Breast cancer screening, area deprivation, and later-stage breast cancer in Appalachia: does geography matter?

Journal Article (Journal Article)

OBJECTIVE: To model the relationship of an area-based measure of a breast cancer screening and geographic area deprivation on the incidence of later stage breast cancer (LSBC) across a diverse region of Appalachia. DATA SOURCE: Central cancer registry data (2006-2008) from three Appalachian states were linked to Medicare claims and census data. STUDY DESIGN: Exploratory spatial analysis preceded the statistical model based on negative binomial regression to model predictors and effect modification by geographic subregions. PRINCIPAL FINDINGS: Exploratory spatial analysis revealed geographically varying effects of area deprivation and screening on LSBC. In the negative binomial regression model, predictors of LSBC included receipt of screening, area deprivation, supply of mammography centers, and female population aged>75 years. The most deprived counties had a 3.31 times greater rate of LSBC compared to the least deprived. Effect of screening on LSBC was significantly stronger in northern Appalachia than elsewhere in the study region, found mostly for high-population counties. CONCLUSIONS: Breast cancer screening and area deprivation are strongly associated with disparity in LBSC in Appalachia. The presence of geographically varying predictors of later stage tumors in Appalachia suggests the importance of place-based health care access and risk.

Full Text

Duke Authors

Cited Authors

  • Anderson, RT; Yang, T-C; Matthews, SA; Camacho, F; Kern, T; Mackley, HB; Kimmick, G; Louis, C; Lengerich, E; Yao, N

Published Date

  • April 2014

Published In

Volume / Issue

  • 49 / 2

Start / End Page

  • 546 - 567

PubMed ID

  • 24117371

Pubmed Central ID

  • PMC3976186

Electronic International Standard Serial Number (EISSN)

  • 1475-6773

Digital Object Identifier (DOI)

  • 10.1111/1475-6773.12108


  • eng

Conference Location

  • United States