Patient and process factors associated with late-stage breast cancer diagnosis in Safety-Net patients: a pilot prospective study.


Journal Article

BACKGROUND: Following reforms to our city's Safety-Net (SN) breast cancer referral process, we investigated whether factors often associated with late-stage diagnosis would differ by referral source--SN versus non-Safety-Net (NSN)--or, among SN patients, by stage at diagnosis. METHODS: From September 2008 to June 2010, SN patients with any-stage (0-IV) and NSN patients with late-stage (IIB-IV) breast cancer were identified prospectively during initial cancer-center consultations. Data were analyzed using logistic regression, chi-square, and t tests; two-tailed P < 0.05 was considered significant. RESULTS: Fifty-seven women completed interviews (33 SN, 24 NSN); 52% of SN-referred patients were diagnosed with late-stage disease. Compared with NSN late-stage patients, SN late-stage patients were more likely to be African-American (83% vs. 21%, P < 0.001), to have an annual household income <$25,000 (89% vs. 38%, P < 0.001), and to report having a health problem in the preceding year but not being able to see a doctor because of cost (67% vs. 25%, P = 0.012); they were less likely to be married/partnered (22% vs. 79%, P < 0.001) and to have post-college education (0% vs. 25%, P < 0.03), any insurance (61% vs. 96%, P < 0.005), and to have sought medical attention within 1 week of realizing they had concerning breast findings (50% vs. 79%, P = 0.047). Married/partnered patients were more likely to delay medical care by >1 week (odds ratio = 9.9, P = 0.038). CONCLUSIONS: SN patients presented with higher-than-expected rates of late-stage disease despite improvements in mammography rates and the referral process. Efforts to further facilitate access to care for this vulnerable SN patient population are needed.

Full Text

Duke Authors

Cited Authors

  • Fayanju, OM; Jeffe, DB; Elmore, L; Ksiazek, DN; Margenthaler, JA

Published Date

  • March 2013

Published In

Volume / Issue

  • 20 / 3

Start / End Page

  • 723 - 732

PubMed ID

  • 23070783

Pubmed Central ID

  • 23070783

Electronic International Standard Serial Number (EISSN)

  • 1534-4681

Digital Object Identifier (DOI)

  • 10.1245/s10434-012-2558-1


  • eng

Conference Location

  • United States