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BACKGROUND: This study was conducted to evaluate trends in survival, by race-ethnicity, for women diagnosed with breast cancer in Florida over a 26-year period. METHODS: This was a retrospective cohort study of women diagnosed with invasive breast cancer in Florida between 1990 and 2015. Data were obtained from the Florida Cancer Data System. Women in the study were categorized according to race (white/black) and Hispanic ethnicity (yes/no). Cumulative incidence estimates of 5- and 10-year breast cancer-related death with 95% confidence intervals (CI) were obtained by race-ethnicity, according to diagnosis year. Subdistribution hazard models were used to obtain subdistribution HRs (sHR) for the relative rate of breast cancer death accounting for competing causes. RESULTS: Breast cancer mortality decreased for all racial-ethnic groups, and racial-ethnic minorities had greater absolute and relative improvement for nearly all metrics compared with non-Hispanic white (NHW) women. However, for the most recent time period (2010-2015), black women still experienced significant survival disparities with non-Hispanic black (NHB) women, having twice the rate of 5-year [sHR = 2.04; 95% confidence interval (CI), 1.91-2.19] and 10-year (sHR = 2.02; 95% CI, 1.89-2.16) breast cancer-related death. Adjustment for covariates substantially reduced the excess rate of breast cancer-related death for black women. CONCLUSIONS: Despite efforts to improve disparities in breast cancer outcomes for underserved women in Florida, black women continue to experience significant survival disparities. IMPACT: These results highlight the need for targeted approaches to eliminate disparities in breast cancer survival for black women.
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Neoplasias da Mama/mortalidade , Disparidades nos Níveis de Saúde , Adolescente , Adulto , Negro ou Afro-Americano/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/etnologia , Feminino , Florida/epidemiologia , Hispânico ou Latino/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida , Populações Vulneráveis/estatística & dados numéricos , População Branca/estatística & dados numéricos , Adulto JovemRESUMO
We investigated characteristics of patients with colon cancer that predicted nonreceipt of posttreatment surveillance testing and the subsequent associations between surveillance status and survival outcomes. This was a retrospective cohort study of the Surveillance, Epidemiology, and End Results database combined with Medicare claims. Patients diagnosed between 2002 and 2009 with disease stages II and III and who were between 66 and 84 years of age were eligible. A minimum of 3 years' follow-up was required, and patients were categorized as having received any surveillance testing (any testing) versus none (no testing). Poisson regression was used to obtain risk ratios with 95% confidence intervals for the relative likelihood of No Testing. Cox models were used to obtain subdistribution hazard ratios with 95% confidence intervals for 5- and 10-year cancer-specific and noncancer deaths. There were 16,009 colon cancer cases analyzed. Patient characteristics that predicted No Testing included older age, Black race, stage III disease, and chemotherapy. Patients in the No Testing group had an increased rate of 10-year cancer death that was greater for patients with stage III disease (subdistribution hazard ratio = 1.79, 95% confidence interval: 1.48, 2.17) than those with stage II disease (subdistribution hazard ratio = 1.41, 95% confidence interval: 1.19, 1.66). Greater efforts are needed to ensure all patients receive the highest quality medical care after diagnosis of colon cancer.
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Neoplasias do Colo/patologia , Neoplasias do Colo/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Quimioterapia Adjuvante , Neoplasias do Colo/mortalidade , Comores , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Razão de Chances , Prognóstico , Modelos de Riscos Proporcionais , Qualidade da Assistência à Saúde , Grupos Raciais , Estudos Retrospectivos , Programa de SEER/estatística & dados numéricos , Fatores Socioeconômicos , Estados UnidosRESUMO
We performed this study to assess women's perceptions, knowledge and behavioral practices for breast cancer prevention in a rural setting. A 61-item questionnaire was developed based on Health Belief Model constructs and completed by 185 women age 35 and older. Results showed significant differences in several areas including perceived susceptibility and severity. Overall knowledge was poor. In logistic regression perceived barriers and yearly clinical breast examination appeared to be significant predictors for regular screening behavior (OR=0.02, CI=0.03-0.09 and OR=0.23, CI=0.05-0.99, respectively). Behavioral interventions targeting barriers for rural women need to be designed to include consideration of specific barriers and clear information on the need for regular screening.
