Annals of Surgical Oncology

, Volume 21, Issue 10, pp 3336–3341 | Cite as

Breast Cancer Screening Patterns Among Military Beneficiaries: Racial Variations in Screening Eliminated in an Equal-Access Model

Breast Oncology



African American women present with more aggressive breast tumors and at later stages than white women. Many factors have been proposed to explain these findings, including socioeconomic status, cultural beliefs, and access to medical care. The purpose of this project was to determine if stage at presentation would be equivalent in a system providing equal access to care and if screening was equivalent.


The Naval Medical Center San Diego (NMCSD) tumor registry from 2007 to 2012 was queried for this cross-sectional study. Eligible women included all those diagnosed and treated for breast cancer at NMCSD. Distribution of tumor stage (early vs. advanced) between racial groups was compared by age, treatment, and receptor status.


A total of 624 women were eligible; 88 % were early stage (0–II) and 12 % presented with advanced stage (III or IV). Racial differences in distribution were significant among African American and Hispanic women for early versus advanced presentation (p = 0.011). No racial disparity was seen in screening patterns among women.


In a military health system with equal access to care and standard screening recommendations, screening patterns did not vary with race but did vary with stage and active duty status. African American women present with breast cancer at later stages and with more hormone-receptor negative tumors, suggesting that biology rather than socioeconomic or access factors may be the most important determinant of stage at presentation of breast cancer for African American women.


