McCoy Clyde B, Pereyra Margaret, Metsch Lisa R, Collado-Mesa Fernando, Messiah Sarah E, Sears Sandy
University of Miami School of Medicine, Department of Epidemiology and Public Health, Miami, Florida 33136,
Rev Panam Salud Publica. 2004 Mar;15(3):160-7. doi: 10.1590/s1020-49892004000300004.
Earlier studies by this research team found that medically underserved minority women in the Miami-Dade County area of the state of Florida, United States, were in need of breast cancer screening and that there were problems with availability, accessibility, and acceptability of services. In response, a community-based comprehensive breast cancer screening program called the Early Detection Program (EDP) was developed. The specific purpose of this study was to assess the effect that EDP participation had on stage at diagnosis and on hazard of death.
Existing data from the Florida Cancer Data System (FCDS), a statewide cancer registry, were linked with data from the EDP. In December 1998 we assembled a multiethnic (African-American, black Hispanic, white Hispanic, and white non-Hispanic) retrospective cohort with the following inclusion criteria: all women aged 40 and older with breast cancer diagnosed and staged at University of Miami/Jackson Memorial Medical Center (which is located in the city of Miami, Florida) from January 1987 through December 1997. EDP participants were medically underserved, that is, they resided in lower socioeconomic areas and/or had limited or no health insurance to cover medical costs. Subjects identified as EDP participants were compared to nonparticipants with respect to disease stage at diagnosis and hazard of death. Logistic regression and Cox regression models were used for analysis.
EDP participants were 2.4 times as likely (95% confidence interval = 1.71 to 3.43) to present with a diagnosis of localized cancer as were nonparticipants, even after controlling for race and age at diagnosis. EDP participation was independently associated with both earlier diagnosis and reduced hazard of death.
Participation in the EDP increases the likelihood of early detection of breast cancer and reduces the hazard of death for medically underserved women in the Miami-Dade County area of Florida. Interestingly, white Hispanics showed a better survival than did both African-Americans and white non-Hispanics. Our research also demonstrates the value of utilizing existing cancer registry data to evaluate a community-based program such as the EDP.
该研究团队早期的研究发现，美国佛罗里达州迈阿密 - 戴德县地区医疗服务不足的少数族裔女性需要进行乳腺癌筛查，且服务的可获得性、可及性和可接受性存在问题。作为回应，开发了一项名为早期检测计划（EDP）的基于社区的综合乳腺癌筛查项目。本研究的具体目的是评估参与EDP对诊断分期和死亡风险的影响。
来自全州癌症登记处佛罗里达癌症数据系统（FCDS）的现有数据与EDP的数据相链接。1998年12月，我们组建了一个多民族（非裔美国人、西班牙裔黑人、西班牙裔白人、非西班牙裔白人）回顾性队列，纳入标准如下：1987年1月至1997年12月期间在迈阿密大学/杰克逊纪念医学中心（位于佛罗里达州迈阿密市）被诊断并分期的所有40岁及以上乳腺癌女性。EDP参与者是医疗服务不足的人群，即他们居住在社会经济地位较低的地区，和/或医疗保险有限或没有医疗保险来支付医疗费用。将被确定为EDP参与者的受试者与非参与者在诊断时的疾病分期和死亡风险方面进行比较。采用逻辑回归和Cox回归模型进行分析。
即使在控制了诊断时的种族和年龄之后，EDP参与者被诊断为局限性癌症的可能性是非参与者的2.4倍（95%置信区间 = 1.71至3.43）。参与EDP与更早的诊断和降低的死亡风险独立相关。
参与EDP增加了佛罗里达州迈阿密 - 戴德县地区医疗服务不足女性早期发现乳腺癌的可能性，并降低了死亡风险。有趣的是，西班牙裔白人的生存率高于非裔美国人和非西班牙裔白人。我们的研究还证明了利用现有癌症登记数据评估像EDP这样的基于社区的项目的价值。
