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Geographic Patterns of Advanced Breast Cancer in Los Angeles: Associations with Biological and Sociodemographic Factors (United States)

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Abstract

Objective

Examination of patterns of advanced breast cancer may provide evidence needed to direct health care resources to those communities or population groups in greatest need. We assessed to what degree biologic, ethnic, and sociodemographic factors could explain such patterns within Los Angeles County.

Methods

The proportion of cases of advanced disease among all breast cancer cases identified during 1992–1996 were analyzed using generalized linear mixed models with random census tract effects. Models included characteristics of the individual and her tumor, census tract of residence, and aggregated health districts.

Results

Approximately 6% of cases, ranging from 4% for Asian to 10% for Black women, were diagnosed as advanced, exhibiting striking geographic patterns. Tumor histology and hormone receptor status were most predictive of advanced disease. Sociodemographic variables such as marital status, median income, and distance to nearest mammography unit showed additional association with risk.

Conclusions

These models explain most of the geographical patterns and eliminate differences between White and Hispanic but not Asian or Black women, identify subpopulations at high risk of advanced disease, and suggest cancer control opportunities.

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Acknowledgements

The authors thank staff of the Food and Drug Administration’s Division of Mammography Quality and Radiation Programs in the Center for Devices and Radiological Health for providing address files for mammographic facilities. In addition, the authors thank James Cucinelli, Mike Barrett, and Scott Sherman of Information Management Services, Inc., for preparing the maps for this manuscript, and Karen A. Johnson, NCI Division of Cancer Prevention, Robin Yabroff, NCI Division of Cancer Control and Population Studies and Peggy Reynolds, California State Department of Health and Human Services, for their comments that helped clarify the text.

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Correspondence to Marcia L. Gumpertz.

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Gumpertz, M.L., Pickle, L.W., Miller, B.A. et al. Geographic Patterns of Advanced Breast Cancer in Los Angeles: Associations with Biological and Sociodemographic Factors (United States). Cancer Causes Control 17, 325–339 (2006). https://doi.org/10.1007/s10552-005-0513-1

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