Abstract
The purpose of this study was to examine the association between neighborhood social deprivation and individual-level characteristics on breast cancer staging in African American and white breast cancer patients. We established a retrospective cohort of patients with breast cancer diagnosed from 1996 to 2015 using the South Carolina Central Cancer Registry. We abstracted sociodemographic and clinical variables from the registry and linked these data to a county-level composite that captured neighborhood social conditions—the social deprivation index (SDI). Data were analyzed using chi-square tests, Student’s t-test, and multivariable ordinal regression analysis to evaluate associations. The study sample included 52,803 female patients with breast cancer. Results from the multivariable ordinal regression model demonstrate that higher SDI (OR = 1.06, 95% CI: 1.02–1.10), African American race (OR = 1.35, 95% CI: 1.29–1.41), and being unmarried (OR = 1.17, 95% CI: 1.13–1.22) were associated with a distant stage at diagnosis. Higher tumor grade, younger age, and more recent year of diagnosis were also associated with distant-stage diagnosis. As a proxy for neighborhood context, the SDI can be used by cancer registries and related population-based studies to identify geographic areas that could be prioritized for cancer prevention and control efforts.
Highlights
The mean age at diagnosis was highest among women who had local-stage disease (62.2 ± 13.4), while it was lowest among women who were diagnosed with regional-stage disease
We found that women living in areas with higher social deprivation had a greater likelihood of being diagnosed with distant-stage breast cancer
This work demonstrates that both individual-level risk factors and neighborhood-level social deprivation are associated with stage at diagnosis of breast cancer
Summary
Breast cancer is the most diagnosed cancer among women in the United States, and mortality from breast cancer is closely related to stage at diagnosis [1,2]. Breast cancers that are diagnosed at a later stage can affect treatment options and can lead to poorer prognosis and outcomes [1]. Participating in recommended screening may help identify cancer at an earlier stage when breast cancer is most likely to respond to treatment and has the potential to lead to better outcomes [3]. Several individual- and area-level characteristics have been shown to be associated with advanced stage at breast cancer diagnosis.
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