  1. 1.
    Seigel R, Naishadham D, Ahmedin J. Cancer statistics 2013. CA Cancer J Clin. 2013;63:11–30.CrossRefGoogle Scholar
  2. 2.
  3. 3.
    Edwards BK, Noone A-M, Mariotto AB, Simard EP, Boscoe FP, et al. Annual Report to the Nation on the Status of Cancer, 1975–2010, featuring prevalence of comorbidity and impact on survival among persons with lung, colorectal, breast, or prostate cancer. Cancer. 2014;10:1219–314.Google Scholar
  4. 4.
    Morris GJ, Mitchell EP. Higher incidence of aggressive breast cancers in African-American women: a review. J Natl Med Assoc. 2008;100:698–702.PubMedGoogle Scholar
  5. 5.
    Bradley CJ, Given CW, Roberts C. Disparities in cancer diagnosis and survival. Cancer. 2001;91:178–88.PubMedCrossRefGoogle Scholar
  6. 6.
    Wingo PA, Ries LA, Giovino GA, Miller DS, Rosenberg HM, Shopland DR, et al. Annual report to the nation on the status of cancer, 1973–1996, with a special section on lung cancer and tobacco smoking. J Natl Cancer Inst. 1999; 91:675–90.PubMedCrossRefGoogle Scholar
  7. 7.
    Shinagawa SM. The excess burden of breast carcinoma in minority and medically underserved communities: application, research, and redressing institutional racism. Cancer. 2000;88(5 Suppl):1217–23.PubMedCrossRefGoogle Scholar
  8. 8.
    Lannin DR, Mathews HF, Mitchell J, Swanson MS, Swanson FH, Edwards MS. Influence of socioeconomic and cultural factors on racial differences in late-stage presentation of breast cancer. JAMA. 1998;279:1801–7.PubMedCrossRefGoogle Scholar
  9. 9.
    Hunter CP, Redmond CK, Chen VW, Austin DF, Greenberg RS Black/White Cancer Survival Study Group et al. (1993) Breast cancer: factors associated with stage at diagnosis in black and white women. J Natl Cancer Inst. 85:1129–1137.PubMedCrossRefGoogle Scholar
  10. 10.
    Freeman HP. Cancer in the socioeconomically disadvantaged. CA Cancer J Clin. 1989;39:266–88.PubMedCrossRefGoogle Scholar
  11. 11.
    Freeman HP. Cancer in the economically disadvantaged. Cancer. 1989;64(Suppl 1):324–34; discussion 342–5.PubMedCrossRefGoogle Scholar
  12. 12.
    Ward E, Jemal A, Cokkinides V, Singh C, Cardinez C, Chafoor A, Thun M. Cancer disparities by race/ethnicity and socioeconomic status. Cancer J Clin. 2004;54:78–93.CrossRefGoogle Scholar
  13. 13.
    Miller BA, Hankey BF, Thomas TL. Impact of sociodemographic factors, hormone receptor status, and tumor grade on ethnic differences in tumor stage and size for breast cancer in US women. Am J Epidemiol. 2002;155:534–45.PubMedCrossRefGoogle Scholar
  14. 14.
    Amend K, Hicks D, Ambrisine CB. Breast cancer in African American women: differences in tumor biology from European-American women. Cancer Res. 2006;66(17):8327–30.PubMedCrossRefGoogle Scholar
  15. 15.
    Greene FL, Page DI, Fleming ID, Fritz AG, Balch CM, Haller DG, Morrow, M. AJCC cancer staging manual. 6th ed. New York: Springer-Verlag; 2002.CrossRefGoogle Scholar
  16. 16.
    Edge SB, Byrd DR, Compton CC, Fritz AG, Greene FL, Trotti A. AJCC cancer staging manual. 7th ed. New York: Springer-Verlag; 2010.Google Scholar
  17. 17.
    Bagchi AD, Schone E, Higgins P, Granger E, Casscells SW, Croghan T. Racial and ethnic health disparities in TRICARE. J Natl Med Assoc. 2009;101(7):663–70.PubMedGoogle Scholar
  18. 18.
    Hassan MO, Arthurs Z, Sohn VY, Steele SR. Race does not impact colorectal cancer treatment or outcomes with equal access. Am J Surg. 2009;197(4):485–90.PubMedCrossRefGoogle Scholar
  19. 19.
    Hofmann LJ, Lee S, Waddell B, Davis KG. Effect of race on colon cancer treatment and outcomes in the Department of Defense Healthcare System. Dis Colon Rectum. 2010;53:9–15.PubMedCrossRefGoogle Scholar
  20. 20.
    Jatoi I, Becher H, Leake CR. Widening disparity in survival between white and African-American patients with breast carcinoma treated in the U. S. Department of Defense Healthcare System. Cancer. 2003;98(5):894–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Enewold L, Zhou Jing, McGlynn KA, Devesa SS, Shriver CD, et al. Racial variation in tumor stage at diagnosis among Department of Defense beneficiaries. Cancer. 2012;118(3):812–20.PubMedCrossRefPubMedCentralGoogle Scholar
  22. 22.
    Smith-Bindman R, Miglioretti DL, Lurie N, Abraham L, et al. Does utilization of screening mammography explain racial and ethnic differences in breast cancer? Ann Intern Med. 2006;144(8):541–53.PubMedCrossRefGoogle Scholar
  23. 23.
    Sassi F, Luft HS, Guadagnoli E. Reducing racial/ethnic disparities in female breast cancer: screening rates and stage at diagnosis. Am J Public Health. 2006;96(12):2165–72.PubMedCrossRefPubMedCentralGoogle Scholar
  24. 24.
    Cancer screening: United States 2010. MMWR. 2012;61(3):41–5.Google Scholar
  25. 25.
    Newman LA, Kuerer HM, Hunt KK, Singh G, Ames FC, Feig BW, et al. Local recurrence and survival among black women with early-stage breast cancer treated with breast-conservation therapy or mastectomy. Ann Surg Oncol. 1999;6:241–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Muss HB, Hunter CP, Wesley M, Correa P, Chen VW, Greenberg RS The National Cancer Institute Black/White Cancer Survival Study Experience et al. (1992) Treatment plans for black and white women with stage II node-positive breast cancer Cancer. 70:2460–2467.PubMedCrossRefGoogle Scholar
  27. 27.
    Dignam JJ, Colangelo L, Tian W, Jones J, Smith R, Wickerham DL, et al. Outcomes among African-Americans and Caucasians in colon cancer adjuvant therapy trials: findings from the National Surgical Adjuvant Breast and Bowel Project. J Natl Cancer Inst. 1999;91:1933–40.PubMedCrossRefGoogle Scholar
  28. 28.
    Nattinger AB, Gottlieb MS, Veum J, Yahnke D, Goodwin JS. Geographic variation in the use of breast-conserving treatment for breast cancer. N Engl J Med. 1992; 326:1102–7.PubMedCrossRefGoogle Scholar
  29. 29.
    Brawley OW, Freeman HP. Race and outcomes: is this the end of the beginning for minority health research? J Natl Cancer Inst. 1999;91:1908–9.PubMedCrossRefGoogle Scholar
  30. 30.
    McCollum AD, Catalano PJ, Haller DG, et al. Outcomes and toxicity in African American and caucasian patients in a randomized adjuvant trial for colon cancer. J Natl Cancer Inst. 2002;94:1160–7.PubMedCrossRefGoogle Scholar
  31. 31.
    Dignam JJ. Differences in breast cancer prognosis among African American and caucasian women. CA Cancer J Clin. 2000;50:50–64.PubMedCrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  1. 1.Department of General SurgeryNaval Medical Center San DiegoSan DiegoUSA
  2. 2.Department of SurgeryUniformed Services UniversityBethesdaUSA

Personalised recommendations