / Q000453:epidemiology; D009367:Neoplasm Staging; D016017:Odds Ratio; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis