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Patient and Process Factors Associated with Late-Stage Breast Cancer Diagnosis in Safety-Net Patients: A Pilot Prospective Study

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Following reforms to our city’s Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source—SN versus non-Safety-Net (NSN)—or, among SN patients, by stage at diagnosis.

Methods

From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant.

Results

Fifty-seven women completed interviews (33 SN, 24 NSN); 52 % of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83 % vs. 21 %, P < 0.001), to have an annual household income <$25,000 (89 % vs. 38 %, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67 % vs. 25 %, P = 0.012); they were less likely to be married/partnered (22 % vs. 79 %, P < 0.001) and to have post-college education (0 % vs. 25 %, P < 0.03), any insurance (61 % vs. 96 %, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50 % vs. 79 %, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038).

Conclusions

SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.

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Acknowledgments

This study was funded by a grant from the Harrah’s Foundation (Principal Investigator, Graham Colditz, MD, DrPH) to the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine for its Program for the Elimination of Cancer Disparities (PECaD). The authors would like to thank Stephen Ristvedt, PhD, for his assistance in developing our questionnaire; Susan Kraenzle, BA, RN, CBCN, for providing information on the Siteman Mammography Van and Breast Cancer Navigator Programs; and Aimee James, PhD, for her assistance with earlier drafts of this manuscript. Portions of this study’s findings were presented at a PECaD Breast Cancer Community Partnership Meeting on July 14, 2011, at the 65th Annual Cancer Symposium of the Society of Surgical Oncology, March 21–24, 2012, and at the 45th Annual Professional Meeting of the Missouri Chapter of the American College of Surgeons, June 8–10, 2012.

Conflict of interest

None of the authors has any financial interests or conflicts to disclose.

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Authors and Affiliations

  1. Department of Surgery, Washington University School of Medicine, St. Louis, MO, USA

    Oluwadamilola M. Fayanju MD, MPHS, Leisha Elmore BS, MPHS & Julie A. Margenthaler MD

  2. Division of Health Behavior Research, Department of Medicine, Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe PhD & Deborah N. Ksiazek BS

  3. The Alvin J. Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine, St. Louis, MO, USA

    Donna B. Jeffe PhD & Julie A. Margenthaler MD

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  1. Oluwadamilola M. Fayanju MD, MPHS
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  2. Donna B. Jeffe PhD
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  3. Leisha Elmore BS, MPHS
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Correspondence to Julie A. Margenthaler MD.

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Fayanju, O.M., Jeffe, D.B., Elmore, L. et al. Patient and Process Factors Associated with Late-Stage Breast Cancer Diagnosis in Safety-Net Patients: A Pilot Prospective Study. Ann Surg Oncol 20, 723–732 (2013). https://doi.org/10.1245/s10434-012-2558-1

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