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Disparities in Cervical and Breast Cancer Prevention and Detection

Disparities in Cervical and Breast Cancer Prevention and Detection. Carin Perkins, PhD Minnesota Cancer Surveillance System Minnesota Department of Health carin.perkins@state.mn.us (612) 676-5657. Breast and cervical cancer in Minnesota – average cases and deaths per year by age, 1995-1998.

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Disparities in Cervical and Breast Cancer Prevention and Detection

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  1. Disparities in Cervical and Breast Cancer Prevention and Detection Carin Perkins, PhD Minnesota Cancer Surveillance System Minnesota Department of Health carin.perkins@state.mn.us (612) 676-5657

  2. Breast and cervical cancer in Minnesota – average cases and deaths per year by age,1995-1998 Source: Minnesota Cancer Surveillance System. http://www.health.state.mn.us/divs/dpc/cdee/mcss.htm

  3. Cervical cancer screening – a success story in cancer control Rate per 100,000 women Incidence Mortality Year of Diagnosis or Death Source: Minnesota Cancer Surveillance System and SEER Cancer Statistics Review, 1973-1998. All rates are age-adjusted to the 1970 US population. SEER data covers 10% of the US population.

  4. Women of color in Minnesota are three times more likely to be diagnosed with invasive cervical cancer than white women Rate per 100,000 women Cases 645 23 35 15 Source: Minnesota Cancer Surveillance System, cases diagnosed 1995-1998. All rates are age-adjusted to the 1970 US population.

  5. Race/ethnic disparities in cervical cancer incidence are greater in Minnesota than reported by SEER Rate per 100,000 women N/A Source: Minnesota Cancer Surveillance System and SEER Cancer Statistics Review, 1973-1998. All rates are age-adjusted to the 1970 US population. The number of Minnesota cases are: White (645), Asian/PI (23), African American (35), and American Indian (15).

  6. Race/ethnic disparities in cervical cancer are greatest among women ages 50 years and older Rate per 100,000 women Age at Diagnosis Source: Minnesota Cancer Surveillance System, cases diagnosed 1995-1998. Women of color include African American, Asian/PI, and American Indian women.

  7. In addition, women of color are more likely to be diagnosed at a later stage Percent Stage at Diagnosis Source: Minnesota Cancer Surveillance System, cases diagnosed 1995-1998. Women of color include African American, Asian/PI, and American Indian women.

  8. Women of color in Minnesota are six times more likely to die of cervical cancer than white women Rate per 100,000 women Cases/Deaths 645 73 161 33 Source: Minnesota Cancer Surveillance System, cases and deaths from 1995-1998. Rates are age-adjusted to the 1970 US population. Women of color include African American, Asian/PI, and American Indian women.

  9. Within each race/ethnic group, disadvantaged women have higher rates of invasive cervical cancer Rate per 100,000 women SES Source: Liu L et al. Socioeconomic status and cancers of the female breast and reproductive organs: a comparison across racial/ethnic populations in Los Angeles County, California. Cancer Cause Control 1998; 9:369-380.

  10. How is Minnesota Doing? Percent had Pap test within 3 years Healthy Minnesotans 2004 Objective: 99% Source: Minnesota Behavioral Risk Factor Survey. Obtained from data query at http://www.cdc.gov/brfss, 06/04/02.

  11. Poor women in Minnesota are stillless likely to be screened Percent had Pap test within 3 years Annual Household Income Source: Minnesota Behavioral Risk Factor Survey, 2000. Obtained from data query at http://www.cdc.gov/brfss, 06/04/02.

  12. Nationally, race/ethnic disparities in cervical cancer screening are largest for younger women Percent had Pap test within 3 years Age Source: NHIS 1998. Breen et al. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 2001;93:1704-13.

  13. Breast cancer mortality – another success story in cancer control Rate per 100,000 women Year of Death Source: Minnesota data are from the Minnesota Cancer Surveillance System. US data are from the SEER Cancer Statistics Review, 1973-1998. All rates are age-adjusted to the 1970 US population.

  14. Nationally, late-stage breast cancer incidence has declined Rate per 100,000 women Year of Diagnosis • Source: SEER rates were calculated from the August 2000 SEER public use file. All rates • are age-adjusted to the 1970 US population.

  15. Women of color in Minnesota die of breast cancer out of proportion to its occurrence Rate per 100,000 women N/A Cases/Deaths 43 108 181 14,535 11 15 43 14 2,811 Source: Minnesota Cancer Surveillance System, 1995-1998. Rates are age-adjusted to the 1970 US population. Cancer incidence includes in situ and invasive tumors.

  16. Women of color in Minnesota have a higher proportion of breast cancers diagnosed at late-stage Rate per 100,000 women Source: Minnesota Cancer Surveillance System, 1995-1998. Rates are age-adjusted to the 1970 US population. Early stage cancers are in situ or localized (confined to the breast). Late stage cancers have spread to lymph nodes or other organs.

  17. Within each stage, breast cancer survival is poorer for African American women Five-year Relative Survival (percent) Note: Based on cases diagnosed 1985-1991 and followed through December 1993. Survival differences for distant disease are not statistically significant. Source: Hsu et al. Racial/ethnic differences in breast cancer survival among San Francisco Bay Area women. J Natl Cancer Inst 1997;89:1311-1312.

  18. How is Minnesota Doing? Percent of Women 40+ had Mammogram within 2 years Healthy Minnesotans 2004 Objective: 90% Source: Minnesota Behavioral Risk Factor Survey. Obtained from data query at http://www.cdc.gov/brfss, 06/04/02.

  19. Nationally, race/ethnic differences in mammography use have decreased Percent of Women 40+ had Mammogram within 2 years Source: Breen et al. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 2001;93:1704-13.

  20. Disparities in mammography use are more strongly related to income than race/ethnicity Percent Women 40+ had Mammogram within 2 years Age Source: NHIS 1998. Poor is less than the federal poverty level, Near Poor is 100-199% of FPL. Breen et al. Progress in cancer screening over a decade: results of cancer screening from the 1987, 1992, and 1998 National Health Interview Surveys. J Natl Cancer Inst 2001;93:1704-13.

  21. Conclusions • Women of color and poor women are at greater risk of being diagnosed with invasive cervical cancer than white women and better-off women. • Women of color and poor women are more likely to be diagnosed with late-stage breast and cervical cancer than white women and better-off women, and experience poorer survival. • For both cancers, inadequate screening is more associated with poverty, lack of education and insurance, and failure to have a usual source of care than race/ethnicity.

  22. Cochrane Review of Mammography --Their Conclusions • All but two of the eight mammography trials were flawed. The best studies found no decrease in breast cancer mortality. • breast cancer screening is unjustified • Being screened decreases the likelihood that breast cancer is listed as the underlying cause of death. • breast cancer mortality should not be used to measure the effect of mammography • Screening leads to treatment of clinically irrelevant disease and increases non-breast cancer deaths. • only all-cause mortality is a valid outcome

  23. Response to Review • Little solid evidence of substantial flaws in randomization or bias in assigning the underlying cause of death. => mammography benefits women • Screening may lead to treatment of some clinically irrelevant disease, but there currently are no reliable methods to predict which tumors will progress. => further research is needed to identify predictors => mortality associated with treatment needs to be better assessed • Increased appreciation that breast cancer is a heterogeneous disease. => mammography cannot prevent all advanced disease

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