Article

Comorbidities and Mammography Use Interact to Explain Racial/Ethnic Disparities in Breast Cancer Stage at Diagnosis

University of California, Davis School of Medicine, Sacramento, California, USA.
Cancer (Impact Factor: 5.2). 07/2011; 117(14):3252-61. DOI: 10.1002/cncr.25857
Source: PubMed

ABSTRACT Interactions with comorbidity burden and comorbidity-related care have not been examined as potential explanations for racial/ethnic disparities in advanced-stage breast cancer at diagnosis.
The authors used linked Surveillance, Epidemiology, and End Results-Medicare data to determine whether comorbidity burden and comorbidity-related care are associated with stage at diagnosis, whether these associations are mediated by mammography use, and whether they explain racial/ethnic disparities. Stage at diagnosis and mammography use were analyzed in multivariate regression models, adjusting for comorbidity burden and comorbidity-race interactions among 118,742 women diagnosed with breast cancer during 1993 to 2005.
Mammography utilization was higher among women with ≥ 3 stable comorbidities than among those without comorbidities. Advanced stage at diagnosis was associated with black race (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.6-1.8), Hispanic ethnicity (OR, 1.3; 95% CI, 1.2-1.5), unstable comorbidity, and age ≥ 80 years. Mammography was protective in all racial/ethnic groups, but neither mammography use (OR, 0.3; 95% CI, 0.3-0.3 and OR, 0.2; 95% CI, 0.2-0.2 for women with 1 and ≥ 2 prior mammograms, respectively) nor overall physician service use (OR, 0.7; 95% CI, 0.7-0.8 for women with ≥ 16 visits) explained the association between race/ethnicity and stage at diagnosis. The black/white OR fell to 1.2 (95% CI, 0.9-1.5) among women with multiple stable comorbidities who received ≥ 2 screening mammograms, and 1.0 (95% CI, 0.8-1.3) among mammography users with unstable comorbidities.
Comorbidity burden was associated with regular mammography and earlier stage at diagnosis. Racial/ethnic disparities in late stage disease were reduced among women who received both regular mammograms and comorbidity-related care.

0 Bookmarks
 · 
94 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Preexisting comorbidity adversely impacts breast cancer treatment and outcomes. We examined the incremental impact of comorbidity undetected until cancer. We followed breast cancer patients in SEER-Medicare from 12 months before to 84 months after diagnosis. Two comorbidity indices were constructed: the National Cancer Institute index, using 12 months of claims before cancer, and a second index for previously undetected conditions, using three months after cancer. Conditions present in the first were excluded from the second. Overall, 6,184 (10.1%) had ≥1 undetected comorbidity. Chronic obstructive pulmonary disease (38%) was the most common undetected condition. In multivariable analyses that adjusted for comorbidity detected before cancer, older age, later stage, higher grade, and poor performance status all were associated with higher odds of ≥1 undetected comorbidity. In stage I-III cancer, undetected comorbidity was associated with lower adjusted odds of receiving adjuvant chemotherapy (Odds Ratio (OR) = 0.81, 95% Confidence Interval (CI) 0.73-0.90, P < 0.0001; OR = 0.38, 95% CI 0.30-0.49, P < 0.0001; index score 1 or ≥2, respectively), and with increased mortality (Hazard Ratio (HR) = 1.45, 95% CI 1.38-1.53, P < 0.0001; HR = 2.38, 95% CI 2.18-2.60, P < 0.0001; index score 1 or ≥2). Undetected comorbidity is associated with less aggressive treatment and higher mortality in breast cancer.
    02/2014; 2014:970780. DOI:10.1155/2014/970780
    This article is viewable in ResearchGate's enriched format
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The purpose of this study was to examine associations between the number and types of patients' chronic diseases and being up to date for breast, cervical, and colorectal cancer screening. Methods: Data were abstracted from medical charts at 4 primary care clinics located in 2 rural Oregon communities. Eligibility criteria included being at least 55 years old and having at least 1 clinic visit in the past 2 years. Results: Of 3433 patients included, 503 (15%) had no chronic illness, 646 (19%) had 1, 786 (23%) had 2, and 1498 (44%) had >= 3 chronic conditions. Women with asthma/chronic lung disease and with cardiovascular disease were less likely to be up o date for mammography screening (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.43-0.80), and those with chronic digestive disorders were more likely to be up to date for mammography (OR, 1.31; 95% CI, 1.03-1.66) compared with those without chronic conditions. Women with arthritis, diabetes mellitus, and hypertension were less likely to be up to date for cervical cancer screening (OR, 0.38; 95% CI, 0.21-0.68) compared with those without chronic conditions. Men with cardiovascular disease were less likely to be up to date for colorectal cancer screening (adjusted OR, 0.59; 95% CI, 0.44-0.80), and women with depression were less likely to be up to date (OR, 0.71; 95% CI, 0.56-0.91) compared with men and women without chronic conditions. Conclusion: Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.
    The Journal of the American Board of Family Medicine 09/2014; 27(5):669-81. DOI:10.3122/jabfm.2014.05.140005 · 1.85 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Mammography use has increased over the past 20 years, yet more than 30% of women remain inadequately screened. Structural barriers can deter individuals from screening, however, cognitive, emotional, and communication barriers may also prevent mammography use. This study sought to identify the impact of number and type of barriers on mammography screening status, and to examine whether number and type of barriers are different for never-screened and off-schedule women. A total of 182 women aged 40 years or older completed a computer kiosk facilitated survey as part of a larger patient navigator intervention. Logistic regression analysis indicated that breast cancer knowledge predicted whether a woman had ever had a mammogram (odds ratio [OR] = 1.04, 95% confidence interval [CI] = 1.02-1.06, p = .0003), while the number of emotional, structural, and communication barriers predicted whether a woman was on-schedule for mammograms (OR = 0.79, 95% CI = 0.65-0.95, p = .0127). The results suggest that to increase the use of mammography at recommended regular intervals, interventions should be tailored toward current screening status.
    Health Education &amp Behavior 04/2014; 42(1). DOI:10.1177/1090198114529589 · 1.54 Impact Factor

Full-text (2 Sources)

Download
5 Downloads
Available from
Oct 13, 2014