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Breast cancer screening program highlights health care disparities
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Women enrolled in Women’s Health Check — a screening program in Idaho sponsored by The National Breast and Cervical Cancer Early Detection Program — were significantly more likely to be diagnosed with breast cancer at a later stage than non-enrolled women, according to a CDC report.
“This study suggests that health care disparities may exist for Idaho Women’s Health Check enrollees in the timely diagnosis of breast cancer, and that these disparities drive overall differences in type of surgery and cause-specific survival,” Christopher J. Johnson, MPH, an epidemiologist of the Cancer Data Registry of Idaho, and colleagues wrote. “This study also illustrates the power of linkages between central cancer registries and the National Breast and Cervical Cancer Early Detection Program [NBCCEDP] databases for quality improvement, program assessment and monitoring population health.”
Johnson and colleagues compared data from Women’s Health Check — designed to provide access to screening for low-income, uninsured and underinsured women — and data from Idaho’s central cancer registry. Researchers sought to evaluate differences in stage distribution, type of surgery and cause-specific survival among women enrolled and not enrolled in Women’s Health Check.
The analysis included 5,606 women from Idaho aged 30 to 64 years diagnosed with breast cancer between 2004 and 2012. Of these cancers, 540 (9.6%) were diagnosed through Women’s Health Check screenings.
Women enrolled in Women’s Health Check were significantly more likely to receive a later stage diagnosis than non-enrolled women (43.4% vs. 31.3%; P <.001).
Women in the Women’s Health Check cohort were younger than non-enrolled women (P = .01); however, findings persisted when researchers controlled for age differences. A later stage of disease at diagnosis was significantly more common in Women’s Health Check-enrolled patients aged 40 to 49 years (45.4% vs. 33.7%; P = .003) and 50 to 64 years (40.9% vs. 29.1%, P < .001) than non-enrolled patients.
Researchers observed no significant difference among women aged 30 to 39 years, for whom breast cancer screening is not generally recommended.
Johnson and colleagues also found that Women’s Health Check-enrolled patients were significantly less likely to have breast-conserving surgery than non-enrolled women (52.3% vs. 59%, P = .01). However, this association lost its significance when researchers stratified data by disease stage.
Age-standardized analyses indicated Women’s Health Check-enrolled patients were less likely to achieve 5-year breast cancer-specific survival (83.9% vs. 89%).
“We speculate that one reason for the increased likelihood of late-stage cancer diagnosis is that Women’s Health Check is not only a screening program but also serves women who have symptoms suspicious of breast and cervical cancer as confirmed by a health care professional,” Johnson and colleagues wrote.
These data provide additional research questions that should be addressed, researchers added.
“Future studies should attempt to identify the reasons for the identified breast cancer disparities,” the researchers wrote. “Methods for doing so may include surveys of NBCCEDP participants to assess delayed diagnosis and patterns-of-care studies that include additional patient characteristics, tumor biology and treatment data.” – by Cameron Kelsall
Disclosure: The researchers report no relevant financial disclosures.
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