title: Racial and ethnic disparities in the diagnosis of breast cancer: changes in presenting stage in minority populations in Florida during 1981-2009.
abstract: We assessed whether presenting breast cancer stage has changed over time in Florida, and whether there is variation in this change with respect to race, ethnicity, and socioeconomic status (SES). Data were obtained from the Florida Cancer Data System. We included females with invasive breast cancer and complete information on race, ethnicity, and SES during 1981-2009 (n = 226,651). Associations between categorical variables were examined using Chi-square tests. Predictors of SEER stage at diagnosis (local, regional, and distant) were modeled with multinomial ordinal logistic regression models. There was a significant increase in local disease and a decrease in regional and distant disease at presentation (p < 0.0001) over the time period assessed. Compared to whites, black patients continue to have lower odds of local presentation (OR 0.73, 95% CI 0.63, 0.85), as do Hispanic patients (OR 0.80, 95% CI 0.76, 0.84) compared to non-Hispanics. The increase in local stage at diagnosis was greater for black than white patients, as was the decrease in regional and distant disease (p < 0.001). Hispanic women also had significant increase in localized disease and decrease in regional and distant disease (p < 0.001), but there was little difference in the change compared to non-Hispanic women. Localized breast cancer stage at diagnosis has become more common over time in all groups. Significant disparity persists, with black and Hispanic patients being less likely to present with localized disease than white patients overall. There was a greater change for black versus white patients, resulting in a narrowing in the racial gap in stage at diagnosis.
authors.affiliation: Medical Education, University of Miami Miller School of Medicine, Miami, FL, USA.
authors.forename: Austin R
authors.initials: AR
authors.lastname: Dosch
authors.forename: Tulay
authors.initials: T
authors.lastname: Koru-Sengul
authors.forename: Feng
authors.initials: F
authors.lastname: Miao
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Tannenbaum
authors.forename: Margaret M
authors.initials: MM
authors.lastname: Byrne
authors.forename: Jean L
authors.initials: JL
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000453:epidemiology*; D005006:Ethnicity / Q000706:statistics & numerical data*; D005260:Female; D005431:Florida / Q000453:epidemiology; D005500:Follow-Up Studies; D054625:Healthcare Disparities; D006801:Humans; D008875:Middle Aged; D008913:Minority Groups / Q000706:statistics & numerical data*; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011379:Prognosis; D044469:Racial Groups / Q000706:statistics & numerical data*; D018426:SEER Program; D012923:Social Class; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult