Screening recommendations and breast cancer incidence and m ortality in South Carolina. A BRFSS and Cancer Registry Data Analysis

Transcription

1 Screening recommendations and breast cancer incidence and m ortality in South Carolina A BRFSS and Cancer Registry Data Analysis

2 Authors & Affiliations Stephanie Clugstone, M SPH 1 Chelsea Lynes, MSPH 1 Deb Hurley, MSPH 1 Daniela Nitcheva, PhD 1 Harley T. Davis, MSPH, PhD 1 Krystal Johnson, PhD 2 1 Bureau of Public Health Statistics, SC DHEC; 2 Bureau of Chronic Disease and Injury Prevention, SC DHEC 2

3 Background The United States Preventive Services Task Force recommends that all women ages receive a mammogram every two years. Even so, the literature shows there are racial disparities in female breast cancer (BC) screening, incidence, and mortality. Racial gap in screening rate between Black and White women has decreased in recent years 1 BC incidence lower in Black women compared to White women 1 BC mortality higher in Black women compared to White women 1 3

4 Research Question Do the disparities with respect to BC screening, incidence, and mortality exist in South Carolina (SC)? 4

5 Dat a Sources: SC BRFSS SC Behavioral Risk Factor Surveillance System (BRFSS) data BC screening, insurance coverage 2013 survey Age Sample size, n = 3,107 Weighted n = 693,624 (weighted annually by CDC 2 ) SC BRFSS: Random-digit dialed telephone-based health survey administered annually Captures data on health behaviors and outcomes (non-institutionalized adults 18+) 5

6 Dat a Sources: SCCCR SC Central Cancer Registry (SCCCR) data Female breast cancer cases and deaths Age Incidence, n = 8,773 cases Invasive only Mortality, n = 1,131deaths 6

7 Tim eline for Data Sources SCCCR Incidence and mortality 2013 SC BRFSS How long has it been since you had your last mammogram? Within the past 2 years Met screening recommendation Within the past year

8 Met h od s: SC BRFSS Survey analysis procedures in SAS 9.2 Weighted prevalence estimates 95% confidence intervals Indicators compared between White and Black women: Screening Met recommendation = mammogram in past 2 years (in ) Did not meet = mammogram >2 years ago (prior to 2011) or never Health insurance status (yes/no) Age (mean) 8

9 Met h od s: SCCCR SEER* St at Age-adjusted rates; rate ratios; proportions 95% CIs The following indicators were compared between white and black women: Age-adjusted incidence & mortality rates Stage at diagnosis (% early/late) Hormone receptor status (%) ER-/PR-/ HER2- & HER2+ Age (mean: diagnosis, death) 9

10 Statistically significant indicat ors Meeting mammography recommendation* Among those meeting rec, average age* Among those meeting rec, have health insurance* BC incidence rate + Whit e 76.0% (95% CI: ) Mean: 61.7 years (95% CI: ) 94.2% (95% CI: ) cases per 100,000 women (95% CI: ) Early stage diagnosis % (95% CI: ) Triple negative (TN) proportion + 6.6% (95% CI: ) HER2 positive proportion % (95% CI: ) Late stage TN proportion + 9.3% (95% CI: ) B C age-adjusted mortality rate + Data sources: *SC BRFSS; + SCCCR 46.3 deaths per 100,000 women (95% CI: ) Black 84.4% (95% CI: ) Mean: 59.6 years (95% CI: ) 89.1% (95% CI: ) cases per 100,000 women (95% CI: ) 65.6% (95% CI: ) 15.0% (95% CI: ) 14.0% (95% CI: ) 20.3% (95% CI: ) 70.5 deaths per 100,000 women (95% CI: ) 10

11 Discussion Although Black women have a higher prevalence of meeting the mammography recommendation than White women: Black women diagnosed with later stage BC Black wom en diagnosed with m ore aggressive types of BC Black wom en have higher BC m ortality rates White women have higher BC incidence rates Generally, this agrees with the literature 1,3,4 Except that racial gap still seen in screening in SC Black women may be receiving lower quality mammograms than White women 3, which leads to More late stage diagnoses; higher mortality 11

12 Discussion continued Limitations Actual screening/mammogram uptake for cases/deaths is unknown Screening is self-reported and cross-sectional Mammogram quality is unknown Health insurance at time of screening unknown Future directions Screening by income level from SC BRFSS Differences by race for NBCCEDP cases 12

13 References 1. Comparing breast cancer screening rates among different groups. Susan G. Komen. Accessed 13 June [URL: ening.html]. 2. Weighting the data. CDC. Accessed 13 June [URL: 3. Rauscher GH, Allgood KL, Whitman S, Conant E. Disparities in screening mammography services by race/ethnicity and health insurance. J Womens Health Feb; 21(2): Deshpande AD, Jeffe DB, Gnerlich J, Iqbal AZ, Thummalakunta A, Margenthaler JA. Racial disparities in breast cancer survival: an analysis by age and stage. J Sur g Res May 1; 153(1):

14 SC BRFSS: Chelsea Lynes, MSPH dhec.sc.gov SCCCR: Stephanie Clugstone, MSPH dhec.sc.gov