Abstract P1-09-16: Factors affecting disparities in advanced stage breast cancer

Abstract

Abstract BACKGROUND: African American women have a lower incidence of breast cancer than white American women. However, black women in the US are 40% more likely to die of breast cancer. Compared to white women, Black women in Florida have among the highest additional breast cancer deaths. Within Florida, Duval County has one of the highest rates of breast cancer. Furthermore, breast cancer mortality is significantly higher for black women (36.7 per 100,000) in Duval County, than for white women (24.0 per 100,000). Therefore, we evaluated breast cancer disparities in Duval County as a representative population to identify factors influencing breast cancer mortality. METHODS: Data on female breast cancer cases from 2004-2010 was extracted using the Florida Cancer Data System (FCDS). Classifications included health zones within Duval County, race, insurance, and age. Insurance categories included Medicare, Medicaid, Uninsured, and Tricare/commercial which were combined in one group. The primary outcome was late stage (Stage 4) at diagnosis versus other stages. Multivariable logistic regression was used to assess the association between late stage at diagnosis and insurance, race, age, and place of residence (health zone). RESULTS: Using the FCDS, 6,502 new breast cancers were identified in Duval County from 2004 – 2010. Of these women, 73% were white, 24% black, 5% Hispanic, 2% Asian, and 2% unknown/other. Health Zone 1 which represents the urban core has the largest population of Black women with breast cancer (76%), although the incidence of breast cancer was not higher in this group. Health Zone 1 has the highest volume of uninsured, and Medicaid breast cancer patients (10% and 8% vs. 4% average for all other zones), and the lowest number of breast cancer patients with Tricare/commercial insurance (33% vs. 56% average for all other zones). Black women overall had a higher percentage of advanced stage IV disease than any other race (8% vs. 4%, p< .001). Women in Health Zone 1 are more likely to present with stage IV breast cancer than any other health zone in Duval County (10% vs. 5%, p<0.01). Medicaid patients, followed by the uninsured had the highest rate of stage IV at diagnosis than those with commercial insurance (20% and 12% vs. 4%, p<.001). Using multivariable logistic regression analysis, only Medicaid insurance (OR = 5.3; 95% CI = (3.6, 7.9)) and living in the urban core (OR = 4.02; 95% CI = (1.9, 8.4)) was significantly associated with stage IV disease. After adjustment for insurance and place of residence, black race did not remain a significant factor (p = 0.1722). CONCLUSION: Living in the urban core, and lack of insurance or Medicaid funding was significantly associated with advanced stage at diagnosis in Duval County, Florida. These results suggest that socioeconomic factors are a major contributor to breast cancer mortality, irrespective of race. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-16.