Differences in Breast Cancer Stage at Diagnosis by Ethnicity, Insurance Status, and Family Income in Young Women in the USA
Describe the clinical and epidemiological data from young women with breast cancer and determine the association between ethnicity, insurance status, family income, and breast cancer stage at the diagnosis in this population.
Women under the age of 40 diagnosed with invasive breast cancer from 2010 to 2014 and identified in the Surveillance, Epidemiology, and End Results (SEER) 18 registries database were included. Binary logistic regression was applied in order to estimate the odds ratios (ORs) for factors that were potentially predictive for receiving a breast cancer diagnosis at stage I.
Of 14,379 young women with invasive breast cancer, 70.9% of the patients were white, 15.9% black, and 13.2% classified as other ethnicity (American Indian, Asian, Pacific Islander). The initial clinical stage at diagnosis was stage I in 28.2%, II in 45.2%, III in 19.0%, and IV in 7.6%. The chi-square test showed a significant association between clinical stage at diagnosis and family income (p < 0.0001), insurance status (p < 0.0001), and ethnicity (p < 0.0001). The ORs for being diagnosed at stage I, regarding different factors, revealed that women with family income higher than US$ 85,000 were more likely to be diagnosed with stage I (OR [95%CI], 1.306 [1.173–1.454]; p value < 0.0001) when compared with patients with family income of less than US$ 60,000. Black women were less likely to be diagnosed with stage I (OR [95%CI], 0.676 [0.605–0.755]; p value < 0.0001), when compared with white women. Uninsured women were less likely to be diagnosed with stage I (OR [95%CI], 0.586 [0.529–0.648]; p value < 0.0001) when compared with women with insurance coverage.
Among young US women diagnosed with invasive breast cancer, most of them presented early stage disease. Women with black ethnicity, low income, and uninsured are at risk for late-stage presentation. Improvements in strategies to allow earlier breast cancer diagnosis in these at risk population are urged.
KeywordsBreast cancer staging Ethnic disparities Socioeconomic disparities
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they have no conflict of interest.
- 1.American Cancer Society. Breast cancer facts & figures 2017–2018.Google Scholar
- 2.International Agency for Research on Cancer. GLOBOCAN 2012: Estimated cancer incidence, Mortality and prevalence worldwide. http://globocan.iarc.fr. Accessed 1 Mar 2019.
- 15.Aiken LS, Fenaughty AM, West SG, Johnson JJ, Luckett TL. Perceived determinants of risk for breast cancer and the relations among objective risk, perceived risk, and screening behavior over time. Women Health. 1995;1(1):27–50.Google Scholar
- 16.McDonald PA, Thorne DD, Pearson JC, et al. Perceptions and knowledge of breast cancer among African-American women residing in public housing. Ethn Dis. 1999;9(1):81–93.Google Scholar
- 19.Yaffe MJ, Mittmann N, Alagoz O, et al. The effect of mammography screening regimen on incidence-based breast cancer mortality. J Med Screen. 2018;26:969141318780152.Google Scholar
- 28.Debiasi M, Polanczyk CA, Ziegelmann P, Barrios C, Cao H, Dignam JJ, et al. Efficacy of anti-HER2 agents in combination with adjuvant or neoadjuvant chemotherapy for early and locally advanced HER2-positive breast cancer patients: a network meta-analysis. Front Oncol. 2018;8:156.CrossRefGoogle Scholar
- 30.Freedman RA, Hughes ME, Ottesen RA, Weeks JC, He Y, Wong YN, et al. Use of adjuvant trastuzumab in women with human epidermal growth factor receptor 2 (HER2)-positive breast cancer by race/ethnicity and education within the National Comprehensive Cancer Network. Cancer. 2013;119(4):839–46.CrossRefGoogle Scholar
- 33.Metropolitan Chicago Breast Cancer Task Force. How far have we come? Improving access to and quality of breast health services in Chicago, Chicago, IL. 2014. Retrieved from http://www.chicagobreastcancer.org/site/files/904/93199/353837/718237/State_of_Breast_Cancer_Disparties_Report_Final_11.pdf. Accessed 1 Mar 2019.
- 36.Lind JN, Perrine CG, Li R, Scanlon KS, Grummer-Strawn LM. Racial disparities in access to maternity care practices that support breastfeeding — United States, 2011. Morb Mortal Wkly Rep. 2014;63(33):725–8.Google Scholar