© 2004 by Oxford University Press
© 2004 Oxford University Press
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Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-up?
Affiliations of authors: Group Health Cooperative, Seattle, WA (SHT, LI, RA, RKB, DC, EOW); Henry Ford Health System, Detroit, MI (MUY); Kaiser Permanente Northern California, Oakland (MMM, WAL); Kaiser Permanente Southern California, Pasadena (AMG); Kaiser Permanente Northwest, Portland, OR (SW); Kaiser Permanente Hawaii, Honolulu (JG); Kaiser Permanente Colorado, Denver (JM, KB); University of Massachusetts Medical School, Worcester (JGZ); Cancer Research and Biostatistics, Seattle, WA (WEB)
Correspondence to: Stephen H. Taplin MD, MPH, Applied Research Program, National Cancer Institute, 9000 Rockville Pike, MSC 7344, EPN 4005, Bethesda, MD 20892-7344 (e-mail: taplins{at}mail.nih.gov)
Background: Mammography screening increases the detection of early-stage breast cancers. Therefore, implementing screening should reduce the percentage of women who are diagnosed with late-stage disease. However, despite high national mammography screening rates, late-stage breast cancers still occur, possibly because of failures in screening implementation. Methods: Using data from seven health care plans that included 1.5 million women aged 50 years or older, we conducted retrospective reviews of chart and automated data for 3 years before 1995–1999 diagnoses of late-stage (metastatic and/or tumor size 
3 cm; case subjects, n = 1347) and early-stage breast cancers (control subjects, n = 1347). We categorized the earliest screening mammogram during the period 13–36 months before diagnosis as none (absence of screening), negative (absence of detection), or positive (potential breakdown in follow-up). We compared the proportion of case and control subjects in each category of screening implementation and estimated the likelihood (odds ratio [OR] with 95% confidence intervals [CIs]) of late-stage breast cancer. We also evaluated demographic characteristics associated with absence of screening in women with late-stage disease. All statistical tests were two-sided. Results: Absence of screening, absence of detection, and potential breakdown in follow-up were distributed differently among case (52.1%, 39.5%, and 8.4%, respectively) and control subjects (34.4%, 56.9%, and 8.8%, respectively) (P = .03). Among all women, the odds of having late-stage cancer were higher among women with an absence of screening (OR = 2.17, 95% CI = 1.84 to 2.56; P<.001). Among case patients, women were more likely to be in the absence-of-screening group if they were aged 75 years or older (OR = 2.77, 95% CI = 2.10 to 3.65), unmarried (OR = 1.78, 95% CI = 1.41 to 2.24), or without a family history of breast cancer (OR = 1.84, 95% CI = 1.45 to 2.34). A higher proportion of women from census blocks with less education (58.5% versus 49.4%; P = .003) or lower median annual income (54.4% versus 42.9%; P = .004) were in the absence-of-screening category compared with the proportion for the other two categories combined. Conclusions: To reduce late-stage breast cancer occurrence, reaching unscreened women, including elderly, unmarried, low-income, and less educated women, should be made a top priority for screening implementation.
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Correspondence about this Article
- Re: Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-Up?
- Alice S. Whittemore
J Natl Cancer Inst 2005 97: 400.[Extract] [Full Text] [PDF]
- RESPONSE: Re: Reason for Late-Stage Breast Cancer: Absence of Screening or Detection, or Breakdown in Follow-Up?
- Stephen Taplin, Marianne Ulcickas-Yood, Ann Geiger, Laura Ichikawa, Kimberley Bischoff, and William Barlow
J Natl Cancer Inst 2005 97: 400-401.[Extract] [Full Text] [PDF]
Editorial about this Article
- Breast Cancer Screening Comes Full Circle
- Michael Baum
J Natl Cancer Inst 2004 96: 1490-1491.[Extract] [Full Text] [PDF]
Related Memo to the Media
- Press Release: Study Examines Reasons for Late-Stage Breast Cancers
- Sarah L. Zielinski
J Natl Cancer Inst 2004 96: 1487.[Extract] [Full Text]
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