Abstract
ProblemIn 2009, breast cancer was the most common cancer in women, and colorectal cancer was the third most common cancer in both men and women. Currently, the majority of colorectal and almost 1/3 of breast cancers are diagnosed at an advanced stage in the US, which results in higher morbidity and mortality than would obtain with earlier detection. The incidence of late-stage cancer diagnoses varies considerably across the US, and few analyses have examined the entire US.PurposeUsing the newly available US Cancer Statistics database representing 98% of the US population, we perform multilevel analysis of the incidence of late-stage cancer diagnoses and translate the findings via bivariate mapping, answering questions related to both Why and Where demographic and geographic disparities in these diagnoses are observed.MethodsTo answer questions related to Why disparities are observed, we utilize a three-level, random-intercepts model including person-, local area-, and region- specific levels of influence. To answer questions related to Where disparities are observed, we generate county level robust predictions of late-stage cancer diagnosis rates and map them, contrasting counties ranked in the upper and lower quantiles of all county predicted rates. Bivariate maps are used to spatially translate the geographic variation among US counties in the distribution of both BC and CRC late-stage diagnoses.ConclusionsEmpirical modeling results show demographic disparities, while the spatial translation of empirical results shows geographic disparities that may be quite useful for state cancer control planning. Late stage BC and CRC diagnosis rates are not spatially random, manifesting as place-specific patterns that compare counties in individual states to counties across all states. Providing a relative comparison that enables assessment of how results in one state compare with others, this paper is to be disseminated to all state cancer control and central cancer registry program officials.
Highlights
Several studies have examined the predictors of stage at diagnosis for breast and colorectal cancers
The majority of colorectal and almost 1/3 of breast cancers are diagnosed at an advanced stage in the US, which results in higher morbidity and mortality than would obtain with earlier detection
We examined cancer cases diagnosed during 2004–2009 from the United States Cancer Statistics (USCS) database, which is a population-based surveillance system of cancer registries with data representing 98% of the U.S population
Summary
Several studies have examined the predictors of stage at diagnosis for breast and colorectal cancers. Other studies which examined whole cancer populations in multiple states or regions in the US found that factors such as area poverty or deprivation, lack of personal insurance, or percent uninsured in the area have associations with late-stage BC diagnosis [3,4]. Another study found that patients privately insured or insured by Medicare plus supplemental plans had lower likelihood of being diagnosed at advanced stages of cancer than persons with other types of insurance, with highest rates among uninsured and Medicaid insureds [5]. The paper examined how the state-level variation in health insurance regulatory environments predicted late-stage cancer diagnosis outcomes through cross-level interactions with community-level factors that were specified from the perspective of the cancer patients in those communities
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