Department of Surgery, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Division of Health Services and Behavioral Research, Department of Public Health Sciences, Penn State College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania; Penn State Cancer Institute, Hershey, Pennsylvania.
Department of Economics, Rutgers University, New Brunswick, New Jersey.
Am J Prev Med. 2021 Dec;61(6):890-899. doi: 10.1016/j.amepre.2021.05.020. Epub 2021 Aug 8.
Many states have mandated breast density notification and insurance coverage for additional screening; yet, the association between such legislation and stage of diagnosis for breast cancer is unclear. This study investigates this association and examines the differential impacts among different age and race/ethnicity subgroups.
The Surveillance, Epidemiology, and End Results database was queried to identify patients with breast cancer aged 40-74 years diagnosed between 2005 and 2016. Using a difference-in-differences multinomial logistic model, the odds of being diagnosed at different stages of cancer relative to the localized stage depending on legislation and individual characteristics were examined. Analyses were conducted in 2020-2021.
The study included 689,641 cases. Overall, the impact of notification legislation was not significant, whereas insurance coverage legislation was associated with 6% lower odds (OR=0.94, 95% CI=0.91, 0.96) of being diagnosed at the regional stage. The association between insurance coverage legislation and stage of diagnosis was even stronger among women aged 40-49 years, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.96) of being diagnosed at the regional stage and 12% lower odds (OR=0.88, 95% CI=0.81, 0.96) of being diagnosed at the distant stage. Hispanic women benefited from notification laws, with 11% lower odds (OR=0.89, 95% CI=0.82, 0.97) of being diagnosed at distant stage. Neither notification nor supplemental screening insurance coverage legislation showed a substantial impact on Black women.
The findings imply that improving insurance coverage is more important than being notified overall. Raising awareness is important among Hispanic women; improving communication about dense breasts and access to screening might be more important than legislation among Black women.
许多州都规定了乳腺密度通知和额外筛查的保险范围；然而，这种立法与乳腺癌诊断阶段之间的关系尚不清楚。本研究调查了这种关联，并检查了不同年龄和种族/族裔亚组之间的差异影响。
使用监测、流行病学和最终结果数据库，确定了 2005 年至 2016 年间诊断为 40-74 岁的乳腺癌患者。使用差分差异多项逻辑模型，根据立法和个体特征，检查了相对于局部阶段，癌症不同阶段的诊断几率。分析于 2020-2021 年进行。
本研究纳入了 689641 例病例。总体而言，通知立法的影响并不显著，而保险范围立法与区域阶段诊断几率降低 6%相关（OR=0.94，95%CI=0.91，0.96）。保险范围立法与诊断阶段之间的关联在 40-49 岁的女性中更为强烈，区域阶段的诊断几率降低了 11%（OR=0.89，95%CI=0.82，0.96），远处阶段的诊断几率降低了 12%（OR=0.88，95%CI=0.81，0.96）。西班牙裔女性受益于通知法，远处阶段的诊断几率降低了 11%（OR=0.89，95%CI=0.82，0.97）。通知法和补充筛查保险范围立法都没有对黑人女性产生实质性影响。
研究结果表明，总体而言，提高保险范围比被通知更为重要。提高西班牙裔女性的认识很重要；与立法相比，提高对致密乳房的沟通和获得筛查的机会可能对黑人女性更为重要。
