Abstract P2-02-02: Lack of screening mammography and black race are associated with late-stage breast cancer diagnosis in safety-net setting

Abstract

Abstract Importance: In our urban safety-net hospital (SNH) setting, we see approximately three times more late-stage (stage III and IV) breast cancer at diagnosis than the rest of the country. Breast cancers diagnosed at later stages have lower survival than those diagnosed at earlier stages. The aim of this study is to determine the factors associated with late-stage breast cancer diagnosis in our SNH setting. Method: This is a retrospective study of all breast cancer cases diagnosed or treated at the primary SNH in the Kansas City, MO metro area between January 2011-July 2018 (n=615). All female breast cancer patients diagnosed with early-stage (stage 0 or I, n=314) or late-stage (stage III or IV, n=98) disease were included. Those diagnosed at stage II (n=176), recurrent breast cancer (n=20) or with conflicting or unknown stage (n=27) were excluded. Variables analyzed: clinical TNM stage at diagnosis, age, race, insurance type, zip code, tumor subtype, whether patient presented with symptoms, whether a screening mammogram was obtained in the two years prior to diagnosis, and whether the patient was referred from outside our institution, or internally. Median household income and distance to treating facility were imputed from patient-level zipcode data. Multiple logistic regression was performed to determine the variables that contributed the most to the late-stage at diagnosis. Results: Three variables were significantly associated with late-stage diagnosis in the multiple regression: not having had a screening mammogram within two years (p<0.0001, OR 0.132, CI= 0.063, 0.277), being black (p= 0.0051, OR 2.549, CI = 1.325, 4.904), and having HER2 positive disease (p=0.0213, OR=2.695, CI= 1.159, 6.265). A race by tumor marker interaction was examined, and was not found to be significant. Conclusions: In our safety-net hospital setting, not having a screening mammogram in the two years prior to a breast cancer diagnosis was the most significant factor associated with late-stage at diagnosis, followed by being black. Screening mammography ought to be actively promoted in safety-net hospital settings with excess late-stage diagnosis. Black women may need different risk-based screening guidelines. Citation Format: Marissa A Mendez, An-Lin Cheng, Nasim Ahmadiyeh. Lack of screening mammography and black race are associated with late-stage breast cancer diagnosis in safety-net setting [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-02-02.