Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada.
Cancer. 2010 Dec 1;116(23):5487-96. doi: 10.1002/cncr.25331.
This study assessed the relationship between area-level poverty and stage of breast cancer at diagnosis among low-income women when screening mammography was available at no cost.
The authors identified women diagnosed with breast cancer from 1999 to 2005 through the Massachusetts Cancer Registry, and compared the odds of advanced stage disease for women with low incomes (n=546) for whom screening mammography and diagnostic services were available at no cost through the Massachusetts Breast and Cervical Cancer Early Detection Program, relative to a nonparticipating comparison group (n=1287) residing in the same neighborhoods with similar distribution of age, race, and ethnicity as Massachusetts Breast and Cervical Cancer Early Detection Program participants. Among Massachusetts Breast and Cervical Cancer Early Detection Program participants, the odds of advanced stage disease were estimated by mammography use.
Although screening mammography was available at no cost, only 36% of program participants diagnosed with breast cancer used screening mammography. Stage of breast cancer at diagnosis was not associated with area-level poverty among Massachusetts Breast and Cervical Cancer Early Detection Program participants. For the comparison group, advanced stage disease was more likely for residents in high-poverty areas, relative to low-poverty areas (49% vs 37%, P<.01). The adjusted odds of advanced stage disease at diagnosis was greater for women aged 41 to 49 years, compared with those aged 50 to 64 years (P=.01).
Programs that ensure breast cancer screening and diagnostic services are available at no cost to low-income women can mitigate the adverse effect of area-level poverty on stage of breast cancer. However, such programs require effective strategies to encourage use of screening mammography to promote diagnosis at an earlier stage.
本研究评估了在低收入女性可免费接受筛查性乳房 X 光检查时，地区贫困程度与乳腺癌诊断分期之间的关系。
作者通过马萨诸塞州癌症登记处，确定了 1999 年至 2005 年期间被诊断患有乳腺癌的女性，并比较了在马萨诸塞州乳腺癌和宫颈癌早期检测计划中，免费获得筛查性乳房 X 光检查和诊断服务的低收入女性（n=546）与居住在同一社区、年龄、种族和族裔分布与马萨诸塞州乳腺癌和宫颈癌早期检测计划参与者相似的非参与者对照组（n=1287）的晚期疾病患病几率。在马萨诸塞州乳腺癌和宫颈癌早期检测计划的参与者中，晚期疾病的患病几率通过乳房 X 光检查的使用情况来估计。
尽管筛查性乳房 X 光检查是免费的，但只有 36%的诊断患有乳腺癌的计划参与者使用了筛查性乳房 X 光检查。在马萨诸塞州乳腺癌和宫颈癌早期检测计划的参与者中，乳腺癌诊断时的分期与地区贫困程度无关。对于对照组，高贫困地区的居民比低贫困地区更有可能患有晚期疾病（49%比 37%，P<.01）。与 50 至 64 岁的女性相比，41 至 49 岁的女性被诊断为晚期疾病的调整后几率更大（P=.01）。
为低收入女性免费提供乳腺癌筛查和诊断服务的计划可以减轻地区贫困程度对乳腺癌分期的不利影响。然而，这些计划需要有效的策略来鼓励使用乳房 X 光检查，以促进更早的诊断。
