title: Breast cancer screening patterns among military beneficiaries: racial variations in screening eliminated in an equal-access model.
abstract: BACKGROUND
  African American women present with more aggressive breast tumors and at later stages than white women. Many factors have been proposed to explain these findings, including socioeconomic status, cultural beliefs, and access to medical care. The purpose of this project was to determine if stage at presentation would be equivalent in a system providing equal access to care and if screening was equivalent.
  
  
  METHODS
  The Naval Medical Center San Diego (NMCSD) tumor registry from 2007 to 2012 was queried for this cross-sectional study. Eligible women included all those diagnosed and treated for breast cancer at NMCSD. Distribution of tumor stage (early vs. advanced) between racial groups was compared by age, treatment, and receptor status.
  
  
  RESULTS
  A total of 624 women were eligible; 88 % were early stage (0-II) and 12 % presented with advanced stage (III or IV). Racial differences in distribution were significant among African American and Hispanic women for early versus advanced presentation (p = 0.011). No racial disparity was seen in screening patterns among women.
  
  
  CONCLUSIONS
  In a military health system with equal access to care and standard screening recommendations, screening patterns did not vary with race but did vary with stage and active duty status. African American women present with breast cancer at later stages and with more hormone-receptor negative tumors, suggesting that biology rather than socioeconomic or access factors may be the most important determinant of stage at presentation of breast cancer for African American women.
authors.affiliation: Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, 92134, USA, Tawakalitu.oseni@med.navy.mil.
authors.forename: Tawakalitu O
authors.initials: TO
authors.lastname: Oseni
authors.forename: Peter W
authors.initials: PW
authors.lastname: Soballe
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D003430:Cross-Sectional Studies; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D008889:Military Personnel / Q000706:statistics & numerical data*; D015233:Models, Statistical; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D044469:Racial Groups / Q000706:statistics & numerical data*; D012042:Registries; D044465:White People / Q000706:statistics & numerical data