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> > > > > PROJECT 1
Neighborhood & Individual Effects on Stage at Diagnosis
 
   
  This project is...
 
  • Exploring the effect of patients’ social environment on access to early detection & diagnosis
  • Examining the effect of social environment after accounting for individual characteristics
  • Examining the effect of age
  • Planning intervention with community partners (see Project 3)
   
  Principal Investigator: Richard B. Warnecke, Ph.D.
  Co-investigators: Richard E. Barrett, Ph.D.; Aida L. Giachello, Ph.D.; and Marilyn A. Willis, R.N., M.S.
   
 
PRELIMINARY RESULTS
   
  Study Population: All women diagnosed with breast cancer between 1994 & 2000, living in Cook County (approximately 29,000 cases identified by the Illinois State Cancer Registry.)
   
  > Race, Ethnicity, & Age
 
  • An analysis of the distribution of stage at diagnosis by race & ethnicity showed that African-American & Hispanic women are at greater risk for being diagnosed with late-stage disease than are White women. (Unadjusted for potential differences with regard to age & other factors known to be associated with stage at diagnosis, such as poverty level.)
 
 
  • At younger ages, African-American women are substantially more likely to be diagnosed at later stages than Whites, but the disparity gradually declines with age.
  • On the other hand, at younger ages, White women are more likely to be diagnosed at the in-situ stage, which is almost always detected via mammography, than African-American women. Interestingly, White women also are more likely to be diagnosed at the localized stage, a difference that does not decline with age.
  • A very similar but less pronounced pattern is seen in the comparison of Hispanics to Whites. The probability of late-stage diagnosis is slightly higher for Hispanics than Whites, but only at a relatively early age. By age 50 or so, there is no difference. Conversely, Whites are more likely to be at the in-situ stage than Hispanics until the same age. Hispanics are more likely to be diagnosed at the regional stage than Whites, & the pattern with respect to age is similar to the African-American/White disparity, although the difference declines more sharply with age. Like African Americans, Hispanics are less likely to be diagnosed at the in-situ stage than Whites, until around age 70.
 

For the past year, we have been carrying out a detailed analysis of these data in order to disentangle the complex interaction of race, ethnicity, age, & poverty on stage at diagnosis. We currently are extending this work to several other areas around the country, including all of Illinois, Maryland, Massachusetts, California, & others.

For more information, contact Dr. Richard T. Campbell at dcamp@uic.edu.

   
  > Neighborhood
 
  • Residence in a census tract that was experiencing socioeconomic improvement (Upward Change) between 1990 and 2000 was associated with increased odds of distant metastatic stage at diagnosis of breast cancer.
  • Residence in a census tract with lower SES in 1990 (Disadvantage, Affluence, & Immigration) also was associated with increased odds of distant metastatic stage at diagnosis
  • Being older & African American were associated with increased odds of distant metastasis at diagnosis; Hispanics had decreased odds (both groups compared to Whites).
  • Women living in changing areas may experience disruption of social networks, interruption in access to care, and stress relating to social isolation & financial concerns. This may have health consequences through decreased utilization of preventive services&/or the direct effect of stress.
  • Note: For these analyses on neighborhood effects, in-situ cases were excluded, so the analysis was based on 21,516 breast cancer cases diagnosed between 1994 and 2000 from the Illinois State Cancer Registry.
 

For more information, contact Dr. Richard Barrett at barrett@uic.edu.

     

University of Illinois at Chicago
Last update 10.29.07