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Trends in Area-Socioeconomic and Race-Ethnic Disparities in Breast Cancer Incidence, Stage at Diagnosis, Screening, Mortality, and Survival among Women Ages 50 Years and Over (1987-2005)

¹ Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, Montreal, Quebec, Canada; ² Health Sciences Division, University of South Australia, Adelaide, South Australia, Australia; ³ Department of Social Medicine, University of Bristol, Bristol, United Kingdom; and ⁴ Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, Maryland

Requests for reprints: Sam Harper, Department of Epidemiology, Biostatistics, and Occupational Health, McGill University, 1020 Pine Avenue West, Room 34, Montreal, Quebec, Canada H3A 1A2. Phone: 514-398-2858; Fax: 514-398-4503. E-mail: sam.harper{at}mcgill.ca

Background: Breast cancer is the most commonly diagnosed cancer and the second leading cause of cancer death among women in the United States and varies systematically by race-ethnicity and socioeconomic status. Previous research has often focused on disparities between particular groups, but few studies have summarized disparities across multiple subgroups defined by race-ethnic and socioeconomic position.

Methods: Data on breast cancer incidence, stage, mortality, and 5-year cause-specific probability of death (100 – survival) were obtained from the Surveillance, Epidemiology, and End Results program and data on mammography screening from the National Health Interview Survey from 1987 to 2005. We used four area-socioeconomic groups based on the percentage of poverty in the county of residence (<10, 10-15, 15-20, +20%) and five race-ethnic groups (White, Black, Asian, American Indian, and Hispanic). We used summary measures of disparity based on both rate differences and rate ratios.

Results: From 1987 to 2004, area-socioeconomic disparities declined by 20% to 30% for incidence, stage at diagnosis, and 5-year cause-specific probability of death, and by roughly 100% for mortality, whether measured on the absolute or relative scale. In contrast, relative area-socioeconomic disparities in mammography use increased by 161%. Absolute race-ethnic disparities declined across all outcomes, with the largest reduction for mammography (56% decline). Relative race-ethnic disparities for mortality and 5-year cause-specific probability of death increased by 24% and 17%, respectively.

Conclusions: Our analysis suggests progress towards race-ethnic and area-socioeconomic disparity goals for breast cancer, especially when measured on the absolute scale. However, greater progress is needed to address increasing relative socioeconomic disparities in mammography and race-ethnic disparities in mortality and 5-year cause-specific probability of death. (Cancer Epidemiol Biomarkers Prev 2009;18(1):121–31)