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OBJECTIVE: To compare adherence to screening mammography recommendations of American Indian and non-Hispanic White women in the Denver, Colorado, area. DESIGN/SETTING/PARTICIPANTS: This study retrospectively examined adherence patterns in 229 American Indian and 60,197 non-Hispanic White women > or = 40 years and older, with at least one screening mammogram in the Colorado Mammography Project (CMAP), from January 1, 1999, to December 31, 2003. The CMAP was a prospective study of women receiving mammograms at participating clinics around Denver. MAIN OUTCOME MEASURES: Using logistic mixed models, we defined two dependent variables as annual and biennial adherence from the intervals between screening mammograms for each woman. RESULTS: Biennial adherence was substantially higher than annual adherence for both American Indian and non-Hispanic White women in our analyses. American Indian women were less likely than non-Hispanic White women to adhere to biennial recommendations in multivariate models controlling for age, family history of breast cancer, and economic status (zip code): odds ratio (OR) .4 and 95% confidence interval (CI) .2-.6. The association between American Indian race/ethnicity and annual adherence was similar, although not as strong (OR .5, 95% CI .3-.8). CONCLUSIONS: American Indian women in the CMAP cohort were less likely than non-Hispanic White women to adhere to recommendations for screening mammography, both annually and biennially. Additional research is needed to explore the effect of biennial screening and other barriers among American Indian women.
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Diretrizes para o Planejamento em Saúde , Indígenas Norte-Americanos/estatística & dados numéricos , Mamografia , Programas de Rastreamento , Cooperação do Paciente/etnologia , Adulto , Fatores Etários , Idoso , Neoplasias da Mama/diagnóstico por imagem , Neoplasias da Mama/etnologia , Colorado/epidemiologia , Fatores de Confusão Epidemiológicos , Etnicidade/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Estudos Prospectivos , Estudos Retrospectivos , População Branca/estatística & dados numéricosRESUMO
OBJECTIVE: To examine theory-based selected factors associated with adherence to mammography screening guidelines in a surveillance database. METHODS: Data from Colorado Mammography Project (CMAP) from 1994-1998 was extracted and analyzed by using SAS statistical software. Based on the Health Belief Model and Behavioral Model of Health Services Utilization a prediction model was developed to examine the mammography utilization patterns and factors influencing the adherence to screening guidelines. RESULTS: Out of 27,778 women, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs < high school, OR= 1.10, 95% CI= 1.04-1.18), college graduate vs < high school (OR=1.33, 95% CI=1.25-1.42); insurance status, (any coverage vs no coverage (OR=1.62, 95% CI=1.25-2.12); and community economic status as defined by median income by zip code of residence ($15,000-$24,999 vs <$15,000, OR=0.84, 95% CI=0.76-0.94; >$55,000 vs <$15,000, OR 1.14, 95% CI=1.03-1.26) were statistically significant predictors of adherence to guidelines. Interaction between age and family history of breast cancer was statically significant. Younger females with a family history of breast cancer were less likely to be adherent than their counterparts without a family history (OR=0.93, 95% CI=0.90-0.96). Inclusion or exclusion of women aged 70 years and older did not change the outcome of the analysis. CONCLUSION: The prediction model variables such as race/ethnicity, age and family history of breast cancer, educational level and community economic status, are associated with adherence status. Family history of breast cancer needs to be examined very carefully in future studies as it may play negative role in adherence to screening mammography.
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OBJECTIVE: To explore patterns of adherence to guidelines for screening mammography among participants in the Colorado Mammography Project (CMAP) surveillance database. METHODS: An algorithm was developed to assess factors associated with adherence to mammography screening guidelines. RESULTS: Of the 27,778 women ranging from 40-90 years of age included in the analysis, 41.4% were adherent with mammography screening guidelines. According to the model tested in this study, race/ethnicity (Black vs White, OR=0.76, 95% CI=0.64-0.91); educational attainment (high school vs