Incorporating Multiple Evidence Sources for the Assessment of Breast Cancer Policies and Practices

J. Jackson-Thompson, Gentry White, Missouri Cancer Registry, University of Missouri-Columbia;

M.J. King, Missouri Department of Health and Senior Services

Background:

•Breast cancer accounts for c. 1/3 of cancers among U.S. women.

•Early detection and timely, appropriate treatment increase 5-year survival.

•Black women with breast cancer are less likely than white women to survive 5 years.

•Lack of health insurance and low income are other factors associated with lower survival.

This project was supported in part by a cooperative agreement between the Centers for Disease Control and Prevention (CDC) and the Missouri Department of Health and Senior Services (DHSS) (#U55/CCU721904-04) and a Surveillance Contract between DHSS and the University of Missouri.

Data Source: MICA (Missouri Information for Community Assessment) http://www.dhss.mo.gov/mica

Age-adjusted Incidence Rates* for Invasive Female Breast Cancer, Missouri 1996-2002

Year White** Black

1996 129.8 127.5

1997 131.0 116.4

1998 129.5 122.1

1999 129.6 125.3

2000 128.5 120.5

2001 126.3 118.4

2002 125.3 111.0

Mortality Rates for Female Breast Cancer, Missouri 1996-2002*

Year White Black

1996 27.6 41.0

1997 26.7 36.4

1998 27.3 37.8

1999 24.6 37.0

2000 26.9 32.6

2001 26.6 34.3

2002 24.8 37.7

* Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population.** Incidence rates for white female breast cancer show a statistically significant decrease in the time period 1996-2001.

* Rates are per 100,000 persons and are age-adjusted to the 2000 U.S. standard population.

Purpose:

•To evaluate efforts to reduce breast cancer incidence and mortality.

•To examine effectiveness of screening policies and practices.

Methods:

•We examined trends for breast cancer incidence, stage at diagnosis and mortality by race for 1996 – 2002.

•We also examined prevalence of mammography screening using Behavioral Risk Factor Surveillance System (BRFSS) data for 1996-2000 and 2002.

Results:

•Incidence rates for white women decreased significantly from 1996 to 2002.

•Incidence rates for black women declined slightly from 1996 to 2002.

•Percentage of early-stage diagnosis was slightly higher for white women than black women throughout the period.

•Mortality rates for black and white women were relatively stable throughout the period.

•Mortality rates for black women were significantly higher than for white women throughout the period.

•There were no differences by race in the percentage of women who reported ever having had a mammogram.

•Black women were more likely to report having had a mammogram in the past two years than white women.

Conclusion:

•Efforts to reduce breast cancer incidence and mortality and effectiveness of screening policies cannot be evaluated adequately using only statewide data.

.

Age-adjusted Invasive Female Breast Cancer Incidence Rates, Missouri 1996-2002*

88

93

98

103

108

113

118

123

128

133

138

1996 1997 1998 1999 2000 2001 2002

year

rate

s p

er

100,0

00

WhiteBlack

Have you ever had a mammogram?^

White Black

Yes 60.8% 60.1%

No 39.2% 39.9%

Have you had a mammogram in the past two years?^^

White Black

Yes 80.4% 88.0%

No 19.6% 12.0%

Percentage of Early-stage§ Diagnosis for Female Breast Cancer, Missouri 1996-2002

Year White Black

1996 65.3% 54.6%

1997 65.2% 59.5%

1998 68.6% 62.3%

1999 66.7% 60.3%

2000 68.2% 57.8%

2001 68.1% 59.8%

2002 66.8% 62.2%

Age-adjusted Female Breast Cancer Mortality Rates, Missouri 1996-2002*

0

5

10

15

20

25

30

35

40

45

1996 1997 1998 1999 2000 2001 2002

year

rate

per

100

,000

White

Black

Weighted Responses to BRFSS Questions, Missouri 1996-2002+

§ Early-stage diagnosis includes In situ and Localized stages.

+ Responses not available for 2001 as questions were not asked that year. ^ Denominator is all women 18 years of age and older.^^ Denominator is all women who responded “yes” to first question.

Recommendations:

•Efforts to increase screening, including targeting low-income, underserved and uninsured women, should continue.