title: Breast cancer stage at diagnosis among medically underserved women screened through the Texas Breast and Cervical Cancer Services.
abstract: The Texas Breast and Cervical Cancer Services (BCCS) program was established to address the socioeconomic disparities in stage at diagnosis and outcomes among breast cancer patients. This study examines the impact of Texas BCCS on stage at diagnosis among low socioeconomic status (SES) breast cancer patients. This is a retrospective analysis of women aged 40-64 years who were screened and diagnosed with breast cancer through the Texas BCCS program (participants) as compared with similar women living in low-SES census tracts and diagnosed outside the program (comparison group) during 1995-2008. Incident cases among the participants were compared with the comparison group as well. Stage at diagnosis was also analyzed separately for the years 1995-2002 and 2003-2008 in order to estimate the effect of BCCS-related Medicaid expansion in 2002. Over the study period of 1995-2008, BCCS participants had a 1.23 (P value<0.0001) times higher odds, and BCCS incident cases had 40% (P value<0.0001) lower odds of advanced stage at diagnosis as compared with the comparison group. A statistically significant difference in stage at diagnosis between the participants and the comparison group only existed for the 2003-2008 (post-Medicaid) period (odds ratio: 1.39, P value<0.0001). Texas BCCS program acts as a source of diagnosis and treatment access to many suspected cancer cases, especially since the 2002 Medicaid expansion, leading to more advanced stage at diagnosis among the BCCS cases as compared with other low-SES cases. Significant expansion of the program to serve a higher proportion of the eligible population is needed to achieve its goals as a screening program.
authors.affiliation: 1 Division of Management, Policy and Community Health, School of Public Health, The University of Texas Health Science Center at Houston , Houston, Texas.
authors.forename: Suja S
authors.initials: SS
authors.lastname: Rajan
authors.forename: Charles E
authors.initials: CE
authors.lastname: Begley
authors.forename: Bumyang
authors.initials: B
authors.lastname: Kim
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D008507:Medically Underserved Area; D008875:Middle Aged; D009367:Neoplasm Staging; D012042:Registries; D012959:Socioeconomic Factors; D013781:Texas / Q000453:epidemiology